Join Team TOCA with Dr. Feng & the Arthritis Foundation for the Walk to Cure Arthritis!

Enjoy the beautiful Arizona weather by joining Team TOCA, Dr. Earl Feng (Orthopedic Surgeon, Arthritis & Total Joint Reconstruction) and the Arthritis Foundation in the Annual Walk for the Cure, Saturday May 5th, 2018 at the Phoenix Zoo! Dr. Feng is not only a TOCA Physician & Surgeon but also serves as a Board Member for the Arthritis Foundation!

At TOCA, each of us has an important role in helping the more than 1.2 million Arizonans living with arthritis including many our patients, our colleagues, and more than 6,000 children in Arizona alone. TOCA is proud to continue our support the 2018 Arizona Walk to Cure Arthritis on May 5th at the Phoenix Zoo. As a sponsor of the Walk to Cure Arthritis, our goal is to help more people with arthritis.

The Arthritis Foundation is the Champion of Yes for patients with arthritis who are being told “no” a lot. No, there isn’t a cure. No, you cannot play sports. No, you cannot pick-up your grandchild.

Here is how you can help!

• Through funding critical research for osteoarthritis to find better treatments and ultimately a cure.
• Giving kids living with arthritis the opportunity to attend Camp Cruz to meet other kids living with arthritis.
• Supporting programs like the Live Yes network for people in our community struggling with pain, connecting them with others with arthritis.
• Getting a patient get back on their feet so they can walk their dog.
• Helping a grandparent alleviate back pain so they can pick up their grandchild.
• Saying “YES” to a patient today!

The event features a three-mile and one-mile course, with arthritis information and activities for the entire family!

Let’s raise funds to find a cure for arthritis, then come together to support each other and walk! Every step counts, every dollar matters!  The Arthritis Foundation’s Walk to Cure Arthritis to help the more than 50 million Americans and 300,000 children with arthritis live better today and to keep the Arthritis Foundation’s promise of finding a cure for tomorrow. Be a Champion of Yes – join our team and raise funds to fight arthritis and find a cure, all while having A LOT OF FUN! If you aren’t able to join the team, we’d appreciate your donation to help reach our goal.

Click here to learn more about this event, join Team TOCA and/or Donate Today! Team TOCA

Event Location:
The Phoenix Zoo
455 N Galvin Pkwy
Phoenix , AZ 85008
Event Schedule:
Event Registration Starts 5/5/2017 6:30 am
Event Registration Ends 5/5/2017 8:00 am
Event Starts 5/5/2017 7:30 am
Event Ends 5/5/2017 10:00 am
Fees:
Walk to Cure Arthritis Registration: No Fees
Event Registration

To Learn more about Dr. Feng and TOCA visit: www.tocamd.com or call 602-277-6211

#Arthritisfoundation #WalktoCureArthritis #Results #Recovery #Relife#TOCAMD #TOCA #ArthritisPhxWalk #PhoenixZoo

Celebrate National PA (Physician Assistant) Week October 6 – 12th!

Each year from October 6-12, we celebrate National PA Week, which recognizes the PA profession and its contributions to the nation’s health.

This week is also an opportunity to raise awareness and visibility of the profession. Before it was a weeklong event, National PA Day was first celebrated on October 6, 1987, in honor of the 20th anniversary of the first graduating class of PAs from the Duke University PA program. October 6th is also the birthday of the profession’s founder, Eugene A. Stead, Jr., MD. Now the profession is 50 years strong!

History of the PA Profession

The PA profession was created to improve and expand healthcare.

In the mid-1960s, physicians and educators recognized there was a shortage of primary care physicians.

To help remedy this, Eugene A. Stead Jr., MD, of the Duke University Medical Center, put together the first class of PAs in 1965. He selected four Navy Hospital Corpsmen who had received considerable medical training during their military service. Stead based the curriculum of the PA program on his knowledge of the fast-track training of doctors during World War II.

The first PA class graduated from the Duke University PA program on Oct. 6, 1967.

The PA concept was lauded early on and gained federal acceptance and backing as early as the 1970s as a creative solution to physician shortages. The medical community helped support the new profession and spurred the setting of accreditation standards, establishment of a national certification process and standardized examination, and development of continuing medical education requirements.

What is a PA? (American Academy of PAs)

What is a PA?

A physician assistant (or PA) is a nationally certified and state-licensed medical professional. There are currently more than 100,000 clinically practicing PA’s in the United States! PA’s practice medicine on health care teams with physicians and other providers. They also prescribe medication in all 50 states.

 

What does a PA do? Well, at the most basic level, a PA is a medical practitioner who works under the supervision of a physician.

Physician assistants (PAs) work closely with doctors and handle duties that range from taking medical histories to setting simple fractures. They are allowed to prescribe medications in some states. Many PAs specialize in a particular area of medicine, such as pediatrics. A master’s degree is required, and all states require that PAs be licensed. Licensing requires passing a multiple-choice exam and completing continuing education courses to keep knowledge current.

Beyond the basic definition, however, the PA profession represents an essential part of the health care infrastructure in a number of important ways.

Physician assistants examine, diagnose and treat patients under the supervision of licensed physician. PAs can prepare casts or splints, suture small wounds and interpret medical tests. According to the American Academy of Physician Assistants (AAPA), these medically-trained professionals can also prescribe medications (www.aapa.org).

Some PAs specialize in a particular area of medicine, such as emergency care or geriatrics, and can assist doctors in advanced medical techniques and procedures. Physician assistants are often the first line of medical care in rural and underserved areas. In some cases, a physician assistant will refer the patient to a medical doctor or make arrangements for transferring the patient to a hospital or clinic.

During this week, TOCA is excited to honor our amazing PAs and to say a big thank you. We appreciate your dedication to patient care, and we recognize the impact that you make in the lives of those patients every day.

To read more about the dedicated Physician Assistant staff at TOCA Click Here

To learn more about TOCA or to schedule an appointment call 602-277-6211

 

#Recovery #Results #Relief #TOCA #TOCAMD #PA #PAWeek #ThankAPA #Patientcare #PhysicianAssistant #PADay #MyOrthoDoc

Total Elbow Replacement: What you need to know

Total Elbow Replacement

The elbow is a necessary joint for normal functioning in daily life, yet it is susceptible to various degenerative conditions and traumatic lesions or posttraumatic sequelae.  Although a total elbow replacement is much less common than knee or hip replacement, it is just as successful in relieving joint pain and returning people to activities they enjoy.

Elbow replacement surgery is a complicated procedure partly because the elbow has several moving parts that balance each other with great precision to control the movements of your forearm.

Your elbow can be damaged by problems ranging from rheumatoid arthritis to traumatic fractures. In some cases, the damage can be surgically repaired. But if the damage is extensive, your doctor might recommend elbow replacement surgery. Pain is the most common reason people choose to have elbow replacement surgery.

Over 3,000 people in the U.S. have elbow replacement surgery annually, according to the Agency for Healthcare Research and Quality.

Whether you have just started exploring treatment options or have  decided to have an elbow replacement surgery, this article will help you understand more about this valuable procedure.

Anatomy

The elbow is a hinge joint which is made up of three bones:

  • The humerus (upper arm bone)
  • The ulna (forearm bone on the pinky finger side)
  • The radius (forearm bone on the thumb side)

The surfaces of the bones where they meet to form the elbow joint are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the elbow joint. In a healthy elbow, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction as you bend and rotate your arm.

 

Muscles, ligaments, and tendons hold the elbow joint together.

 

(The main structures of the elbow when viewed from the side.)

Types of elbow replacement

In some cases, you may need a replacement of just one portion of the joint. For example, if only the head of one of your forearm bones (radius) is damaged, it can be replaced with an artificial head.

If the entire joint needs to be replaced, the ends of the bones that come together in the elbow will be removed. Bones are hard tubes that contain a soft center. The long, slender ends of the artificial joint are inserted into the softer central part of the bones.

There are two main types of prosthetic devices available:

  • Linked. This type of prosthesis acts somewhat like a loose hinge because all the parts of the replacement joint are connected. This provides good joint stability, but the stresses of movement can sometimes result in the prosthesis working itself loose from where it’s inserted into the arm bones.
  • Unlinked. This type of device comes in two separate pieces that aren’t connected to each other. This design depends on the surrounding ligaments to help hold the joint together, which can make it more prone to dislocation.

Description

In total elbow replacement surgery, the damaged parts of the humerus and ulna are replaced with artificial components. The artificial elbow joint is made up of a metal and plastic hinge with two metal stems. The stems fit inside the hollow part of the bone called the canal.

(Total elbow replacement components.)

There are different types of elbow replacements, and components come in different sizes. There are also partial elbow replacements, which may be used in very specific situations. A discussion with your doctor will help to determine what type of elbow replacement is best for you.

