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Conditions Treated 

What Are Ankle Sprains?Esguinces de tobillo

What Are Ankle Sprains?

The ankle is one of the most common places in the body for a sprain. Landing wrong on your foot can cause the ankle to roll to the side. This can stretch or tear ligaments. Ankle sprains can occur at any time, such as when you step off a curb or play sports. Once you’ve had an ankle sprain, you may be more likely to sprain that ankle again.

Image of a mild sprain showing a slightly stretched or torn ligament. Image showing moderate sprain with a partly torn ligament. Image showing a severe sprain showing a completely torn ligament.

When Ligaments Tear

Your ankle joint is where the bones in your leg and foot meet. Strong bands of tissue called ligaments connect these bones. Tendons cross the ankle and connect muscles in the lower leg to the foot. The ligaments and tendons help keep the ankle joint stable when you move. If you twist or turn your ankle, the ligaments can stretch or tear. This is called a sprain. A sprain can be mild, moderate, or severe. This depends on how badly the ligaments are damaged.

Image of man in shorts sitting next to a tennis racket holding his ankle.

Symptoms

Your symptoms depend on how badly the ligaments are damaged. You may have little pain and swelling if the ligaments are only stretched. If the ligaments tear, you will have more pain and swelling. The more severe the sprain, the less you’ll be able to move the ankle or put weight on it. The ankle may also turn black-and-blue, and the bruising may extend into the foot and leg.

Ankle Pain

Ankle pain is often due to an ankle sprain but can also be caused by other issues.

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ArthritisArtritis

Arthritis

What is arthritis?

Arthritis and other rheumatic diseases are characterized by pain, swelling, and limited movement in joints and connective tissues in the body. According to the CDC, nearly 50 million people in the U.S. have some form of arthritis or chronic joint symptoms.

Older man rubbing hands together

Arthritis, which literally means inflammation of a joint (where two or more bones meet), actually refers to more than 100 different diseases. Rheumatic diseases include any diseases that cause pain, stiffness, and swelling in joints or other supportive body structures, such as muscles, tendons, ligaments, and bones.

Arthritis and other rheumatic diseases are often mistakenly associated with old age because osteoarthritis (the most common form of arthritis) occurs more often among elderly persons. However, arthritis and other rheumatic diseases affect people of all ages and are more common in women than men.  

Arthritis is usually chronic, which means that it rarely changes, or it progresses slowly. Specific causes for most forms of arthritis are not yet known.

What are the parts of a joint?

Joints are the areas where two bones meet. Most joints are mobile, allowing the bones to move. Joints consist of:

  • Cartilage. A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.

  • Synovial membrane. A tissue called the synovial membrane lines the joint. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.

  • Ligaments. Strong ligaments (tough, elastic bands of connective tissue) surround the joint to give support and limit the joint's movement.

  • Tendons. Tendons (another type of tough connective tissue) on each side of a joint attach to muscles that control movement of the joint.

  • Bursas. Fluid-filled sacs, called bursas, between bones, ligaments, or other adjacent structures help cushion the friction in a joint.

What are the most common types of arthritis?

The three most prevalent forms of arthritis include:

  • Osteoarthritis. The most common type of arthritis. It is a chronic disease involving the joints, particularly the weight-bearing joints such as the knee, hip, and spine. Osteoarthritis is characterized primarily by the destruction of cartilage and narrowing of the joint space. It can also include bone overgrowth, spur formation, and impaired function.

    It occurs in most people as they age, but also may occur in young people as a result of injury or overuse.

  • Fibromyalgia. A chronic, widespread pain in muscles and soft tissues surrounding the joints throughout the body.

  • Rheumatoid arthritis. An inflammatory disease that involves the lining of the joint (synovium). The inflammation may affect all of the joints.

  • Other forms of arthritis, or related disorders, include the following:

    • Gout. A result of a defect in body chemistry (such as uric acid in the joint fluid), this painful condition most often attacks small joints, especially the big toe. It can usually be controlled with medication and changes in diet.

    • Systemic lupus erythematosus (lupus). A very serious, chronic, autoimmune disorder characterized by periodic episodes of inflammation of and damage to the joints, tendons, other connective tissues, and organs, including the heart, lungs, blood vessels, brain, kidneys, and skin.

    • Scleroderma. A very serious disease of the body's connective tissue that causes thickening and hardening of the skin.

    • Ankylosing spondylitis. A disease that affects the spine, causing the bones of the spine to grow together.

    • Juvenile idiopathic arthritis (JIA) or juvenile rheumatoid arthritis (JRA). A form of arthritis in children ages 16 or younger that causes inflammation and stiffness of joints for more than six weeks. Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children often outgrow JRA. However, the disease can affect bone development in the growing child.

What are the symptoms of arthritis?

The following are the most common symptoms of arthritis. However, each individual may experience symptoms differently. Symptoms may include:

  • Pain and stiffness in the joints

  • Swelling in one or more joints

  • Continuing or recurring pain or tenderness in a joint

  • Difficulty using or moving a joint in a normal manner

  • Warmth and redness in a joint

The symptoms of arthritis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is arthritis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for arthritis may include:

  • X-rays or other imaging procedures (to show the extent of damage to the joint)

  • Blood tests and other laboratory tests, including:

    • Antinuclear antibody (ANA) test (to check levels of antibodies in the blood)

    • Arthrocentesis or joint aspiration (to remove a sample of the synovial fluid to determine if crystals, bacteria, or viruses are present)

    • Complete blood count (to determine if white blood cell, red blood cell, and platelet levels are normal)

    • Creatinine (to monitor for underlying kidney disease)

    • Sedimentation rate (to detect inflammation)

    • Hematocrit (to measure the number of red blood cells)

    • Rheumatoid factor test (to determine if rheumatoid factor is present in the blood)

    • Urinalysis (to determine levels of protein, red blood cells, white blood cells, and casts)

    • White blood cell count (to determine level of white blood cells in the blood)

    • Uric acid (to diagnosis gout)

    • HLA tissue typing (to look for genetic markers in ankylosing spondylitis)

  • Skin biopsy (to diagnose a type of arthritis that involves the skin, such as lupus or psoriatic arthritis)

  • Muscle biopsy (to diagnose arthritis or rheumatic diseases, such as polymyositis or vasculitis)   

Rehabilitation for arthritis

An arthritis rehabilitation program is designed to meet the needs of the individual patient, depending on the type and severity of the arthritis. Active involvement of the patient and family is vital to the success of the program.

The goal of arthritis rehabilitation is to help the patient return to the highest level of function and independence possible while improving the overall quality of life--physically, emotionally, and socially. The focus of rehabilitation is on relieving pain and increasing motion in the affected joint(s).

In order to help reach these goals, arthritis rehabilitation programs may include the following:

  • Exercises and to control joint pain and swelling

  • Exercises to improve mobility (movement) and physical fitness

  • Heat and cold therapy

  • Massage

  • Transcutaneous electrical nerve stimulation to help relieve pain

  • Acupuncture

  • Stress management and emotional support

  • Joint immobilization and methods to protect the joints from further damage, degeneration, and deformities

  • Nutritional counseling to improve weight control

  • Use of assistive devices

  • Patient and family education

Rehabilitation after joint replacement

The goal of hip and knee replacement surgery is to improve the function of the joint. Full recovery after joint replacement usually takes about three to six months, depending on the type of surgery, overall health of the patient, and the success of rehabilitation.

