December 28, 2015
"I hurt my arm and my fingertips are numb!"
Because our nerve pathways run throughout the body, any orthopedic injury can also be accompanied by nerve problems. A nerve that is pressured or stretched too much can be damaged. While nerve injuries can be permanent in the worst scenarios, most are temporary and will heal after some type of medical treatment, or even after just ice and rest.
Persisting numbness in the fingertips following an arm or elbow injury is cause to see an orthopedic doctor, preferably one specializing in treating the arm area. (Any inflammation through the hand, wrist, arm, elbow, shoulder, neck, or spine can affect feeling in the hands.) If the injury is not severe, your doctor will take steps to reduce inflammation. In most cases such treatment will take pressure off the nerves and restore feeling. A "pins and needles" sensation during the healing period is a sign that feeling is coming back.
A more severe arm injury can cause equally severe nerve damage. Not only may the injury itself require surgery, but additional surgery to repair the nerve may be required. This can be done by fixing the existing nerve structure or by grafting in a new section in place of a missing segment. Any of these surgeries are best performed by an orthopedic doctor specializing in the arm area. A post-surgery custom physical therapy program will follow this type of injury.
Numbness or tingling in any part of the body, whether it set in gradually or suddenly, needs medical attention.
November 23, 2015
Cyclists: Keep Your Ankles Healthy!
The many miles and hills around the South Bay make cycling an exciting way to stay fit, not to mention the gorgeous views. It’s easy to make this a lifestyle, especially with such a large cycling community in the area. With habit, though, comes repetition, and with it must come good form in order to stay pain free.
The ankles can get stressed after long rides. This can be from improper foot position, having flat feet, having too high of a saddle, riding in soft-soled shoes, having a bent pedal or crank…the list goes on.
The most common ankle pain complaint from cyclists is pain in the back of the ankle, which often indicates Achilles tendonitis. Severe Achilles tendon problems may require surgery, but In early stages, they can often be remedied with ice, anti-inflammatory medication, and rest. Gently stretching the Achilles tendon is also important. One way to do this is to stand with the ball of the foot on a stair or curb for 20-30 seconds and let the heel hang down, taking care not to overstretch. If the symptoms don’t subside, or the pain has migrated or is getting worse, it’s time to see an orthopedic doctor.
A board certified orthopedic doctor specializing in ankle problems is usually the best choice for these types of issues. He or she can create a custom treatment program that helps you get back on your bike sooner and can advise you about the most ideal form for your particular body mechanics. If you need custom shoe orthotics, this person is also the most qualified resource. Having the right diagnosis and treatment for your pain, especially if you want to get back to logging miles quickly, takes a qualified medical expert who will listen carefully to your needs and goals, and be your partner as you heal and move into health again.
October 15, 2015
Why Low Back Pain Keeps Coming Back
Pain in the low back affects millions of people each year. Those with minor pain often don't seek treatment, especially if the pain goes away for a while or is only there during certain activities. People with low-level dull pain may learn to tolerate it rather than get help.
The spine needs a lot of support from the surrounding muscles. When that support isn't working right because of an injury or imbalance, aches, pains, deterioration, and displacement can happen. When it does, it's common sense to refrain from activities that aggravate back pain. This can allow inflammation to subside and along with it, the pain. Taking safe doses of anti-inflammatory medications and using a cold pack can also help. But too often the pain comes back either during a different activity or because the original activity can't be avoided. What's the best way to address the pain when it recurs?
Starting with the right diagnosis from an orthopedic doctor specializing in the spine is the best first step for effective treatment. He or she can help pinpoint the source of the pain and determine whether there's actual damage to structures, inflammation, or even muscle spasms. The doctor will want to know how bad it hurts, what triggered it, and what causes it to hurt now. A health history is also helpful so that the doctor knows about any special limitations they need to consider while treating you. The doctor will also want to know about your goals and lifestyle for returning to health. This can affect decisions about the speed and type of treatment that's best for you.
Less severe back problems, especially those that recur, often respond very well to physical therapy and a regular exercise program designed to strengthen the muscles around the affected area. Injections, medications, activity changes, ice, and rest may also be helpful. More severe back problems are sometimes but not always treated with surgery. Many surgeries can be done with newer, minimally invasive techniques that lessen recovery time and post-operative pain.
September 10, 2015
"Do I really need elbow surgery?"
If an injury or painful condition in your elbow doesn't get better with treatments such as rest, activity modification, injections, and physical therapy, you may be a candidate for elbow surgery. Although TOSMG orthopedic doctors are able to treat most elbow problems without surgery, it still sometimes turns out to be the smartest option.