 

Causes

Several conditions can cause elbow pain and disability, and lead patients and their doctors to consider elbow joint replacement surgery.

Rheumatoid Arthritis

This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness.

Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”

Osteoarthritis (Degenerative Joint Disease)

Osteoarthritis is an age-related, “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the elbow softens and wears away. The bones then rub against one another. Over time, the elbow joint becomes stiff and painful.

Rheumatoid arthritis and osteoarthritis cause cartilage damage that can result in severe pain and disability.

Post-traumatic Arthritis

This type of arthritis can follow a serious elbow injury. Fractures of the bones that make up the elbow, or tears of the surrounding tendons and ligaments may cause damage to the articular cartilage over time. This causes pain and limits elbow function.

Severe Fractures

A severe fracture of one or more bones that make up the elbow is another common reason people have elbow replacements. If the elbow is shattered, it may be very difficult for a doctor to put the pieces of bone back in place. In addition, the blood supply to the bone pieces can be interrupted. In this type of case, a surgeon may recommend an elbow replacement. Older patients with osteoporosis (fragile bone) are most at risk for severe elbow fractures.

In addition, some fractures do not heal well and may require an elbow replacement to address continuing problems.

Instability

Instability occurs when the ligaments that hold the elbow joint together are damaged and do not work well. The elbow is prone to dislocation. Chronic instability is most often caused by an injury.

 

Teamwork

TOCA’s treatment teams include specialists in orthopedic surgery and in physical medicine and rehabilitation. These experts work together with the goal of restoring strength and range of motion in your elbow.

 

Diagnostic and surgical innovation

TOCA’s physicians  have developed several diagnostic examinations and surgical techniques to help make elbow replacement a highly effective treatment option.

Table. Treatment Options for Elbow-Related Problems

Affected joint(s) Options Plain radiographs
Radial head Radial head replacement Figure 1
Ulna Total elbow arthroplasty Figure 2
Humeroradial Radial head replacement Figure 1
Unicompartmental replacement Figure 3
Humeroulnar Total elbow arthroplasty Figure 2
Humerus Hemiarthroplasty Figure 4
Radioulnar Radial head replacement Figure 1
Radial head resection

Preparing for Surgery

Medical Evaluation

If you decide to have elbow replacement surgery, your orthopaedic surgeon at TOCA may ask you to schedule a complete physical examination with your family physician several weeks before surgery. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process.

Many patients with chronic medical conditions, like heart disease, must also be evaluated by a specialist, such a cardiologist, before the surgery.

Medications

Be sure to talk to your orthopaedic surgeon and TOCA medical team about the medications you take. Some medications may need to be stopped before surgery. For example, the following over-the-counter medicines may cause excessive bleeding and should be stopped 2 weeks before surgery:

  • Non-steroidal anti-inflammatory medications, such as aspirin, ibuprofen, and naproxen sodium
  • Most arthritis medications

If you take blood thinners, either your primary care doctor or cardiologist will advise you about stopping these medications before surgery.

Home Planning

Making simple changes in your home before surgery can make your recovery period easier.

For the first several weeks after your surgery, it will be hard to reach high shelves and cupboards. Before your surgery, be sure to go through your home and place any items you may need afterwards on low shelves.

When you come home from the hospital, you will need help for a few weeks with some daily tasks like dressing, bathing, cooking, and laundry. If you will not have any support at home immediately after surgery, you may need a short stay in a rehabilitation facility until you become more independent.

 

Your Surgery

Before Your Operation

You will most likely be admitted to the hospital on the day of your surgery. After admission, you will be taken to the preoperative preparation area and will meet a doctor from the anesthesia department.

You, your anesthesiologist, and your surgeon will discuss the type of anesthesia to be used. In most total elbow replacement surgeries, a general anesthetic that puts you to sleep for the entire operation is used.

Surgical Procedure

To reach the elbow joint, your surgeon will make an incision (cut), usually at the back of the elbow. After making the incision, your surgeon will gently move muscles aside to get access to the bone. After removing scar tissue and spurs around the joint, your surgeon will prepare the humerus to fit the metallic piece that will replace that side of the joint. The same preparation is done for the ulna.

The replacement stems are placed into the humerus and ulna bones, and kept in place with a bone cement. The two stems are connected by a hinge pin. After the wound is closed, a padded dressing is then placed to protect the incision while it heals.

Some surgeons will place a temporary tube in the joint to drain the surgical fluid. This tube can be easily removed in your hospital room within the first few days after surgery.

 

Implants

The metal replacement parts are made of chrome-cobalt alloy or titanium and there is a liner made of polyethylene (plastic). The bone cement is made of polymethylmethacrylate (acrylic, a type of plastic).

Recovery

Your medical team will give you several doses of antibiotics to prevent infection. Most patients are able to eat solid food and get out of bed the day after surgery. You will most likely stay at the hospital 2 to 4 days after your surgery.

Pain Management

After surgery, you will feel some pain, but your surgeon and nurses will provide medication to make you feel as comfortable as possible. Talk with your surgeon if postoperative pain becomes a problem.

Rehabilitation

A careful, well-planned rehabilitation program is critical to the success of an elbow replacement. You will be taught some exercises for your hand and wrist to avoid stiffness and help to control swelling. You will do gentle elbow range-of-motion exercises as the incision heals. Your doctor may prescribe therapy or may teach you how to do the exercises yourself.

You will most likely not be allowed to put any weight on your arm or push against resistance with your hand until about 6 weeks after your surgery.

Long-Term Outcomes

The majority of patients have experienced an improved quality of life after total elbow replacement surgery. They experience less pain, improved motion and strength, and better function.

You should expect to do all basic activities of daily living, such as getting a plate out of a cabinet, cooking dinner, lifting a milk jug, styling your hair, basic hygiene, and dressing. Talk to your doctor about activities you may want to avoid, such as contact sports and activities with a major risk of falling (such as horseback riding or climbing ladders), as well as heavy lifting. These things increase the risk of the metal parts loosening or breaking, or the bone breaking.

When traveling on airplanes, be prepared for extra security screening. There is a chance that your metal implant will set off the metal detector during the security check-in.

To make the check-in go more smoothly, tell the security officer beforehand that you have an elbow replacement and carry a medical identification card. Although this does not change the screening requirements, it will help the security officer confirm the nature of the alarm. Be prepared for the security officer to use a wand scanner, and perhaps examine your arm in a private area in order to see the scar. The new body scanners can identify joint replacements, making further individual screening unnecessary.

 

If you are experiencing pain from an elbow injury or chronic condition schedule an appointment with an Orthopedic Specialist at TOCA by calling 602-277-6211!

 

#Recovery #Results #Relief #MyOrthoDoc #ElbowSurgery #ElbowPain #TOCA #TOCAMD

Congratulations Dr. Christopher Huston!

Congratulations Dr. Christopher Huston! Dr. Huston was recently named Top Doctor in the Physical Medicine & Rehabilitation category by Castle Connolly Medical Ltd. for 2017!

Dr. Huston is an expert in Interventional Spine, Neck & Back issues, Spine complications & Electrodiagnostics at TOCA.

Dr. Christopher W. Huston is fellowship-trained in the diagnosis, rehabilitation and utilization of interventional spine procedures for the treatment of painful spine disorders. He reviews for various medical journals, which has included the Archives of Physical Medicine and RehabilitationJournal of Physical Medicine, and Current Reviews in Musculoskeletal Medicine.

Dr. Huston has served on several award, planning, and spine committees for the Physiatric Association of Spine, Sports & Occupational Rehabilitation. Additionally, he served as assistant chief of physical medicine and rehabilitation at the Walter Reed Army Medical Center for the U.S. Army in Washington, D.C.

He has published various scientific abstracts, manuscripts, articles, and book chapters for various physical medicine, rehabilitation and spine disorder publications regarding spine disorders and interventions. Dr. Huston is regularly asked to present on those topics across North America. He is the TOCA Interventional Spine Fellowship Director. Physicians from across the country apply for the TOCA Interventional Spine Fellowship to work with Dr. Huston.

Castle Connel Medical LTD

Since 1991 Castle Connolly Medical Ltd. has been dedicated to helping consumers find the best healthcare in America. Along with the “Top Doctor” book series we publish, including our most popular volume to-date, America’s Top Doctors®, our website enables visitors to easily search for doctors by specialty, location or name. We also offer a “Top Hospital” search for patients in need of guidance on where to go for expert, local medical care.

The company was founded by two respected leaders in healthcare, John K. Castle and John J. Connolly, Ed.D. Dr. Connolly was the President of New York Medical College for more than ten years. Mr. Castle served for six years as a commissioner and executive officer of the Joint Commission (formerly JCAHO); he also served as Chairman of the Board of New York Medical College for eleven years and served on its Board for twenty-two years.