Rehabilitation programs after joint replacement may include the following:

  • Exercises to improve mobility (movement) and physical fitness

  • Gait (walking) retraining

  • Pain management

  • Nutritional counseling to improve weight control

  • Use of assistive devices

  • Patient and family education

The arthritis rehabilitation team

Arthritis rehabilitation programs can be conducted on an inpatient or outpatient basis. Many skilled professionals are part of the arthritis rehabilitation team, including any or all of the following:

  • Orthopedist/orthopedic surgeon

  • Rheumatologist

  • Physiatrist

  • Primary care doctor (for example, family medicine or internal medicine) 

  • Rehabilitation nurse

  • Dietitian

  • Physical therapist

  • Occupational therapist

  • Social worker

  • Psychologist/psychiatrist

  • Recreational therapist

  • Vocational therapist

Arthritis

Arthritis is inflammation of one or more joints. There are over 100 types of arthritis.

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Ligament Injuries to the KneeLesiones de los Ligamentos de la Rodilla

Ligament Injuries to the Knee

What are knee ligaments?

There are 4 major ligaments in the knee. Ligaments are elastic bands of tissue that connect bones to each other and provide stability and strength to the joint. The four main ligaments in the knee connect the femur (thighbone) to the tibia (shin bone), and include the following:

Anatomy of the knee
Click image to enlarge

  • Anterior cruciate ligament (ACL). The ligament, located in the center of the knee, that controls rotation and forward movement of the tibia (shin bone).

  • Posterior cruciate ligament (PCL). The ligament, located in the back of the knee, that controls backward movement of the tibia (shin bone).

  • Medial collateral ligament (MCL). The ligament that gives stability to the inner knee.

  • Lateral collateral ligament (LCL). The ligament that gives stability to the outer knee.

How are cruciate ligaments injured?

The anterior cruciate ligament (ACL) is one of the most common ligaments to be injured. The ACL is often stretched and/or torn during a sudden twisting motion (when the feet stay planted one way, but the knees turn the other way). Skiing, basketball, and football are sports that have a higher risk of ACL injuries.

The posterior cruciate ligament (PCL) is also a common ligament to become injured in the knee. However, the PCL injury usually occurs with sudden, direct impact, such as in a car accident or during a football tackle.

What are the symptoms of a cruciate ligament injury?

Often, a cruciate ligament injury does not cause pain. Instead, the person may hear a popping sound as the injury occurs, followed by the leg buckling when trying to stand on it, and swelling. However, each individual may experience symptoms differently.

The symptoms of a cruciate ligament injury may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How are collateral ligaments injured?

The medial collateral ligament is injured more often than the lateral collateral ligament. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the outer side of the knee, such as when playing hockey or football.

What are the symptoms of a collateral ligament injury?

Similar to cruciate ligament injuries, an injury to the collateral ligament causes the knee to pop and buckle, causing pain and swelling.

The symptoms of a collateral ligament injury may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How is a knee ligament injury diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for a knee ligament injury may include the following:

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film to rule out an injury to bone instead of, or in addition to, a ligament injury.

  • 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; can often determine damage or disease in bones and a surrounding ligament or muscle.

  • Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure 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; used to evaluate any degenerative and/or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation.

Treatment for knee ligament injuries

Specific treatment for a knee ligament injury will be determined by your doctor based on:

  • Your age

  • Your overall health and medical history

  • How bad your injury is

  • How well you can tolerate specific medications, procedures, and therapies

  • How long it may take for your injury to heal

  • Your opinion or preference

Treatment may include:

  • Medication such as ibuprofen

  • Muscle-strengthening exercises

  • Protective knee brace (for use during exercise)

  • Ice pack application (to reduce swelling)

  • Surgery

Knee Ligament Injuries

Ligament injuries to the knee can include damage to the ACL (most common), MCL, LCL or the PCL.

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FracturesFracturas

Fractures

What is a fracture?

A fracture is a partial or complete break in the bone. When a fracture occurs, it is classified as either open or closed:

  • Open fracture (also called compound fracture). The bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin.

  • Closed fracture (also called simple fracture). The bone is broken, but the skin is intact.

Fractures have a variety of names. Some of the common types that may occur are:

  • Greenstick fracture. This is an incomplete fracture. A portion of the bone is broken, causing the other side to bend. This type of fracture is more common in children.

  • Transverse fracture. The break is in a straight line perpendicular to the bone.

  • Spiral fracture. The break spirals around the bone; common in a twisting injury.

  • Oblique fracture. The break is diagonal across the bone.

  • Compression fracture. The bone is crushed, causing the broken bone to be wider or flatter in appearance.

  • Comminuted. The break is in 3 or more pieces and fragments are present at the fracture site.

  • Segmental. The same bone is fractured in two places, so there is a "floating" segment of bone.

Greenstick fracture
Greenstick fracture. Click Image to Enlarge

Transverse fracture
Transverse fracture. Click Image to Enlarge

Spiral fracture
Spiral fracture. Click Image to Enlarge

Oblique fracture
Oblique fracture. Click Image to Enlarge

Compression fracture
Compression fracture. Click Image to Enlarge

What causes a fracture?

Fractures occur when there is more force applied to the bone than the bone can absorb. Breaks in bones can occur from falls, trauma, or as a result of a direct blow or kick to the body.

What are the symptoms of a fracture?

The following are the most common symptoms of a fracture. However, each individual may experience symptoms differently. Symptoms may include:

  • Pain in the injured area

  • Swelling in the injured area

  • Obvious deformity in the injured area

  • Difficulty using or moving the injured area in a normal manner

  • Warmth, bruising, or redness in the injured area

The symptoms of a broken bone may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is a fracture diagnosed?

In addition to a complete medical history (including asking how the injury occurred) and physical examination, diagnostic procedures for a fracture may include the following:

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

  • 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.

Treatment for a fracture

Specific treatment for a fracture will be determined by your doctor based on:

  • Location and type of fracture

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

The goal of treatment is to control the pain, promote healing, prevent complications, and restore normal use of the fractured area.

An open fracture (one in which the bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin) is considered an emergency. Seek immediate medical attention for this type of fracture.

Treatment may include:

  • Splint or cast. This immobilizes the injured area to promote bone alignment and healing to protect the injured area from motion or use.

  • Medication. This is taken to control pain.

  • Traction. Traction is the application of a force to stretch certain parts of the body in a specific direction. Traction consists of pulleys, strings, weights, and a metal frame attached over or on the bed. The purpose of traction is to stretch the muscles and tendons around the broken bone to allow the bone ends to align and heal.

  • Surgery. Surgery may be required to put certain types of broken bones back into place. Occasionally, internal fixation (metal rods or pins located inside the bone) or external fixation devices (metal rods or pins located outside of the body) are used to hold the bone fragments in place to allow alignment and healing.

Smoking and the musculoskeletal system

Smoking takes a significant toll on your musculoskeletal system. Tobacco and nicotine increase the risk of bone fractures and interfere with the healing process, according to a growing body of research. Nicotine can slow fracture healing, estrogen effectiveness, and can counter the antioxidant properties of vitamin C. According to the American Academy of Orthopaedic Surgeons, research on the topic of smoking and its effect on the musculoskeletal system was reviewed. Some of the orthopedic problems caused by smoking include:

  • More severe disk degeneration

  • Increased risk for a hip fracture with age

  • An association with low back pain

  • Weakened spinal ligaments

  • Reduced production of bone cells

  • Faster bone loss in postmenopausal women

  • Fractures take longer to heal

  • Association with rotator cuff disease 

  • Longer healing time for surgical incisions

  • More post-surgery complications

  • Delayed spinal fusion

However, quitting smoking seems to improve the healing process in many cases.

Fracture

A fracture occurs when a bone is cracked or broken. There are several types of fracture.

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Understanding Joint Pain

Understanding Joint Pain

Sprained ankles and wrists, arthritic knees and hips, and torn rotator cuffs all have one thing in common: they result in joint pain.

The usual causes of joint pain are over use, sprains, fractures, and arthritis. Becoming familiar with the usual causes and symptoms of joint pain can help you seek appropriate treatment and ongoing care, if necessary.

Here are several medical conditions that can cause joint pain.

Arthritis

Persistent joint pain, swelling, and limited range of motion are typical symptoms of arthritis. Inflammatory types of arthritis, such as rheumatoid or gouty arthritis, may also make the joint red, hot, and tender to the touch.

Mild arthritis can often be self-managed with pain relievers, ice, and gentle range of motion exercise. Pain that is getting worse or is severe warrants a trip to the doctor to verify the diagnosis and get stronger medications or other therapies. 

Osteoarthritis

This is a chronic disease of the joints and the most common joint disorder. The cartilage between a joint's bones gradually wears away with time and use. The lack of cartilage results in pain and stiffness in the joint.

Tendonitis

Tendonitis is inflammation of a tendon, a thick fibrous cord that attaches muscle to bone. Some common names for tendonitis are tennis or golfer’s elbow and repetitive stress injury. Symptoms include pain, tenderness, and mild swelling near a joint.

Self-care that includes ice and resting the joint are often effective. A doctor should evaluate ongoing pain.

Sprains

A sprain is an injury to a ligament. The severity of the injury depends on how badly a ligament is torn or strained and the number of ligaments involved. A sprain can result from a fall, sudden twist, or blow to the body that forces a joint out of its normal position.

The usual signs and symptoms include pain, swelling, bruising, and loss of the ability to use the joint.

Bursitis

The bursae are fluid-filled sacs around the joints that allow muscles and tendons to slip easily over the ends of bones. If these bursae become inflamed, the joint will be painful.

See a doctor

Although mild joint pain can often be treated with RICE (Rest, Ice, Compression, and Elevation) and over-the-counter pain and inflammation relievers, you should see a doctor if you have severe pain, can’t put any weight on the joint, it looks crooked, or you can’t move it.

Do not resume full activity before you are fully recovered or you are at greater risk for reinjury.

Joint Pain

Joint pain can be caused by injury affecting any of the ligaments, bursae, or tendons surrounding the joint.

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Psoriatic ArthritisArtritis Psoriásica

Psoriatic Arthritis

What is psoriatic arthritis?

Psoriatic arthritis is a form of arthritis associated with psoriasis, a chronic skin and nail disease characterized by red, scaly rashes and thick, pitted fingernails. The disease is similar to rheumatoid arthritis in symptoms, characterized by joint inflammation. However, psoriatic arthritis tends to affect fewer joints than rheumatoid arthritis and does not produce the typical rheumatoid arthritis antibodies. The arthritis associated with psoriatic arthritis comes in five forms:

  • Arthritis that affects the small joints in the fingers and/or toes

  • Asymmetrical arthritis of the joints in the extremities

  • Symmetrical polyarthritis, a type of arthritis similar to rheumatoid arthritis

  • Arthritis mutilans, a rare type of arthritis that destroys and deforms joints

  • Psoriatic spondylitis, arthritis of the sacroiliac sac (in the lower back) and the spine

What causes psoriatic arthritis?

Although the cause of psoriatic arthritis is unknown, factors such as immunity, genetics, and the environment may play a role.

What are the symptoms of psoriatic arthritis?

The following are the most common symptoms of psoriatic arthritis. The skin condition, psoriasis, may actually precede or follow psoriatic arthritis. However, each individual may experience symptoms differently. Symptoms may include:

  • Inflamed, swollen, and painful joints, usually in the fingers and toes

  • Deformed joints from chronic inflammation

The symptoms of psoriatic arthritis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is psoriatic arthritis diagnosed?

When psoriasis has been diagnosed, a diagnosis of psoriatic arthritis may be easily confirmed. However, when psoriatic arthritis symptoms precede other symptoms of psoriasis, diagnosis is more difficult. Although psoriatic arthritis sometimes causes an increased erythrocyte sedimentation rate (ESR), mild anemia, and elevated blood uric acid levels, these symptoms are also associated with other rheumatic diseases, including gout. ESR is a measurement of how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. Thus, when measured, they fall and settle faster at the bottom of the test tube. Generally, the faster the blood cells fall, the more severe the inflammation.

Treatment for psoriatic arthritis

Specific treatment for psoriatic arthritis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, and therapies

  • Expectation for the course of the disease

  • Your opinion or preference

Treatment usually involves treating both the skin condition and the joint inflammation. Some medications used to treat rheumatoid arthritis are also used to treat psoriatic arthritis, including:

  • Nonsteroidal anti-inflammatory medications to relieve symptoms

  • Vitamins and minerals, such as calcium and vitamin D, to slow bone deformation

  • Immunosuppressive medications, such as methotrexate to suppress inflammation if NSAIDs are not effective 

  • Biologic medications, such as the drugs Enbrel (etanercept) and Humira (adalimumab) 

Other treatment may include:

  • Corticosteroids for inflammation

  • Ultraviolet light treatment (UVB or PUVA)

  • Heat and cold

  • Splints

  • Exercise

  • Physical therapy to improve and maintain muscle and joint function

  • Occupational therapy to improve ability to perform activities of daily living

  • Dermatology management of psoriasis skin rash, if present

  • Surgery to repair or replace a damaged joint; if warranted, this usually occurs years after the initial diagnosis

Psoriatic Arthritis

Psoriatic arthritis is a chronic disease characterized by inflammation of the skin and joints.

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KyphosisCifosis

Kyphosis

What is kyphosis?

A normal spine, when viewed from behind appears straight. However, a spine affected by kyphosis shows evidence of a forward curvature of the back bones (vertebrae) in the upper back area, giving an abnormally rounded or "humpback" appearance.

Illustration of a child with kyphosis
Click Image to Enlarge

Kyphosis is defined as a curvature of the spine measuring 50 degrees or greater on an X-ray (a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film). The normal spine can bend from 20 degrees to 45 degrees of curvature in the upper back area. Kyphosis is a type of spinal deformity.