How Castle Connolly Identifies Top Doctors

At Castle Connolly Medical Ltd. we identify top doctors, both nationally and regionally, based on an extensive nominations process open to ALL licensed physicians in America. The Castle Connolly physician-led research team reviews and screens all nominated physicians before selecting those regarded as the most outstanding healthcare providers to be Top Doctors. Physicians do not and cannot pay to be selected as a Castle Connolly Top Doctor.

To read more about Dr. Huston visit: www.tocamd.com

For more information about Castle Connolly Medical please visit: https://www.castleconnolly.com

 

#Recovery #Results #Relief #MyOrthoDoc #TOCA #TOCAMD #TopDoc

Sciatica

If you suddenly start feeling pain in your lower back or hip that radiates to the back of your thigh and into your leg, you may have a protruding (herniated) disk in your spinal column that is pressing on the nerve roots in the lumbar spine. This condition is known as sciatica.

What is sciatica?

Sciatica (pronounced sigh-at-eh-kah)  is pain in the lower extremity resulting from irritation of the sciatic nerve. The pain of sciatica is typically felt from the low back (lumbar area) to behind the thigh and can radiate down below the knee. The sciatic nerve is the largest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb. The pain of sciatica is sometimes referred to as sciatic nerve pain.

Symptoms

Sciatica may feel like a bad leg cramp, with pain that is sharp (“knife-like”), or electrical. The cramp can last for weeks before it goes away. You may have pain, especially when you move, sneeze, or cough. You may also have weakness, “pins and needles” numbness, or a burning or tingling sensation down your leg.

Sciatic pain can vary from infrequent and irritating to constant and incapacitating. Symptoms are usually based on the location of the pinched nerve.

Causes

Sciatica rarely occurs before age 20, and becomes more commonplace in middle age. It is most likely to develop around age 30 and 50.

Perhaps because the term sciatica is often used loosely to describe leg pain, estimates of its prevalence vary widely. Some researchers have estimated it will affect up to 43% of the population at some point.

Often, a particular event or injury does not cause sciatica—rather it tends to develop over time.

The vast majority of people who experience sciatica get better within a few weeks or months and find pain relief with nonsurgical sciatica treatment. For others, however, the leg pain from a pinched nerve can be severe and debilitating.

Seeing a doctor for sciatica pain is advised, both for learning how to reduce the pain and to check for the possibility of a serious medical issue.

While sciatica is most commonly a result of a lumbar disc herniation directly pressing on the nerve, any cause of irritation or inflammation of the sciatic nerve can produce the symptoms of sciatica. This irritation of nerves as a result of an abnormal intervertebral disc is referred to as radiculopathy. Approximately 1 in every 50 people will experience a herniated disk at some point in their life. Of these, 10% to 25% have symptoms that last more than 6 weeks. In rare cases, a herniated disk may press on nerves that cause you to lose control of your bladder or bowel, referred to as cauda equina syndrome. If this happens, you may also have numbness or tingling in your groin or genital area. This is an emergency situation that requires surgery. Phone your doctor immediately. Aside from a pinched nerve from a disc, other causes of sciatica include irritation of the nerve from adjacent bone, tumors, muscle, internal bleeding, infections in or around the lumbar spine, injury, and other causes. Sometimes sciatica can occur because of irritation of the sciatic nerve during pregnancy.

6 Most Common Causes of Sciatica

When discussing sciatica, it is important to understand the underlying medical cause, as effective treatment will focus on addressing the pain’s root cause as well as alleviating acute symptoms.

  • Lumbar herniated disc
    A herniated disc occurs when the soft inner material of the disc leaks out, or herniates, through the fibrous outer core and irritates or pinches the contiguous nerve root.

Other terms used to refer to a herniated disc are slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve. Sciatica is the most common symptom of a lumbar herniated disc.

  • Degenerative disc disease
    While some level of disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica.

Degenerative disc disease is diagnosed when a weakened disc results in excessive micro-motion at that spinal level, and inflammatory proteins from inside the disc become exposed and irritate the nerve root(s) in the area.

Bone spurs, which may develop with spinal degeneration, also may press against a nerve, resulting in sciatica.

  • Isthmic spondylolisthesis
    This condition occurs when a small stress fracture allows one vertebral body to slip forward on another; for example, if the L5 vertebra slips forward over the S1 vertebra.

With a combination of disc space collapse, the fracture, and the vertebral body

  • Lumbar spinal stenosis
    This condition commonly causes sciatica due to a narrowing of the spinal canal. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults older than age 60.

The condition typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots, causing sciatica pain.

Lumbar spinal stenosis commonly occurs along with spinal arthritis, and arthritis can also cause or contribute to sciatica symptoms.

  • Piriformis syndrome
    The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttock. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain.

This is not a true lumbar radiculopathy, which is the clinical definition of sciatica. However, because the leg pain can feel the same as sciatica or radiculopathy, it is sometimes referred to as sciatica.

  • Sacroiliac joint dysfunction
    Irritation of the sacroiliac joint—located at the bottom of the spine—can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain.

Again, this is not a true radiculopathy, but the leg pain can feel the same as sciatica caused by a nerve irritation.

What are risk factors for sciatica? What are sciatica symptoms?

Risk factors for sciatica include degenerative arthritis of the lumbar spine, lumbar disc disease, and slipped disc, and trauma or injury to the lumbar spine.

Sciatica causes pain, a burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. The result is lumbar painbuttock painhip pain, and leg pain. Sometimes the pain radiates around the hip or buttock to feel like hip pain. While sciatica is often associated with lower back pain (lumbago), it can be present without low back pain. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down. The pain relief by changing positions can be partial or complete.

When Sciatica Is Serious

Certain sciatica symptoms, while rare, require immediate medical, and possibly surgical, intervention. These include, but are not limited to, progressive neurological symptoms (e.g. leg weakness) and/or bowel or bladder dysfunction (cauda equina syndrome). Infection or spinal tumors can also cause sciatica.

Because sciatica is caused by an underlying medical condition, treatment is focused on addressing the cause of symptoms rather than just the symptoms. Treatment is usually self-care and/or nonsurgical, but for severe or intractable pain and dysfunction it may be advisable to consider surgery.

How do health-care professionals diagnose sciatica?

Diagnosis begins with a complete patient history. Your doctor will ask you to explain how your pain started, where it travels, and exactly what it feels like.

A physical examination may help pinpoint the irritated nerve root. Your doctor may ask you to squat and rise, walk on your heels and toes, or perform a straight-leg raising test or other tests.

X-rays and other specialized imaging tools, such as a magnetic resonance imaging (MRI) scan, may confirm your doctor’s diagnosis of which nerve roots are affected.

Nonsurgical Treatment

The condition usually heals itself, given sufficient time and rest. Approximately 80% to 90% of patients with sciatica get better over time without surgery, typically within several weeks.

Nonsurgical treatment is aimed at helping you manage your pain without long-term use of medications. Nonsteroidal anti-inflammatory drugs such as ibuprofen, aspirin, or muscle relaxants may also help. In addition, you may find it soothing to put gentle heat or cold on your painful muscles. It is important that you continue to move. Do not remain in bed, as too much rest may cause other parts of the body to feel discomfort.

Find positions that are comfortable, but be as active as possible. Motion helps to reduce inflammation. Most of the time, your condition will get better within a few weeks.

Sometimes, your doctor may inject your spinal area with a cortisone-like drug.

As soon as possible, start stretching exercises so you can resume your physical activities without sciatica pain. Your doctor may want you to take short walks and may prescribe physical therapy.

Surgical Treatment

You might need surgery if you still have disabling leg pain after 3 months or more of nonsurgical treatment. A part of your surgery, your herniated disk may be removed to stop it from pressing on your nerve.

 

The surgery (laminotomy with discectomy) may be done under local, spinal, or general anesthesia. This surgery is usually very successful at relieving pain, particularly if most of the pain is in your leg.

Rehabilitation

Your doctor may give you exercises to strengthen your back. It is important to walk and move while limiting too much bending or twisting. It is acceptable to perform routine activities around the house, such as cooking and cleaning.

Following treatment for sciatica, you will probably be able to resume your normal lifestyle and keep your pain under control. However, it is always possible for your disk to rupture again.

Physical Therapy and Exercise for Sciatica

Physical therapy exercises incorporating a combination of strengthening, stretching, and aerobic conditioning are a central component of almost any sciatica treatment plan.

When patients engage in a regular program of gentle exercises, they can recover more quickly from sciatica pain and are less likely to have future episodes of pain.

Sciatica exercises usually focus on three key areas: strengthening, stretching, and aerobic conditioning.

  • Strengthening exercises
    Many exercises can help strengthen the spinal column and the supporting muscles, ligaments, and tendons. Most of these back exercises focus not only on the lower back, but also the abdominal (stomach) muscles and gluteus (buttock) and hip muscles.