What causes kyphosis?

Kyphosis can be congenital (present at birth), or due to acquired conditions that may include the following:

  • Metabolic problems

  • Neuromuscular conditions

  • Osteogenesis imperfecta (also called "brittle bone disease"). A condition that causes bones to fracture with minimal force.

  • Spina bifida

  • Scheuermann's disease. A condition that causes the vertebrae to curve forward in the upper back area. The cause of Scheuermann's disease is unknown and is commonly seen in males.

  • Postural kyphosis. The most common type of kyphosis. It generally becomes noticeable in adolescence and can be associated with slouching versus a spinal abnormality. Exercise is used to help correct posture.

Kyphosis is more common in females than males.

What are the symptoms of kyphosis?

The following are the most common symptoms of kyphosis. However, each individual may experience symptoms differently. Symptoms may include:

  • Difference in shoulder height

  • The head bends forward compared to the rest of the body

  • Difference in shoulder blade height or position

  • When bending forward, the height of the upper back appears higher than normal

  • Tight hamstrings (back thigh) muscles

Back pain, pain down the legs, and changes in bowel and bladder habits are not commonly associated with kyphosis. A person experiencing these types of symptoms requires further medical evaluation by a doctor.

The symptoms of kyphosis may resemble other spinal conditions or deformities, or may be a result of an injury or infection. Always consult your doctor for a diagnosis.

How is kyphosis diagnosed?

The doctor makes the diagnosis of kyphosis with a complete medical history, physical examination, and diagnostic tests. If the patient is a child, the doctor obtains a complete prenatal and birth history of him or her and asks if other family members are known to have kyphosis. The doctor also will ask about developmental milestones since some types of kyphosis can be associated with other neuromuscular disorders. Developmental delays may require further medical evaluation.

Diagnostic procedures may include the following:

  • X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. This test is used to measure and evaluate the curve. With the use of a full-spine X-ray, the doctor or radiologist measures the angle of the spinal curve. A determination for treatment can often be made based on this measurement.

  • Radionuclide bone scan. A nuclear imaging technique that 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.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.

  • 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.

  • Blood tests

Early detection of kyphosis is important for successful treatment. Pediatricians or family doctors, and even some school programs, routinely look for signs that kyphosis may be present.

Treatment of kyphosis

Specific treatment for kyphosis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, and therapies

  • Expectation for the course of the disease

  • Your opinion or preference

The goal of treatment is to stop the progression of the curve and minimize deformity. Treatment may include:

  • Observation and repeated examinations. The child will need observation and repeated examinations. Progression of the curve depends on the amount of skeletal growth, or how skeletally mature, the child is. Curve progression slows down or stops after the child reaches puberty.

  • Bracing. If the child is still growing, the doctor may prescribe a brace. The type of brace and the amount of time spent in the brace will be determined by your doctor.

  • Surgery. In rare instances, surgery is recommended when the curve measures 75 degrees or more on X-ray and bracing is not successful in slowing down the progression of the curve.

Kyphosis

A condition in which the normal roundback in the upper spine is increased.

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Common Injuries of the Shoulder

Common Injuries of the Shoulder

Whether throwing a ball, paddling a canoe, lifting boxes, or pushing a lawn mower, we rely heavily on our shoulders to perform a number of activities.

Normally, the shoulder has a wide range of motion, making it the most mobile joint in the body. Because of this flexibility, however, it is not very stable and is easily injured.

The shoulder is made up of 2 main bones: the end of upper arm bone (humerus) and the shoulder blade (scapula). The end of the humerus is round, and it fits into a socket in the scapula. The scapula extends around the shoulder joint to form the roof of the shoulder, and this joins with the collar bone (clavicle). Surrounding the shoulder is a bag of muscles and ligaments. Ligaments connect the bones of the shoulders, and tendons connect the bones to surrounding muscle. Four muscles begin at the scapula and go around the shoulder and attach to the humerus, these are the rotator cuff.

When the shoulder moves, the end of the humerus moves in the socket. Very little of the surface of the bones touch each other. Ligaments and muscles keep the humerus from slipping out of the socket and keep the clavicle attached to the scapula.

To keep shoulders healthy and pain-free, it's important to know how to spot and avoid common injuries.

Shoulder instability

Shoulder instability occurs when the shoulder feels like it might slip out of place. It occurs most often in young people and athletes. The shoulder becomes unstable when muscles and ligaments that hold it together are stretched beyond their normal limits. For younger people, this condition may be a normal part of growth and development. Shoulders generally stiffen or tighten with age.

In athletes, shoulder instability is caused by activities, such as tackling or pitching that put extreme force on the shoulder, stretching the shoulder ligaments gradually. Symptoms of shoulder instability are pain that comes on either suddenly or gradually, a feeling that the shoulder is loose, or a weakness in the arm. Treatment may be rest, physical therapy or surgery.

A shoulder separation, also called a sprain, occurs when the ligaments that hold the clavicle to the roof of the shoulder tear. If this happens, the clavicle is pushed out of place and forms a bump at the top of the shoulder. Sprains are common in falls, when the hand or arm is outstretched to stop the fall, or when the fall is on a hard surface. Symptoms are severe pain when the sprain occurs, a misshapen shoulder and decreased movement of the shoulder. Treatment depends on the severity of the sprain. Ice applied immediately after the injury helps decrease pain and swelling. Keeping the arm in a sling to limit the movement of the shoulder allows ligaments to heal; this is followed by physical therapy exercises. Sometimes, surgery is needed.

If the ligaments that hold the shoulder muscles to bones tear and can't hold the joint together, the shoulder is dislocated. A fall onto an outstretched hand, arm or the shoulder itself, or a violent twisting, can cause a shoulder dislocation. The main symptom is pain in the shoulder that becomes worse when the shoulder is moved. Treatment for a dislocation is ice applied immediately after the injury to decrease pain, swelling and bleeding around the joint. Within 15 minutes to 30 minutes of the injury, the joint will be painful and swollen. A dislocated shoulder needs immediate medical care. Doctors treat dislocations by using gentle traction to pull the shoulder back into place. When the shoulder pops out of the socket repeatedly, the condition is called recurrent instability. Recurrent instability can be treated with surgery to repair the torn ligaments.

Rotator cuff tear

The rotator cuff is a group of 4 muscles of the upper arm that raise and rotate the arm. The muscles are attached to the bones by tendons. The job of muscles is to move bones. The tendons of the rotator cuff allow the muscles to move the arm. If the tendons tear, the humerus can't move as easily in the socket, making it difficult to move the arm up or away from the body.

As people age and their physical activity decreases, tendons begin to lose strength. This weakening can lead to a rotator cuff tear. Rotator cuff injuries occasionally occur in younger people, but most of them happen to middle-aged or older adults who already have shoulder problems. This area of the body has a poor supply of blood, making it more difficult for the tendons to repair and maintain themselves. As a person ages, these tendons degenerate. Using your arm overhead puts pressure on the rotator cuff tendons. Repetitive movement or stress to these tendons can lead to impingement, in which the tissue or bone in that area becomes misaligned and rubs or chafes.

The rotator cuff tendons can be injured or torn by trying to lift a very heavy object while the arm is extended, by falling, or by trying to catch a heavy falling object.

Symptoms of a torn rotator cuff include tenderness and soreness in the shoulder during an activity that uses the shoulder. A tendon that has ruptured may make it impossible to raise the arm. It may be difficult to sleep lying on that side, and you may feel pain when pressure is put on the shoulder.

Treatment depends on the severity of the injury. If the tear is not complete, your health care provider may recommend RICE, for rest, ice, compression and elevation. Resting the shoulder is probably the most important part of treatment, although after the pain has eased, you should begin physical therapy to regain shoulder movement. Your doctor may prescribe a nonsteroidal anti-inflammatory drug (NSAID) for pain.

Frozen shoulder

This extreme stiffness in the shoulder can occur at any age. It affects approximately 2% of Americans, most often between 40 years and 60 years of age. Although the causes are not completely understood, it can affect people with diabetes, thyroid disease, heart disease, or Parkinson's disease. It can also occur if the shoulder has been kept immobile for a period of time. It occurs when a minor shoulder injury heals with scar tissue that affects how the joint moves. This scar tissue reduces flexibility in the shoulder and makes it more prone to injury. The major symptom is the inability to move the shoulder in any direction without pain. Treatment can be NSAIDs, cortisone injections or physical therapy. You can reduce further injury and stiffness by stretching before starting activities.

Overuse/strains

Sudden increases in activity can place extensive stress on the shoulders and lead to a decrease in flexibility. This is a common problem in middle age, especially among "weekend warriors," or people who don't exercise regularly but go out every now and then for an intense sport.

Although painful and inconvenient, these overuse problems can usually be treated with rest, NSAIDs and stretching exercises.

Arthritis

Beginning as early as age 50, some people develop osteoarthritis, which causes painful movement. This occurs as the smooth surfaces of the cartilage that line the bones of the shoulder joint are worn away, and joints begin to wear out and become larger. The most common cause of osteoarthritis is overuse. Treatments for arthritis in the shoulder depend on the severity of pain. The usual treatments are rest, NSAIDs and cortisone injections.  In some instances, a replacement of the shoulder joint is necessary.

Shoulder & Elbow Pain

Pain in the shoulder or elbow is extremely common with many possible causes.

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TendonitisTendinitis

Tendonitis

What are tendon problems?

Two major problems associated with tendons include tendonitis and tenosynovitis. Tendonitis, inflammation of a tendon (the tough cords of tissue that connect muscles to bones) can affect any tendon in the body. When the tendons become irritated, swelling, pain, and discomfort will occur.

Tenosynovitis is the inflammation of the lining of the tendon sheaths that enclose the tendons. The tendon sheath is usually the site that becomes inflamed, but both the sheath and the tendon can become inflamed simultaneously. The cause of tenosynovitis is often unknown, but usually strain, overuse, injury, or excessive exercise may be implicated. Tendonitis may also be related to disease (for example, diabetes or rheumatoid arthritis).

Common tendon disorders include the following:

  • Lateral epicondylitis (commonly known as tennis elbow). A condition characterized by pain in the back side of the elbow and forearm, along the thumb side when the arm is alongside the body with the thumb turned away. The pain is caused by damage to the tendons that bend the wrist backward away from the palm.

  • Medial epicondylitis (commonly known as golfer's or baseball elbow). A condition characterized by pain from the elbow to the wrist on the palm side of the forearm. The pain is caused by damage to the tendons that bend the wrist toward the palm.

  • Rotator cuff or biceps tendonitis. A shoulder disorder characterized by the inflammation of the shoulder capsule and related tendons.

  • DeQuervain's tenosynovitis. The most common type of tenosynovitis disorder characterized by the tendon sheath swelling in the tendons of the thumb.

  • Trigger finger/trigger thumb. A tenosynovitis condition in which the tendon sheath becomes inflamed and thickened, thus preventing the smooth extension or flexion of the finger/thumb. The finger/thumb may lock or "trigger" suddenly.

What are the symptoms of tendonitis?

The following are the most common symptoms of tendonitis. However each individual may experience symptoms differently. Symptoms may include:

  • Pain in the tendon when moved

  • Swelling from fluid accumulation and inflammation, or a grating sensation if not swollen

The symptoms of tendonitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is tendonitis diagnosed?

Diagnosis of tendonitis is usually confirmed based on a complete medical history and physical examination. Tendonitis is often diagnosed after other diagnostic tests have been completed to rule out other conditions or diseases. Joint aspirations may help to rule out gout or an infection, while X-rays may help to rule out arthritis (although tendons cannot be seen on an X-ray).

Treatment for tendonitis

Specific treatment for tendonitis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, and therapies

  • Expectation for the course of the disease

  • Specific organs that are affected

  • Your opinion or preference

Treatment may include:

  • Activity modification

  • Ice

  • Splinting or immobilization

  • Steroid injections

  • Nonsteroidal anti-inflammatory medications

  • Surgery

Tendonitis

Tendonitis is the inflammation of the tendons, occurs for a variety of reasons.

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Ankylosing SpondylitisEspondilitis Anquilosante

Ankylosing Spondylitis

What is ankylosing spondylitis?

Anatomy of the male pelvis
Click Image to Enlarge

Ankylosing spondylitis (AS) is a type of arthritis that affects the spine. Ankylosing means stiff or rigid, spondyl means spine, and itis refers to inflammation. The disease causes inflammation of the spine and large joints, resulting in stiffness and pain. The disease may result in erosion at the joint between the spine and the hip bone (the sacroiliac joint), and the formation of bony bridges between vertebrae in the spine, fusing those bones. In addition, bones in the chest may fuse. The cause of AS is unknown, although researchers suspect genetics play a role. A gene called HLA-B27 occurs in over 95 percent of those with AS. However, some people with the HLA-B27 gene do not have AS.

Who is affected by ankylosing spondylitis?

AS is more common among young people, between ages 17 and 35, but it can occur in children and older adults as well. The disease affects two to three times more young men than women and it tends to run in families.

What are the symptoms of ankylosing spondylitis?

Symptoms of AS tend to occur and disappear over periods of time. The following are the most common symptoms of AS. However each individual may experience symptoms differently. Symptoms may include:

  • Back pain, usually most severe at night during rest

  • Early morning stiffness

  • Stooped posture in response to back pain (bending forward tends to relieve the pain)

  • Straight and stiff spine

  • Inability to take a deep breath, if the joints between the ribs and spine are affected

  • Appetite loss

  • Weight loss

  • Fatigue

  • Fever

  • Anemia

  • Joint pain

  • Mild eye inflammation

  • Organ damage, such as the heart, lungs, and eyes

  • Skin rashes 

  • Gastrointestinal illness (such as Crohn's or ulcerative colitis) 

The symptoms of ankylosing spondylitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is ankylosing spondylitis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for ankylosing spondylitis may include:

  • X-ray. This diagnostic test uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

  • Erythrocyte sedimentation rate (also called ESR or sed rate). This is a measurement of how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. Thus, when measured, they fall and settle faster at the bottom of the test tube. Generally, the faster the blood cells fall, the more severe the inflammation; less than 70 percent of persons with AS have an elevated ESR.