Strong core muscles can provide pain relief because they support the spine, keeping it in alignment and facilitating movements that extend or twist the spine with less chance of injury or damage.

  • Stretching exercises
    Stretching is usually recommended to alleviate sciatic pain. Stretches for sciatica are designed to target muscles that cause pain when they are tight and inflexible.

Hamstring stretching is almost always an important part of a sciatica exercise program. Most people do not stretch these muscles, which extend from the pelvis to the knee in the back of the thigh, in their daily activities.

Another stretch that is often helpful in easing sciatica is the Bird Dog move: After getting on their hands and knees, individuals extend one arm and the opposite leg. The arm and leg extensions are then alternated. A more advanced version of this exercise is the Plank Bird Dog move, in which the extensions are done once the person is in the plank position on their hands and toes.

  • Low-impact aerobic exercise
    Some form of low-impact cardiovascular exercise, such as walking, swimming, or pool therapy is usually a component of recovery, as aerobic activity encourages the exchange of fluids and nutrients to help create a better healing environment.

Aerobic conditioning also has the unique benefit of releasing endorphins, the body’s natural pain killers, which helps reduce sciatic pain.

These types of exercise may be done separately or in combination. Examples of types of exercise that may include both strengthening and stretching include yogatai chi, and Pilates.

For anyone in chronic pain or with a relatively high level of sciatica pain, one option for gentle exercise is water therapy, which is a controlled, progressive exercise program done in a warm pool.

When sciatica pain is at its most severe, patients may find the pain hard to bear and may need to rest for a day or two. However, resting for more than one or two days is generally not advised, as prolonged rest or inactivity can increase pain and will lead to deconditioning. Regular movement is important to provide healing nutrients to the injured structures that are causing the pain.

If you are experiencing back or neck pain the experts at TOCA are here to help! Call our dedicated team to schedule your consultation today at: 602-277-6211!

#Recovery #Results #Relief #MyOrthoDoc #TOCA #TOCAMD #backpain

What is Spinal Stenosis & How do I treat it?

What Is Spinal Stenosis?

Spinal stenosis is a condition, mostly in adults 50 and older, in which your spinal canal starts to narrow. This can cause pain and other problems.

Your spine is made up of a series of connected bones (or “vertebrae”) and shock-absorbing discs. It protects your spinal cord, a key part of the central nervous system that connects the brain to the body. The cord rests in the canal formed by your vertebrae.

For most people, the stenosis results from changes because of arthritis. The spinal canal may narrow. The open spaces between the vertebrae may start to get smaller. The tightness can pinch the spinal cord or the nerves around it, causing pain, tingling, or numbness in your legs, arms, or torso.

There’s no cure, but there are a variety of nonsurgical treatments and exercises to keep the pain at bay. Most people with spinal stenosis live normal lives.

 

Healthy Spine

The spinal canal has a rounded triangular shape that holds the nerve roots without pinching. Nerve roots leave the spinal canal through openings called nerve root canals which are also free of obstruction.

Affected Spine

New bone growth within the spinal canal causes compression of nerve roots, which leads to the pain of spinal stenosis.

 

Causes

The leading reason for spinal stenosis is arthritis, a condition caused by the breakdown of cartilage — the cushiony material between your bones — and the growth of bone tissue.

Osteoarthritis can lead to disc changes, a thickening of the ligaments of the spine, and bone spurs. This can put pressure on your spinal cord and spinal nerves.

Other causes include:

  • Herniated discs. If the cushions are cracked, material can seep out and press on your spinal cord or nerves.
  • Injuries. An accident may fracture or inflame part of your spine.
  • Tumors. If cancerous growths touch the spinal cord, you may get stenosis.
  • Paget’s disease. With this condition, your bones grow abnormally large and brittle. The result is a narrowing of the spinal canal and nerve problems.
  • Overgrowth of bone. Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget’s disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
  • Thickened Ligaments. The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.

Some people are born with spinal stenosis or diseases that lead to it. For them, the condition usually starts to cause problems between the ages of 30 and 50.

Symptoms

Spinal stenosis usually affects your neck or lower back. Not everyone has symptoms, but if you do, they tend to be the same: stiffness, numbness, and back pain.

When symptoms do occur, they often start gradually and worsen over time. Symptoms vary, depending on the location of the stenosis:

  • In the neck (cervical spine).Cervical stenosis can cause numbness, weakness or tingling in a leg, foot, arm or hand. Tingling in the hand is the most common symptom, and many people also report problems with walking and balance. Nerves to the bladder or bowel may be affected, leading to incontinence.
  • In the lower back (lumbar spine).Compressed nerves in your lumbar spine can cause pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases when you bend forward or sit down.

 

More specific symptoms include:

  • Sciatica. These shooting pains down your leg start as an ache in the lower back or buttocks.
  • Foot drop. Painful leg weakness may cause you to “slap” your foot on the ground.
  • A hard time standing or walking. When you’re upright, it tends to compress the vertebrae, causing pain.
  • Loss of bladder or bowel control. In extreme cases, it weakens the nerves to the bladder or bowel.

If you’re having symptoms, you might want to talk them over with your doctor. If you’re having a loss of bladder or bowel control, call your doctor at once.

Diagnosis and Tests

When you visit your doctor, she’s likely to ask you questions about your medical history. After that, she might order at least one of the following tests to figure out whether you have the condition:

  • X-rays. These can show how the shape of your vertebrae has changed.
  • Magnetic resonance imaging (MRI). By using radio waves, an MRI creates a 3-D image of your spine. It can show tumors, growths, and even damage to discs and ligaments.
  • Computerized tomography (CT scan). A CT scan uses X-rays to create a 3-D image. With the help of a dye injected into your body, it can show damage to soft tissue as well as issues with your bones.

Treatment

Your doctor may start off with nonsurgical treatments. These might include:

Medication: Common pain remedies such as aspirinacetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen can offer short-term relief. All are available in low doses without a prescription. Other medications, including muscle relaxants and anti-seizure medications, treat aspects of spinal stenosis, such as muscle spasms and damaged nerves.

Corticosteroid injections: Your doctor will inject a steroid such as prednisone into your back or neck. Steroids make inflammation go down. However, because of side effects, they are used sparingly.

Anesthetics: Used with precision, an injection of a “nerve block” can stop pain for a time.

Exercise: You can improve your flexibility, strength, and balance with regular activity. Your doctor may recommend a physical therapist to help you.

Assistive devices: You might get braces, a corset, or a walker to help you move about.

Surgery

Some people have severe cases. They struggle to walk or have issues with their bladder and bowel. Doctors may recommend surgery for these people. Procedures such as laminectomy and laminoplasty create space between the bones so inflammation can go down.

Surgery carries its own risks. You should have a talk with your doctor about how much it can help, recovery time, and more before taking that step.

Many patients also try nontraditional therapies, including chiropractic and acupuncture. Again, be sure your doctor knows if you’re trying a nontraditional approach.

What You Can Do at Home

Some things you can do to help ease symptoms of spinal stenosis include:

  • Exercise. Think about moderation — not 100 push-ups. Just take a 30-minute walk every other day. Talk over any new exercise plan with your doctor.
  • Apply heat and cold. Heat loosens up your muscles. Cold helps heal inflammation. Use one or the other on your neck or lower back. Hot showers are also good.
  • Practice good posture. Stand up straight, sit on a supportive chair, and sleep on a firm mattress. And when you lift heavy objects, bend from your knees, not your back.
  • Lose weight. When you are heavier, there will be more pressure on your back.

 

If you are experiencing back or neck pain the experts at TOCA are here to help! Call our dedicated team to schedule your consultation today at: 602-277-6211!

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What Is Scoliosis, Causes and Treatment Options

What Is Scoliosis, Causes and Treatment Options: Scoliosis (pronounced sko-lee-o-sis) is a three-dimensional abnormality that occurs when the spine becomes rotated and curved sideways.

If you look at someone’s back, you’ll see that the spine runs straight down the middle. When a person has scoliosis, their backbone curves to the side.

Image result for scoliosisThe angle of the curve may be small, large or somewhere in between. But anything that measures more than 10 degrees is considered scoliosis. Doctors may use the letters “C” and “S” to describe the curve of the backbone.

You probably don’t look directly at too many spines, but what you might notice about someone with scoliosis is the way they stand. They may lean a little or have shoulders or hips that look uneven.

What Causes Scoliosis?

In most cases, doctors don’t find the exact reason for a curved spine. Scoliosis without a known cause is what doctors call “idiopathic.”

Some kinds of scoliosis do have clear causes. Doctors divide those curves into three types:

  • Infantile idiopathic scoliosis: develops from birth to 3 years old
  • Juvenile idiopathic scoliosis: develops from 4 to 9 years old
  • Adolescent idiopathic scoliosis: develops from 10 to 18 years old

Adolescent scoliosis comprises approximately 80% of all idiopathic scoliosis cases. Adolescence is when rapid growth typically occurs, which is why the detection of a curve at this stage should be monitored closely for progression as the child’s skeleton develops.