  • Genetic testing. Genetic testing is performed to determine if a person carries a copy of an altered gene for a particular disease; the specific gene (HLA-B27) is found to be present in over 95 percent of people with AS.

Treatment for ankylosing spondylitis

The goal of treatment for AS is to reduce pain and stiffness, prevent deformities, and maintain as normal and active a lifestyle as possible. Treatment may include:

  • Nonsteroidal anti-inflammatory medications (to reduce pain and inflammation)

  • Tumor-necrosis-factor blockers also known as biologic medications (may be used in progressive disease to reduce inflammation and swelling, but can increase risk of infections, especially tuberculosis)

  • Disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine, work in a number of different ways to decrease inflammation and control AS

  • Short-term use of corticosteroids (to reduce inflammation)

  • Short-term use of muscle relaxants and pain relievers (to relieve severe pain and muscle spasms)

  • Surgery (to replace a joint; to place rods in the spine; to remove parts of the thickened and hardened bone)

  • Maintain proper posture

  • Regular exercise, including exercises that strengthen back muscles

Ankylosing Spondylitis

Is a form of chronic, often painful, arthritis. It affects joints in the spine and the pelvis.

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Lumbar Disk Disease (Herniated Disk)Enfermedad del Disco Lumbar [Hernia de Disco]

Lumbar Disk Disease (Herniated Disk)

Illustration of a herniated intervertebral disc
Click Image to Enlarge

Anatomy of the lumbar spine

The vertebral column, also called the backbone, is made up of 33 vertebrae that are separated by spongy disks and classified into four distinct areas. The cervical area consists of seven bony parts in the neck; the thoracic spine consists of 12 bony parts in the back area; the lumbar spine consists of five bony segments in the lower back area; five sacral bones (fused into one bone, the sacrum); and four coccygeal bones (fused into one bone, the coccyx).

Lumbar disk disease occurs in the lumbar area of the spine. The lumbar area of the spine (and other areas of the spine) is made up of two parts, including the following:

  • Vertebral bodies. The parts that are made of bone.

  • Intervertebral disks (also known as the disks). The disks are located between the bony parts of the spine and act as "shock absorbers" for the spine.

The vertebral bodies are numbered from 1 to 5 in the lumbar spine and the disks are located between two of the vertebral bodies and are numbered accordingly (such as a disk at L2-3, or between the lumbar disks numbered 2 and 3).

The intervertebral disk is composed of two parts, including the following:

  • Annulus fibrosis. A tough outer ring of fibrous tissue.

  • Nucleus pulposus. Located inside the annulus fibrosis; a more gelatinous or soft material.

Illustration of different types of skull fractures
Click Image to Enlarge

What is lumbar disk disease (herniated disk, ruptured disk or bulging disk)?

As we age, the intervertebral disk may lose fluid and become dried out. As this happens, the disk compresses. This may lead to the deterioration of the tough outer ring allowing the nucleus, or the inside of the ring, to bulge out. This is considered a bulging disk.

As the disk continues to degenerate, or with continued stress on the spine, the inner nucleus pulposus may actually rupture out from the annulus. This is considered a ruptured, or herniated, disk. The fragments of disk material can then press on the nerve roots that are located just behind the disk space. This can cause pain, weakness, numbness, or changes in sensation.

Most disk herniations happen at the lower lumbar spine, especially at the L4-5 and L5-S1 levels.

What causes lumbar disk disease?

Lumbar disk disease is due to a change in the structure of the normal disk. Most of the time, disk disease comes as a result of aging and the degeneration that occurs within the disk. Occasionally, severe trauma can cause a normal disk to herniate. Trauma may also cause an already herniated disk to worsen.

What are the symptoms of lumbar disk disease?

The symptoms of lumbar disk disease vary depending on where the disk has herniated, and what nerve root it is pushing on. The following are the most common symptoms of lumbar disk disease. However, each individual may experience different symptoms. Symptoms may include:

  • Intermittent or continuous back pain. This may be made worse by movement, coughing, sneezing, or standing for long periods of time.

  • Spasm of the back muscles

  • Sciatica. Pain that starts near the back or buttock and travels down the leg to the calf or into the foot.

  • Muscle weakness in the legs

  • Numbness in the leg or foot

  • Decreased reflexes at the knee or ankle

  • Changes in bladder or bowel function

The symptoms of lumbar disk disease may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.

How is lumbar disk disease diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for lumbar disk disease may include the following:

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

  • 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.

  • Myelogram. A procedure that uses dye injected into the spinal canal to make the structure clearly visible on X-rays.

  • 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.

  • Electromyography (EMG). A diagnostic test that measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle

Treatment for lumbar disk disease

Specific treatment for lumbar disk disease will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Type of condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Typically, conservative therapy is the first line of treatment to manage lumbar disk disease. This may include a combination of the following:

  • Bed rest

  • Patient education on proper body mechanics (to help decrease the chance of worsening pain or damage to the disk)

  • Physical therapy, which may include ultrasound, massage, conditioning, and exercise programs

  • Weight control

  • Use of a lumbosacral back support

  • Medications (to control pain and/or to relax muscles)

When these conservative measures fail, surgery for removal of a herniated disk may be recommended. Surgery is done under general anesthesia. An incision is placed in the lower back over the area where the disk is herniated. Some bone from the back of the spine may be removed to gain access to the area where the disk is located. Typically, the herniated part of the disk and any extra loose pieces of disk are removed from the disk space.

After surgery, restrictions may be placed on the patient's activities for several weeks while healing is taking place to prevent another disk herniation from occurring. Your surgeon will discuss any restrictions with you.

There are other experimental therapies that are being used to treat lumbar disk disease. Discuss these treatment options with your health care provider.

Herniated Disk

This condition occurs when a disk has slipped along the spinal cord. Also referred to as cervical radiculopathy.

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Neck Pain and ProblemsDolores y Problemas del Cuello

Neck Pain and Problems

What is neck pain?

The neck is located between the head and the shoulders. Because of its location and range-of-motion, it is often left unprotected and subject to injury.

What causes neck pain?

Photo of woman touching her neck

Neck pain can result from many different causes from injury, to age-related disorders, or inflammatory disease. Causes of neck pain and problems may include the following:

  • Injury (damage to the muscles, tendons, and/or ligaments)

  • Herniated cervical disk

  • Arthritis (for example, osteoarthritis or rheumatoid arthritis)

  • Cervical disk degeneration

  • Congenital (present at birth) abnormalities of the vertebrae and bones

  • Tumors

How is neck pain diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for neck pain may include the following:

  • Blood tests. These tests can help determine the diagnosis of inflammatory disease.

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of bones onto film.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease of internal structures within our joints, or in a surrounding ligament or muscle.

  • 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.

  • Electromyogram (EMG). A test to evaluate nerve function.

Treatment for neck pain

Specific treatment for neck pain will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Your diagnosis

  • Extent of the condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Treatment may include:

  • Medication (to reduce inflammation)

  • Medication (to control pain)

  • Rest

  • Physical therapy

  • Neck brace or immobilization

  • Exercise

  • Surgery

Neck Pain & Injuries

Age-related wear and tear affecting the neck joints. This may also be referred to as cervical spondylosis.