Common Types of Curves

Image result for Common Types of scoliosis CurvesA scoliosis curve usually looks a bit like a backward C shape and involves the spine bending sideways to the right, which is also called dextroscoliosis. Sideways spinal curvature on the left side of the back is more like a regular C shape and called levoscoliosis. Here are four common types of scoliosis curves:

  • Right thoracic curve. If a straight line were drawn down the center of the back, this curve bends to the right side of the upper back (thoracic region).

See Thoracic Spine Anatomy and Upper Back Pain

  • Right thoracolumbar curve. This curve bends to the right side—starting in the upper back (thoracic) and ending in the lower back (lumbar).

See Lumbar Spine Anatomy and Pain

  • Right lumbar curve. This curve bends to the right side—starting and ending in the lower back.
  • Double major curve. Typically, a double curve involves right thoracic curve on top and left lumbar curve on bottom. People who have a double major curve may initially have a less obvious deformity because the two curves balance each other out more.

When Idiopathic Scoliosis Needs Treatment

Treatment options for idiopathic scoliosis could include:

  • Observation. Typically, a doctor will advise observation for a scoliosis curve that has not yet reached 25 degrees. Every 4 to 6 months, the doctor will take another X-ray of the spine to see if the scoliosis is progressing or not.
  • Bracing. If the scoliosis has progressed past 20 or 25 degrees, a back brace could be prescribed to be worn until the adolescent has reached full skeletal maturity. The goal of bracing is to prevent the curve from getting worse and to avoid surgery.

See Bracing Treatment for Idiopathic Scoliosis

  • Surgery. If the curve continues to progress despite bracing, surgery could be considered. The most common surgical option for scoliosis today is a posterior spinal fusion, which can offer better corrections with fewer fusion levels (preserving more back mobility) than what was done in years past.

In nonstructural scoliosis, the spine works normally, but looks curved. Why does this happen? There are a number of reasons, such as one leg’s being longer than the other, muscle spasms, and inflammations like appendicitis. When these problems are treated, this type of scoliosis often goes away.

In structural scoliosis, the curve of the spine is rigid and can’t be reversed.

Causes include:

Congenital scoliosis begins as a baby’s back develops before birth. Problems with the tiny bones in the back, called vertebrae can cause the spine to curve. The vertebrae may be incomplete or fail to divide properly. Doctors may detect this condition when the child is born. Or, they may not find it until the teen years.

Family history and genetics can also be risk factors for idiopathic scoliosis. If you or one of your children has this condition, make sure your other kids are screened regularly.

Scoliosis shows up most often during growth spurts, usually when kids are between 10 and 15 years old. About the same number of boys and girls are diagnosed with minor idiopathic scoliosis. But curves in girls are 10 times more likely to get worse and may need to be treated.

Scoliosis diagnosed during the teen years can continue into adulthood. The greater the angle of the spine curve, the more likely it is to increase over time. If you had scoliosis in the past, have your doctor check your back regularly.

Degenerative scoliosis affects adults. It usually develops in the lower back as the disks and joints of the spine begin to wear out as you age.

A mild scoliosis curve can go unnoticed to the untrained eye. However, if the curve progresses, various signs and symptoms can become obvious.

Common Early Signs of Scoliosis

Oftentimes scoliosis is first suspected when someone notices something slightly off and comments. Some examples could include:

  • Clothes fit awkwardly or hang unevenly. A parent, friend, or even the person with scoliosis might notice that a shirt or blouse appears uneven, which could be cause for further investigation.
  • Sideways curvature observed while in bathing suit or changing. For instance, a parent could first notice the sideways curvature in an adolescent’s back while at the pool or beach.

Even if a newly discovered asymmetry appears minor, it should be checked by a doctor because scoliosis is easier to treat when caught early.

Symptoms of Moderate or Severe Scoliosis

Only about 10% of people with idiopathic scoliosis have a curve that progresses beyond mild and needs treatment.3 If that progression happens, the deformity becomes more obvious to other people and more likely to cause noticeable symptoms.

Some of the more common symptoms present in moderate or severe scoliosis could include:

  • Changes with walking. When the spine abnormally twists and bends sideways enough, it can cause the hips to be out of alignment, which changes a person’s gait or how they walk. The extra compensating that a person does to maintain balance for the uneven hips and legs can cause the muscles to tire sooner. A person might also notice that one hand brushes against a hip while walking but the other does not.
  • Reduced range of motion. The deformity from spinal twisting can increase rigidity, which reduces the spine’s flexibility for bending.
  • Trouble breathing. If the spine rotates enough, the rib cage can twist and tighten the space available for the lungs. Bone might push against the lungs and make breathing more difficult.
  • Cardiovascular problems. Similarly, if the rib cage twists enough, reduced spacing for the heart can hamper its ability to pump blood.
  • Pain. If curvature becomes severe enough, back muscles could become more prone to painful spasms. Local inflammation may develop around the strained muscles, which can also lead to pain. It is possible for the intervertebral discs and facet joints to start to degenerate due to higher loads.
  • Lower self-esteem. This symptom is commonly overlooked or minimized by outside observers, but it can be a significant factor for people who have a noticeable spinal deformity. Especially for adolescents who want to fit in with their friends, it can be stressful and depressing to look different, have clothes fit unevenly, or wear a noticeable back brace that may be uncomfortable or limit activity.

Can It Be Prevented?

No. So forget the rumors you may have heard, such as, “Childhood sports injuries can cause scoliosis.” Not true.

Likewise, if your kids are in school, you may be concerned about the weight of the textbooks they carry. While heavy backpacks may cause back, shoulder, and neck pain, they don’t lead to scoliosis.

And what about poor posture? The way a person stands or sits doesn’t affect their chances for scoliosis. But a curved spine may cause a noticeable lean. If your child isn’t able to stand upright, ask your doctor to look at her spine.

Adam’s Forward Bend Test

Image result for Adam’s Forward Bend Test

involves a healthcare professional observing the patient bending forward at the waist 90 degrees with arms stretched toward the floor and knees straight. From this position, most scoliosis signs that present as asymmetry are clearly visible in the spine and/or trunk of the body, such as:

The first step toward getting an idiopathic scoliosis diagnosis is typically the Adam’s forward bend test, which primarily looks for abnormal spine rotation.

 

 

This test

 

  • One shoulder or shoulder blade is higher than the other
  • Rib cage appears higher on one side (also called a rib hump)
  • One hip appears higher or more prominent than the other
  • The waist appears uneven
  • The body tilts to one side
  • One leg may appear shorter than the other

The Adam’s forward bend test can be useful in detecting scoliosis located in the upper or mid back, which is where idiopathic scoliosis usually occurs. However, the forward bend test is not as effective at detecting scoliosis in the low back because it does not involve rib rotation.

Scoliometer to Measure Spine Rotation

As part of the forward bend test, the clinician might use a scoliometer, also called an inclinometer, to estimate the angle of trunk rotation (ATR). While the patient is still bending forward, the clinician can put the scoliometer flat on the back in the area or areas where the asymmetry looks the greatest.

As a general rule, if an ATR of at least 5 degrees is recorded, the patient will either be scheduled for a follow-up exam or referred to a doctor who can image the back for more accurate scoliosis testing.7,8 X-ray imaging is needed to measure the degree of the curve and confirm scoliosis.

Cobb Angle Measurement

The lateral curve of scoliosis is described by the Cobb angle. Using an X-ray of the full spine, the Cobb angle is found by drawing a perpendicular line from the spine’s most-tilted vertebra above the sideways curve’s apex and a second perpendicular line from the most-tilted vertebra beneath the apex. The angle formed where those two lines meet is the Cobb angle.

A Cobb angle of at least 10 degrees is typically considered the borderline for a scoliosis diagnosis.

Key Components of a Scoliosis Diagnosis

When diagnosing idiopathic scoliosis, there are 3 key components to take into consideration:

  • Lateral curvature. The lateral (sideways) curvature of the spine is measured by the Cobb angle. The bigger the Cobb angle, the greater the spinal deformity.
  • Axial rotation. In addition to the sideways curvature, the spine abnormally rotates along the vertical axis. Spinal rotation can affect rib rotation, as well as curve rigidity.
  • Skeletal maturity. Often estimated by the Risser sign (amount of calcification at the hip bone’s ridged top as seen on the same X-ray as the Cobb angle), the amount of skeletal maturity remaining is critical to making scoliosis treatment decisions in children and teens.

Understanding these components of a scoliosis diagnosis can help the medical team evaluate the severity of the curve, likelihood for progression, and which treatment options could be best.