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Dislocations (Shoulder, Jaw, Elbow, Finger)Dislocaciones (hombro, mandíbula, codo, dedo)

Dislocations (Shoulder, Knee Cap, Elbow, Finger)

A joint is the place where your bones come together. Normally, bones glide smoothly within your joints, allowing a wide range of motion. But a bone can be pushed or pulled out of position. This is known as a dislocation. Dislocation prevents normal joint movement and can be very painful. Prompt treatment is crucial.

X-ray of dislocated shoulder with bones highlighted in white.
An X-ray of a dislocated shoulder joint.

Causes of Dislocations

Dislocations can happen to almost any joint. But they're most common in the shoulder, knee cap, elbow, and finger. Dislocated elbows occur most often in children. Many dislocations result from trauma, such as a blow or fall. But some can happen during normal activities. A shoulder can dislocate during the act of throwing a ball.

When to Go to the Emergency Room (ER)

A dislocation needs emergency care. Injuries that aren`t treated promptly take longer to heal and may result in lasting damage to the joint. Seek medical help right away if you:

  • Have severe pain in a joint.

  • Can't move the joint normally.

  • Can see the misplaced bone.

  • Have numbness or tingling.

  • Have a break in the skin over the painful joint.

To help reduce swelling and pain due to a dislocation:

  • Apply ice to the joint (keep a thin cloth between the ice and your skin).

  • Raise the injured area above heart level if you can.

What to Expect in the ER

  • You will be given pain medication to make you more comfortable.

  • The joint will be examined and an x-ray may be taken to check for fractures or other injuries.

  • The joint is put back into place.

  • A dislocated finger or elbow may be splinted to keep it from moving while it heals. An injured shoulder may be placed in a sling.

  • A second x-ray may be done before you leave the hospital.

  • In some cases, you may be referred to a bone specialist (orthopaedist) or a primary care sports medicine doctor. He or she will make sure you heal properly.

Dislocation

A dislocation is a separation of bones at the joint. A dislocation may cause nerve damage.

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Hip Problems Problemas de la Cadera

Hip Problems

What is the hip?

Anatomy of the hip joint
Click Image to Enlarge

The hip is defined as the region on each side of the pelvis. The pelvis bone is made up of 3 sections, including the following:

  • Ilium. The broad, flaring portion of the pelvis.

  • Pubis. The lower, posterior part of the pelvis.

  • Ischium. One of the bones that helps form the hip.

The hip joint is a ball-and-socket joint that allows motion and provides stability needed to bear body weight.

The socket area, which is inside the pelvis, is called the acetabulum. The ball part of this joint is the top of the leg bone. It joins with the acetabulum to form the hip joint.

The hip is 1 of the most stable joints in the body. But, its function, bearing the body's weight, makes it susceptible to arthritis due to excessive pressure. Pain in the hip may involve injury to muscles, tendons, or bursae (small fluid-filled sacs that cushion and lubricate joints).

What are common hip problems?

The following are some of the most common hip problems:

  • Arthritis. The most common cause of the breakdown of hip tissue. There are 3 kinds of arthritis that commonly affect the hip, including the following:

    • Osteoarthritis. Also referred to as "wear and tear" arthritis; this type of arthritis involves the cartilage that cushions the bones of the hip wearing away, letting the bones then rub together, causing hip pain and stiffness.

    • Rheumatoid arthritis. A disease in which, for unknown reasons, the synovial membrane becomes irritated and produces too much fluid. It damages the cartilage, leading to pain and stiffness.

    • Traumatic arthritis. Often the result of an injury or fracture, there are more than 300,000 hospitalizations for hip fractures in the United States every year.

  • Avascular necrosis. Involves the loss of bone caused by insufficient blood supply, injury, and bone tumors and may lead to breakdown of the hip joint.

  • Bursitis. In this condition, the bursa, a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body, becomes inflamed. There are 2 major bursae of the hip, both of which can be associated with stiffness and pain around the hip joint, including the following:

    • Trochanteric bursa. The bursa located on the side of the hip and separated significantly from the actual hip joint by tissue and bone.

    • Ischial bursa. The bursa located in the upper buttock area.

  • Hip pointer. A bruise or tear in the muscle that connects to the top of the ilium (the crest of the pelvis, just below the waist). Causes of a hip pointer may include a blow, a fall, or a quick twist or turn of the body.

Hip Pain

This condition can range from mild to severe pain. This may be caused by a number of medical disorders.

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Torn MeniscusDesgarro del Menisco

Torn Meniscus

What is a torn meniscus?

Anatomy of the knee showing a healthy meniscus and a torn meniscus.
Click image to enlarge

The ends of the 3 bones in the knee the femur, tibia, and patella are covered with cartilage. Cartilage is a smooth material that covers the ends of the bones and cushions them where they meet. It allows the joint to move easily and acts as a shock absorber. Between the bones of the knees are 2 crescent-shaped discs of connective tissue, called menisci. These also act as shock absorbers, protecting the lower part of the leg from the weight of the rest of the body.

Meniscus tears can occur during a rotating movement while bearing weight. One example would be twisting your upper leg while the foot stays in place during sports and other activities. Tears can be minor, with the meniscus staying connected to the knee, or major, with the meniscus barely attached to the knee by a thread f cartilage.

What are the symptoms of a torn meniscus?

Symmptoms of a torn meniscus may be different for each person. Some of the most common symptoms are:

  • Pain, especially when holding the knee straight

  • Swelling and stiffness

  • Knee may click or lock

  • Knee may feel weak

The symptoms of a torn meniscus are similar to other medical conditions or problems. Always see your health care provider for a diagnosis.

How is torn meniscus diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for a torn meniscus may include the following:

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

  • 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; can often determine damage or disease in a surrounding ligament or muscle.

  • Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure 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; used to evaluate any degenerative and/or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation.

Arthroscopic meniscus repair
Click image to enlarge

Treatment for a torn meniscus

Specific treatment for a torn meniscus will be determined by your doctor based on:

  • Your age

  • Your overall health and medical history

  • How bad your injury is

  • How well you can tolerate specific medications, procedures, and therapies

  • The length of time it will take to heal

  • Your opinion or preference

Treatment may include:

  • Icing

  • Medication, such as ibuprofen

  • Muscle-strengthening exercises

  • Arthroscopic surgery

Meniscus Tears

One of the most commonly injured parts of the knee, the meniscus, is located where the major bones of the leg connect.

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Rheumatoid ArthritisArtritis Reumatoide

Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic disease that causes inflammation of the joints. The inflammation can become so severe that the function and appearance of the hands, as well as other parts of the body, can become affected. In the hand, rheumatoid arthritis may cause deformities in the joints of the fingers, making movement difficult. Lumps, known as rheumatoid nodules, may form over small joints in the hands and the wrist. Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 16 or younger that causes inflammation and stiffness of joints for more than six weeks. Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children often outgrow JRA. However, the disease can affect bone development in the growing child.

What causes rheumatoid arthritis?