Idiopathic Scoliosis Is a Diagnosis of Exclusion

Idiopathic means a condition is of unknown cause. As such, idiopathic scoliosis technically cannot be diagnosed until other types of scoliosis are ruled out. Other types of scoliosis could include:

  • Congenital scoliosis. This type of scoliosis is present from birth and is the result of the spine not forming properly.
  • Neuromuscular scoliosis. Many types of neuromuscular conditions can lead to muscle problems in the back that result in scoliosis. A few examples include cerebral palsy and myelodysplasia.
  • Degenerative scoliosis. Also called adult onset scoliosis, this type of scoliosis results from the deterioration of the facet joints in the spine.
  • Nonstructural scoliosis. This type of scoliosis, also known as functional scoliosis, occurs due to a temporary cause that only affects lateral curvature without spinal rotation. For example, a difference in leg heights could potentially cause a sideways curve in the spine that is corrected with a shoe insert.

If scoliosis starts to cause a noticeable deformity or is at high risk of doing so, a doctor might prescribe a brace to prevent the curve from getting any worse. Typically, a brace is worn until the adolescent has reached full skeletal maturity.

Knowing if a person’s scoliosis curve is likely to worsen is crucial to developing a treatment plan. Bracing is a major time commitment and uncomfortable for adolescents—both physically and emotionally—and is usually not prescribed unless the curve is at significant risk for progressing.

Brace Options

There are two general treatment options for scoliosis bracing:

  • Full-time bracing. These braces are designed to be worn 16 to 23 hours a day. The goal is to wear them all the time with exceptions for bathing, skin care, and exercising.
  • Nighttime bracing. These braces use hyper-corrective forces (which put the body out of normal balance and cannot realistically be applied while a person is standing and/or performing daily activities) and are to be worn at least 8 hours a night.

Choosing between full-time bracing and nighttime bracing can depend on size and location of curves, as well as what the patient is willing to do. Some studies have found that nighttime bracing tends to be more effective because patients are more likely to wear a brace at night as prescribed, but other studies have found that full-time bracing—when adhered to as directed—could work even better.

Other Nonsurgical Treatments Unproven

While some people claim that treatments such as physical therapy and manual manipulation can help stop the progression of scoliosis, there is little scientific evidence to support these claims. Bracing is currently the only nonsurgical treatment that has been proven to reduce the natural progression of idiopathic scoliosis curves.

However, if given the okay by a doctor, exercise is healthy for people with scoliosis and helps keep the back strong and flexible.

When Bracing Fails

Sometimes an idiopathic scoliosis curve continues to progress despite bracing. If this happens and the curve progresses past 40 or 50 degrees, surgery may be considered.

3 Goals of Scoliosis Surgery

Scoliosis surgery typically has the following goals:

  1. Stop the curve’s progression. When scoliosis requires surgery, it is usually because the deformity is continuing to worsen. Therefore, scoliosis surgery should at the very least prevent the curve from getting any worse.
  2. Reduce the deformity. Depending on how much flexibility is still in the spine, scoliosis surgery can often de-rotate the abnormal spinal twisting in addition to correcting the lateral curve by about 50% to 70%. These changes can help the person stand up straighter and reduce the rib hump in the back.
  3. Maintain trunk balance. For any changes made to the spine’s positioning, the surgeon will also take into account overall trunk balance by trying to maintain as much of the spine’s natural front/back (lordosis/kyphosis) curvature while also keeping the hips and legs as even as possible.

In addition, any adjustment of the spine must also consider the possible effect on the spinal cord. The health of the spinal cord must be monitored throughout the surgery.

Surgical Options for Idiopathic Scoliosis

There are 3 general categories of scoliosis surgery:

  • Fusion. This spinal surgery permanently fuses two or more adjacent vertebrae so that they grow together at the spinal joint and form a solid bone that no longer moves. Modern surgical approaches and instrumentation—rods, screws, hooks, and/or wires placed in the spine—have enabled spinal fusion surgeries to achieve better curvature correction and faster recovery times than in the past.

An advantage to spinal fusion surgery is that it has a long-term record of safety and efficacy for treating scoliosis. While a drawback to the procedure is that any fused vertebrae will lose mobility, which can limit some of the back’s bending and twisting, today’s spinal fusions tend to fuse fewer vertebrae and maintain more mobility than in the past.

  • Growing systems (to delay fusion). Rods are anchored to the spine to help correct/maintain the spine’s curvature while the child grows. Every 6 to 12 months, the child has another surgery to lengthen the rods to keep up with the spine’s growth. Once the patient is close enough to skeletal maturity, the patient will usually get a spinal fusion.

If a spinal fusion is done at too young of an age (typically younger than age 10 in girls or less than 12 in boys), that could leave less room for the lungs to develop in addition to the child having an unusually short trunk compared to the limbs. To avoid these complications, the growing systems method helps guide the spine as it grows, preventing the curve from worsening as the spine matures and eventually becomes ready for a fusion if needed.

  • Fusionless. Current fusionless surgery methods employ growth modulation on the spine similar to what has been done in the past to treat unequal leg heights in growing children. The theory is that by putting constant pressure on a bone, it will grow slower and denser. By applying such pressure on the outer side of a spinal curve, the surgeon aims to slow or stop the growth of the curve’s outer side while the curve’s inner side continues to grow normally. As the spine continues to grow in this manner, the lateral curvature should reduce as the spine becomes straighter.

One fusionless method uses a vertebral tethering system, which involves placing screws on the outer side of the curve and then pulling them taut with a cord so the spine straightens. Compared to spinal fusion, fusionless surgery has the potential benefit of retaining more spinal mobility. However, this is a newer approach and long-term data about the risks and benefits are not yet available.

For an adolescent or young adult opting for scoliosis surgery today, by far the most commonly performed surgery is a spinal fusion.

 

If you or a family member are experiencing symptoms or discomfort from Scoliosis or suspect scoliosis, the experts in Spine Care,  Interventional Spine and Back, Orthopedics and Physical Therapy here at TOCA are here to help! For questions or to schedule an appointment call us today at: 602-277-6211!

 

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Where Back and Neck Pain Begin

Where Back and Neck Pain Begin: Upper back and neck pain can stop you in your tracks, making it difficult to go about your typical day. The reasons behind this discomfort vary, but they all come down to how we hold ourselves while standing, moving, and — most important of all — sitting.

What is low back pain?

Low back pain can range from mild, dull, annoying pain, to persistent, severe, disabling pain in the lower back. Pain in the lower back can restrict mobility and interfere with normal functioning and quality of life.

What is neck pain?

Neck pain is pain that occurs in the area of the cervical vertebrae in the neck. Because of its location and range of motion, the neck is often left unprotected and subject to injury.

Pain in the back or neck area can be acute, which comes on suddenly and intensely, or chronic, which can last for weeks, months, or even years. The pain can be continuous or intermittent.

Common Causes of Back Pain and Neck Pain

Fortunately, most episodes of back pain will heal with time: approximately 50% of patients will feel relief from low back pain within two weeks, and approximately 90% within three months, regardless of the treatment.

The majority of episodes of acute back pain are due to a muscular strain and these will usually resolve with time because muscles have a good blood supply to bring the necessary nutrients and proteins for healing to take place.

Even with today’s technology, the exact cause of back and neck pain can be found in few cases. In most cases, back and neck pain may be a symptom of many different causes, including any of the following:

  • Overuse, strenuous activity, or improper use such as repetitive or heavy lifting
  • Trauma, injury, or fractures
  • Degeneration of vertebrae, often caused by stresses on the muscles and ligaments that support the spine, or the effects of aging
  • Infection
  • Abnormal growth such as a tumor or bone spur
  • Obesity due to increased weight on the spine and pressure on the discs
  • Poor muscle tone
  • Muscle tension or spasm
  • Sprain or strain
  • Ligament or muscle tears
  • Joint problems, such as arthritis
  • Smoking
  • Protruding or herniated (slipped) disk and pinched nerve
  • Osteoporosis and compression fractures
  • Congenital (present at birth) abnormalities of the vertebrae and bones
  • Abdominal problems, such as an aortic aneurysm

Back Pain Caused by Lumbar Spine Problems

For patients with low back pain that lasts longer than three months, or patients with predominantly leg pain, a more specific and definable problem for the pain should be sought. There are several very common causes of low back pain and leg pain:

In younger adults (20-60 year olds) the disc is likely to be the pain generator and conditions may include:

In older adults (over 60 years old), the source of back pain or leg pain is more likely to be the facet joints or osteoarthritis, and back conditions may include:

In addition to the above, there are several miscellaneous causes of back pain.

Neck Pain from Cervical Spine Conditions

While neck pain is less prevalent than lower back pain, there are several cervical spine conditions that may cause neck pain, arm pain and other symptoms, including:

Additionally, there are several miscellaneous causes of upper extremity pain related to conditions of the cervical spine.