The exact cause of rheumatoid arthritis is not known. Rheumatoid arthritis is an autoimmune disorder, which means the body's immune system attacks its own healthy cells and tissues. The response of the body causes inflammation in and around the joints, which then may lead to a destruction of the skeletal system. Rheumatoid arthritis also may have devastating effects to other organs, such as the heart and lungs. Researchers believe certain factors, including heredity, may contribute to the onset of the disease.

Rheumatoid arthritis affects more women than men (70 percent of persons with rheumatoid arthritis are women). The disease most often occurs between the ages of 30 and 50.

What are the symptoms of rheumatoid arthritis?

The joints most commonly affected by rheumatoid arthritis are in the hands, wrists, feet, ankles, knees, shoulders, and elbows. The disease typically causes inflammation symmetrically in the body, meaning the same joints are affected on both sides of the body. Symptoms of rheumatoid arthritis may begin suddenly or gradually. The following are the most common symptoms of rheumatoid arthritis in the hands. However, each individual may experience symptoms differently. Symptoms may include:

  • Pain

  • Stiffness, especially in the morning

  • Swelling over the joints

  • Decreased movement

  • Pain that is worse with movement of the joints

  • Bumps may be noted over the small joints

  • Difficulty performing activities of daily living (ADLs), such as tying shoes, opening jars, or buttoning shirts

  • Decreased ability to grasp or pinch

  • Fatigue

  • Occasional fever

The symptoms of rheumatoid arthritis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is rheumatoid arthritis diagnosed?

Diagnosis of rheumatoid arthritis may be difficult in the early stages because symptoms may be very subtle and go undetected on X-rays or blood tests. In addition to a complete medical history and physical examination, diagnostic procedures for rheumatoid arthritis may include the following:

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

  • Joint aspiration. This involves a removal of fluid from the swollen bursa to exclude infection or gout as possible causes.

  • Biopsy (of nodules tissue). A procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope to determine if cancer or other abnormal cells are present.

  • Blood tests. These tests are done to detect certain antibodies, called rheumatoid factor, and other indicators for rheumatoid arthritis.

Treatment for rheumatoid arthritis

Specific treatment for rheumatoid arthritis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Treatment may include:

  • Medications. Some medications may be used for pain relief, other medications will be used to treat inflammation, and finally some medications will be used to slow the disease from progressing. Depending on your symptoms and preferences, your doctor may treat you with one or more types of treatments.

  • Splints. Splints may be used to help protect the joints and strengthen the weak joints.

  • Physical therapy. Physical therapy may be used to help increase the strength and movement of the affected areas.

  • Surgery. Surgery may be performed if the above treatment options fail. The decision for surgery should be made in consultation with your doctor. Repair or reconstruction of the hand and wrist can be performed in a variety of ways, including the following:

    • Surgical cleaning. This option may be performed on patients with rheumatoid arthritis, or other types of hand arthritis. Inflamed and diseased tissues within the hands can be removed to help increase function.

    • Joint replacement. This type of surgery, also called arthroplasty, may be used in cases of severe arthritis of the hand. This option may be performed on older patients with a lower activity level. Joint replacement may provide a decrease in pain and an increase in function of the hands and fingers. This involves replacing a joint that has been destroyed by the disease process with an artificial joint. This artificial joint may be made out of metal, plastic, silicone rubber, or the patient's own body tissue (such as the tendon).

    • Joint fusion. This option usually involves removing the joint and fusing together two ends of bones. This makes one large bone without a joint. This option is usually used on patients with advanced arthritis. After the fusion of the bone, there is an elimination of movement in the fused joint.

It is important to remember that surgery does not correct the underlying disease. It only helps correct the deformities caused by the disease. Rheumatoid arthritis can continue to cause problems in the hand, and may even require additional surgery. Close follow-up with your doctor is required for optimal control of this disease.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease, mainly characterized by inflammation of the lining of the joints.

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OsteoarthritisArtrosis

Osteoarthritis

What is osteoarthritis?

Osteoarthritis, the most common form of arthritis, is a chronic degenerative joint disease that affects mostly middle-aged and older adults. Osteoarthritis is characterized by the breakdown of joint cartilage. Although it can occur in any joint, usually it affects the hands, knees, hips, or spine. The disease is also known as degenerative arthritis or degenerative joint disease.

Illustration of an Arthritic Hip Joint
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What causes osteoarthritis?

Osteoarthritis can be classified as primary or secondary. Primary osteoarthritis has an unknown cause, while secondary osteoarthritis is caused by another disease, infection, injury, or deformity. Osteoarthritis is characterized by the breakdown of cartilage in the joint. As the cartilage wears down, the bone ends may thicken, forming bony growths or spurs that interfere with joint movement. In addition, bits of bone and cartilage may float in the joint space and fluid-filled cysts may form in the bone, limiting joint movement. Several risk factors are associated with osteoarthritis, including the following:

  • Heredity. Slight joint defects or double-jointedness (laxity) and genetic defects may contribute to the development of osteoarthritis.

  • Obesity. Excessive weight can put undue stress on such joints as the knees over time.

  • Injury or overuse. Significant injury to a joint, such as the knee, can later result in osteoarthritis. Injury may also result from repeated overuse or misuse over a period of time.

What are the symptoms of osteoarthritis?

The most common symptom of osteoarthritis is pain after overuse of a joint or prolonged inactivity of a joint. Symptoms of osteoarthritis usually develop slowly over many years. The following are the most common symptoms of osteoarthritis. However each individual may experience symptoms differently. Symptoms may include:

  • Joint pain

  • Joint stiffness, especially after sleeping or inactivity

  • Limited joint movement as the disease progresses

  • Grinding of joints when moved (in more advanced stages of osteoarthritis) as the cartilage wears away

The symptoms of osteoarthritis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is osteoarthritis diagnosed?

In addition to a complete medical history and physical examination, the most common way to diagnose osteoarthritis in a joint is by X-ray.

Treatment for osteoarthritis

Specific treatment for osteoarthritis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, and therapies

  • Expectation for the course of the condition

  • Your opinion or preference

The goals of treatment for osteoarthritis are to reduce joint pain and stiffness, and improve joint movement. Treatment may include:

  • Exercise. Regular, aerobic exercise, and stretching and strengthening exercises may help reduce the symptoms of and pain associated with osteoarthritis.

  • Heat treatment. Treating the affected joint with heat may help reduce pain.

  • Physical and occupational therapy. Physical and occupational therapy may help to reduce joint pain, improve joint flexibility when performing daily activities, and reduce joint strain. Splints and other assistive devices may also be used.  

  • Weight maintenance. Maintaining your recommended weight or losing weight (if overweight) may help to prevent or reduce the symptoms of osteoarthritis.

  • Medication. Medication for specific symptoms may include pain relievers (in pill form or topical cream) and anti-inflammatory medications, if inflammation is present.

  • Injections of thick liquids into the joints. These liquids mimic normal joint fluid.

  • Joint surgery. Surgery may be necessary to repair or replace a severely damaged joint.

Osteoarthritis

Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints.

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Trauma Services at Baylor

Surgeons on the medical staff at Baylor specialize in the critical care needs of our patients.

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