Understanding Back Pain

he back and spine are designed to provide a great deal of strength, protecting the highly sensitive spinal cord and nerve roots, yet flexible, providing for mobility in all directions.Image result for Understanding Back Pain

However, there are many different parts of the spine that can produce back pain, such as irritation to the large nerve roots that run down the legs and arms, irritation to small nerves inside the spine, strains to the large back muscles, as well as any injury to the disc, bones, joints or ligaments in the spine.

Acute back pain comes on suddenly and usually lasts from a few days to a few weeks. Chronic back pain is typically described as lasting for more than three months.

Back pain can take on a wide variety of characteristics:

  • The pain may be constant, intermittent, or only occur with certain positions or activities
  • The pain may remain in one spot or refer or radiate to other areas
  • It may be a dull ache, or a sharp or piercing or burning sensation
  • The problem may be in the neck or low back but may radiate into the leg or foot (sciatica), arm or hand.

Other than pain, back pain symptoms may include weakness, numbness or tingling.

Fortunately, most forms of back pain get better on their own: approximately 50% of patients will experience back pain relief within two weeks and 90% within three months.

If the pain lasts for more than a few days, is getting worse, does not respond to back pain remedies such as a short period of rest, using ice or heat, lower back pain exercises and over-the-counter pain relievers, then it is usually advisable to see a back doctor. There are two instances in which emergency medical care is needed:

  • Bowel and/or bladder dysfunction
  • Progressive weakness in the legs

Fortunately, these conditions are rare.

Conditions That Can Create Back Pain

By far the most common cause of lower back pain is a muscle strain or other soft tissue damage. While this condition is not serious, it can be severely painful. Typically, lower back pain from a muscle strain will get better within one to three weeks.

Treatment usually involves a short period of rest, activity restriction, use of hot packs and/or cold packs for local discomfort, and pain medication. Over the counter pain medication used to treat muscle strain may include acetaminophen (e.g. Tylenol), ibuprofen (Advil), Motrin, or naproxen (e.g. Aleve). Prescription pain medications may be recommended for severe back pain.

Different Causes of Back Pain

Typically, younger individuals (30 to 60 year olds) are more likely to experience back pain from the disc space itself (e.g. lumbar disc herniation or degenerative disc disease). Older adults (e.g. over 60) are more likely to suffer from pain related to joint degeneration (e.g. osteoarthritis, spinal stenosis).

In some instances, a patient may experience more noticeable leg pain as opposed to back pain as a result of certain conditions in the lower back, including:

  • Lumbar herniated disc. The inner core of the disc may lead out and irritate a nearby nerve root, causing sciatica (leg pain).
  • Lumbar spinal stenosis. The spinal canal narrows due to degeneration, which can put pressure on the nerve root and cause sciatica.
  • Degenerative disc disease. As the disc degenerates it can allow small amounts of motion in that segment of the spine and irritate a nerve root and cause sciatica.
  • Isthmic spondylolisthesis. A small stress fracture allows one vertebra to slip forward on another, usually at the bottom of the spine. This can pinch the nerve, causing lower back pain and leg pain.
  • Osteoarthritis. Degeneration of the small facet joints in the back of the spine can cause back pain and decreased flexibility. May also lead to spinal stenosis and nerve pinching.

It is important to know the underlying condition that is causing the low back pain, as treatments will often differ depending on the causes of back pain.

How can back and neck pain be prevented?

The following may help to prevent back and neck pain:

  • Practice correct lifting techniques
  • Use telephones and workplace computers and other equipment properly
  • Maintain correct posture while sitting, standing, and sleeping
  • Participate in regular exercise (with proper stretching before participation)
  • Avoid smoking
  • Maintain a healthy weight
  • Reduce emotional stress that may cause muscle tension

Symptoms and Diagnosis

The cause of back pain can usually be diagnosed with a detailed description of one’s symptoms. The description of back pain symptoms, along with one’s medical history (and possibly diagnostic testing), will usually lead to a diagnosis of a general cause (such as back strain), or a specific condition (such as a herniated disc).

Back Pain Symptoms from a Sprain or Strain

Back sprain or strain symptoms generally include:

  • Pain is usually localized in the low back (doesn’t radiate down the leg)
  • Pain often starts after lifting something heavy, lifting while twisting, or a sudden movement or fall
  • Pain may include muscle spasms, tenderness upon touch
  • Pain is less when resting and worse during certain activities.

Lower back pain from a muscle strain usually will get better within one to three days.

Chronic Back Pain Symptoms

Symptoms that are part of a diagnosable chronic condition can include:

  • Leg pain (sciatica) and possible numbness. Pain can radiate down the leg to the buttock and/or the foot, and can be worse with sitting or prolonged standing. This type of pain can be due to a lumbar herniated disc.
  • Pain with certain movement and positions (such as bending forward, running). The pain tends to fluctuate, with low level or no pain at times, and then flare up at other times. This chronic back pain can be caused by degenerative disc disease.
  • Lower back pain, often accompanied by leg pain, which worsens when standing or walking for long periods. This pain may be caused by a small stress fracture in the back of the spine called isthmic spondylolisthesis.
  • Lower back pain that is worse in the morning and in the evening, and stiffness (usually in older adults). This back pain may be caused by facet joint osteoarthritis(degenerative arthritis).
  • Pain that is felt down the legs when walking and standing upright and that feels worse with more walking and gets better after sitting down (usually in older adults). This pain may be caused by lumbar spinal stenosis and/or degenerative spondylolisthesis.

There are many more conditions can cause lower back pain, leg pain and other symptoms; the intention of this article is to highlight the most common ones.

There are a few symptoms that are possible indications of serious medical conditions, and patients with these symptoms should contact a doctor immediately:

  • Difficulty passing urine or having a bowel movement
  • Progressive weakness in the legs
  • Severe, continuous abdominal and lower back pain.

What Can Increase The Potential for Back Problems?

There are many risk factors for back pain, including aging, genetics, occupational hazards, lifestyle, weight, posture, pregnancy and smoking. With that said, back pain is so prevalent that it can strike even if you have no risk factors at all.

Specific Risk Factors for Back Pain

Patients with one or more of the following factors may be at risk for back pain:

Aging. Over time, wear and tear on the spine that may result in conditions (e.g., disc degeneration, spinal stenosis) that produce neck and back pain. This means that people over age 30 or 40 are more at risk for back pain than younger individuals. People age 30 to 60 are more likely to have disc-related disorders, while people over age 60 are more likely to have pain related to osteoarthritis.

Genetics. There is some evidence that certain types of spinal disorders have a genetic component. For example, degenerative disc disease seems to have an inherited component.

Occupational hazards. Any job that requires repetitive bending and lifting has a high incidence of back injury (e.g., construction worker, nurse). Jobs that require long hours of standing without a break (e.g., barber) or sitting in a chair (e.g., software developer) that does not support the back well also puts the person at greater risk.

Sedentary lifestyle. Lack of regular exercise increases risks for occurrence of lower back pain, and increases the likely severity of the pain.

Excess weight. Being overweight increases stress on the lower back, as well as other joints (e.g. knees) and is a risk factor for certain types of back pain symptoms.

Poor posture. Any type of prolonged poor posture will, over time, substantially increase the risk of developing back pain. Examples include slouching over a computer keyboard, driving hunched over the steering wheel, lifting improperly.

Pregnancy. Pregnant women are more likely to develop back pain due carrying excess body weight in the front, and the loosening of ligaments in the pelvic area as the body prepares for delivery.

Smoking. People who smoke are more likely to develop back pain than those who don’t smoke.

When To Call a Doctor

Image result for When To Call a DoctorThe bottom line that everyone should remember is that if one is in doubt, consult a doctor. If back pain is getting worse over time, does not feel better with rest and over the counter pain remedies, and/or involves neurological symptoms then it is advisable to be evaluated by a back pain doctor.

When to See a Back Pain Doctor

In general, if the pain has any of the following characteristics, it is a good idea to see a physician for an evaluation:

  • Back pain that follows an accident, such as a car accident or falling off a ladder
  • The back pain is ongoing and is getting worse
  • The pain continues for more than four to six weeks
  • The pain is severe and does not improve after a few days of typical remedies, such as rest, ice and common pain relievers (such as ibuprofen or Tylenol)
  • Severe pain at night that wakes you up, even from a deep sleep
  • There is back and abdominal pain
  • Numbness or altered feelings in the upper inner thighs, groin area, buttock or genital area
  • Neurological symptoms, such as weakness, numbness or tingling in the extremities – the leg, foot, arm or hand
  • Unexplained fever with increasing back pain
  • Sudden upper back pain, especially if you are at risk for osteoporosis.

Back Pain Symptoms That Require Urgent Medical Care

The following back pain symptoms may be indications of a serious medical condition and anyone with these should seek immediate medical care:

  • Difficulty passing urine or having a bowel movement
  • Progressive weakness in the legs
  • Severe, continuous abdominal and low back pain.

People should also seek prompt medical attention if other unexplained symptoms accompany their back pain, such as fever, history of cancer, recent unexplained weight loss, pain that is so bad it awakens them from sleep, or pain after a trauma.

Diagnostic Tests for Indicators of Back Pain

Diagnostic tests can indicate if a patient’s back pain is due to an anatomic cause. However, because diagnostic tests in and of themselves are not a diagnosis, arriving at an accurate clinical diagnosis requires any test to be to be correlated with the patient’s back pain symptoms and physical exam.

The most common diagnostic tests include:

  • X-ray. This test provides information on the bones in the spine. An x-ray is often used to check for spinal instability (such as spondylolisthesis), tumors and fractures.
  • CT scan. This test is a very detailed x-ray that includes cross section images. CT scans provide details about the bones in the spine. They may also be used to check for specific conditions, such as a herniated disc or spinal stenosis. CT scans tend to be less accurate for spinal disorders than MRI scans.
  • MRI scan. An MRI scan is particularly useful to assess certain conditions by providing detail of the intervertebral disc and nerve roots (which may be irritated or pinched). MRI scans are useful to rule out spinal infections or tumors.

Injections may also be used to help diagnose certain types of pain. If an injection of a pain relieving medication into a certain spot in the spine provides back pain relief, than it confirms that is the area causing pain.

 

If you are experiencing back or neck pain the team of physicians and staff members at TOCA (The Orthopedic Clinic Association) are here to help! For more information you can read more about our Neck & Spine Physicians and The Spine Center at TOCA for non-operative and operative procedures. For questions or to schedule an appointment with our orthopedic spinal surgery and general musculoskeletal physical medicine and rehabilitation specialists call: 602-277-6211!

 

#Results #Recovery #Relief #BackPain #PainInMyNeck #NeckPain #TOCA #TOCAMD #BackPainRelief #NeckPainRelief

Dr. Cummings and Vito Berlingeri talk Golf, injuries and recovery in the latest addition of the AZ Golf Insider!

Dr. Cummings and Vito Berlingeri talk Golf, injuries and recovery in the latest addition of the AZ Golf Insider. Check out the full artical by clicking here: http://staging.yudu.com/…/…/45vcVtT1Y15VmxzM/html/index.html

“When I went into his office, Dr. Cummings greeted me like he had known me for 30 years”, said Berlingeri. “He told me with surgery and physical rehab, I would be back to hitting golf balls within seven weeks.”

That’s exactly what happened, with Berlingeri able to play 18 holes just three months after surgery.

Associated with TOCA since 2001, Dr. Cummings estimates that up to 40% of the patients he sees play golf, including numerous PGA Tour professionals. No matter the skill level, he encourages all golfers to take injury prevention measures, especially keeping your core strong.

“Your body only has so much time before wear and tear happens. I’ve recommended other golfer friends with injuries go to Dr. Cummings at TOCA ever since.” (said Vito Berlingeri)

Getting an accurate diagnosis and then a plan is critical to the process, Berlingeri and his physician (Dr. Dean Cummings) agreed.

“You have to spend at least 10-15 minutes warming up in what I call a combination dynamic and static workout. That’s doing some stretches plus some movement patterns. I also recommend stretching while you’re playing.”

“At TOCA we provide an excellent assessment while looking at the whole body and not just an individual body part,” Dr. Cummings said. “We also make sure that each patient is treated with conservative therapeutic management first, and then surgery if needed. I think we have doctors in our group who are phenomenally gifted, but the good thing is they know when to operate, which is very important.”

Dr. P. Dean Cummings is an Orthopedic Surgeon & Sports Medicine Physician and Surgeon at TOCA.

To learn more about Dr. Cummings and TOCA or to schedule an appointment visit: www.tocamd.com or call 602-277-6211!

#Results #Recovery #Relife #Golf #AZGolf #AZGolfInsider #AGA#BunkertoBunker #TOCA #TOCAMD 

March 2017 is Cheerleading Safety Month!

March 2017 is Cheerleading Safety Month! Safety is a big concern in all sports and cheerleading is no exception. Because it combines both stunting and gymnastics, there are many opportunities for accidents if the proper precautions aren’t taken. While we often think of them as being nothing more than entertainment on the sidelines, cheerleaders serve a vital role, and the stunts they pull are demanding both mentally and physically. Cheerleading Safety Month comes each year to raise awareness that safety is vital to the health and performance of our team’s biggest supporters.

Basic Cheer Safety:
* Remove all jewelry
* Wear athletic shoes
* Keep your hair tied back
* Always have supervision
* Practice on safe surfaces such as mats and padded floors
* Have an emergency plan

In order to stay out of harm’s way and still perform spectacular stunts, there are a few basic guidelines that must be followed:
* Get proper instruction
* Always use a spotter
* Follow proper progression
* Practice proper technique
* Don’t push it
* Focus
* Warm up
* Communicate
* Don’t ignore injuries
* Stay in shape

Of course, cheerleading safety should be practiced any time cheerleading is being performed, but March – Cheerleading Safety Month – provides the perfect opportunity to shine the spotlight on cheerleading safety.

March often marks the winding down of basketball season and with it most school cheerleading will also come to an end. Soon, tryouts for the next season will take place, giving coaches the opportunity to implement their safety programs for a new team.

There are four groups directly responsible for the safety of the cheerleader – the administration, the coaches, the cheerleaders themselves, and the cheerleaders’ parents. Each can use this month to focus on cheerleading safety and enhance safety in their programs.

Administrators, are you involved in your cheer program? Make sure you have selected a qualified coach to supervise the team and give them sufficient support. At a minimum, the coach should complete the American Association of Cheerleading Coaches and Administrators safety course. Coaches should also take advantage of any other training available, such as training provided by the National Federation of State High School Associations or the US All Star Federation. They should be encouraged to attend camps, clinics and coaching conferences in order to further their knowledge of skill techniques. As an administrator, you should make sure your program has adequate practice facilities and matting and that the coach is following the safety rules.

Coaches, are you fully aware of your responsibilities with regard to safety? You should make sure your cheerleaders are using proper skill progressions. Don’t pressure your cheerleaders to try skills they are not ready to attempt. You or someone at practice, such as a coach’s assistant, should be CPR certified and trained in basic first aid. Make sure that you are following recognized safety rules and practices (AACCA, NFHS or USASF) outlined for your program. Develop and practice an emergency plan in the event a serious injury occurs.

Cheerleaders, you too have a responsibility for your own safety. If you feel scared about a particular stunt or tumbling skill, voice your concerns to your coach or parent. Take stunting very seriously, and stay focused on the skill and your part in it until it is safely completed. Practice good health and fitness habits so you can perform to the best of your ability. Remember, others are relying on you to be at your best during every performance.

Parents, use your voice! Know the safety rules, and If you find that standard practices aren’t being employed, bring it to the attention of the coach. If that doesn’t resolve the matter, do not hesitate to take your concerns to the administration. Ultimately, if you feel that your child’s safety is being compromised, take the difficult step of removing them from the program.

Cheerleading can be a safe and healthy activity when it is properly supervised. Let’s use this month of awareness to make sure we are all doing our part!

History of Cheerleading Safety Month
As the basketball season winds down to a close, Cheerleading tryout season often starts, and a bunch of intrepid new group comes to pick up the pom-pom and start down the demanding path of becoming a cheerleader. With the Administrators, Coaches, the Cheerleaders Parents, and Cheerleaders all working together, an education on how to perform at their very best while being safe in their efforts can be passed on and absorbed.
Cheerleading has been around for a long time, since the late 1800’s in fact, and believe it or not back then it was an all-male sport. From 1877-1923, it was the men that led the cheers, that helped to support their team, and in 1898 the idea of organized teams entered the scene. It wasn’t until 1923 that there women actually entered the field of cheerleading, and it took until 1940 for them to actually be recognized in things like student pamphlets and newspapers.
In 1987 the American Association of Cheerleading Coaches & Administrators was formed, and it wasn’t long after that that the important of safety education among Cheerleaders and those who trained them became obvious. This was the first seeds of National Cheerleading Safety Month coming to pass.

How To Celebrate Cheerleading Safety Month
There are a number of great ways to celebrate Cheerleading Safety Month, starting with being an active advocate for safety in your local cheerleading squad. This is a special opportunity for parents and administrators, a chance to make certain that your children or team is observing all the necessary safety practices to ensure they have a great, and safe, time.
You can also make contact with the National Cheer Safety Foundation to register as an official Cheer Safety Ambassador with their organization. This allows you to report injuries in cheerleading, build an emergency plan, and generally be a great asset to your team, your children, and their safety.

 

For more information on orthopedic sports medicine call 602-277-6211!

#cheersafe#Results#Recovery#Relief#Gameon#Sportsmedicine#Injuryprevention