The good news is that many procedures can be done with an arthroscope, which is a small camera inserted into the elbow through a small incision. Other small incisions are made in the area to insert surgical instruments. Because there is less cutting due to the smaller instruments, recovery is faster, there is less bruising, bleeding, and swelling, and the procedure itself is often faster than traditional open surgeries. Some of the most common elbow arthroscopy procedures treat:
• rheumatoid arthritis
• tennis elbow
• range of motion problems
• pain caused by bone fragments or loose cartilage
When elbow arthroscopy cannot be performed, an open procedure may be recommended. Some conditions that usually require open surgery are:
• multiple or complex fractures
• golfer's elbow
• elbow joint replacement
• damage to collateral ligaments (on the sides of the elbow joint)
Multi-faceted elbow problems may be treated with both arthroscopy and open surgery for the different issues.
A board certified, experienced orthopedic doctor who specializes in the elbow is the best resource for successful elbow treatment. Seeing a doctor who wants to help you meet your sports and lifestyle goals is key to any orthopedic treatment plan. Only you and your doctor can decide what's best for you.
September 2, 2015
Do knee cartilage tears need surgery right away?
In the first stages of the injury, a meniscal tear (knee cartilage tear), is painful and swollen. Most people go to the doctor right away and expect to be told they will need surgery. Many meniscal tears, though, can "settle down" with non-surgical treatment and may never require surgery. Common conservative treatments include physical therapy, rest, ice, anti-inflammatory medication, and activity modification. If within about three months the symptoms go away, the treatment will likely be considered successful.
Meniscal tears that require surgery will still bother the patient after conservative therapies have been exhausted. Patients that want to return at the same level to the sport that caused the tear, and those with particularly painful or severe meniscal tears may also be candidates for surgery. Every meniscal tear is unique. A thorough physical examination, imaging, and good communication between the patient and doctor are the best ways to approach this type of injury. An orthopedic doctor who specializes in the knee area and/or sports medicine will have the most experience and training for diagnosing and treating a meniscal tear.
August 25, 2015
"But it was just a little twist and fall!"
The foot can get injured with very little impact or drama. Even tripping over the top of something and falling can cause problems that need medical attention. Although at first it may feel like a sprain, there's more to the foot than just ligaments that get overstretched. The mid-foot area is packed with several bones and ligaments that stabilize the foot and transfer weight properly to the leg. This area is called the Lisfranc Joint Complex. When these structures are misaligned or broken in any way, it can negatively affect the entire mechanics of body motion.
Common symptoms of a Lisfranc injury are:
• Pain and swelling on the top of the foot
• Bruising on both the top and bottom of the foot
• Pain, sometimes severe, when trying to walk
• Pain in the mid-foot when standing one-legged on the injured foot and trying to raise up to a "tiptoe" position
An orthopedic doctor, preferably one specializing in the foot, needs to perform an examination if any of these symptoms are present. If the doctor suspects a Lisfranc injury, he or she will likely take x-rays, since they show both fractures and misalignment. MRI and/or CT scans may be taken to see further details prior to a surgery but are usually not necessary to diagnose the injury.
Treatment for a Lisfranc injury requires many weeks of non-weight bearing, even in less severe cases. A cast and crutches are still needed for partial ligament tears and no fractures. Surgery is recommended if any bones are fractured or if any ligaments are completely torn. Hardware is used to fix the structures back into position or to fuse bones that cannot be repositioned.
Lisfranc injuries are unfortunately known for limiting a return to sports. A successful recovery can still result in arthritis to the injured area. An orthopedic doctor who is highly trained and who specializes in the foot is the most qualified doctor to diagnose and treat this complex problem with the most desired results.
August 18, 2015
Grating, Clicking, Pain, and Weakness in the Shoulder
These symptoms are common in many types of shoulder injuries, but the shoulder can be damaged in several ways. It takes an attentive orthopedic doctor specializing in shoulder problems to make the right diagnosis. Shoulder tears in the glenoid labrum are one common cause of shoulder pain. The glenoid labrum is soft tissue attached to the socket part of the shoulder. It provides extra stability for the ball part of the joint, keeping it from popping out of the socket too easily and allowing the shoulder to move in many different directions.
Specific symptoms of a glenoid labrum tear may include:
• Pain when raising the arms overhead
• Noises such as clicking and popping
• A sensation of the shoulder locking up or getting caught
• A feeling of instability in the joint
• Pain during rest or everyday activities
• Weakness in the shoulder
• Inability to fully move the shoulder in all directions
The glenoid labrum can tear in more than one direction. Symptoms are different depending on the direction. Pain from a tear can happen gradually from repetitive motion, or it can be the result of a sudden injury.
These and other factors make it important to see an experienced orthopedic doctor to get a proper diagnosis. He or she may take different types of images to see what's going on. X-rays won't show soft tissue tears, but they can rule out other causes of pain. MRI or CT scans can but don't always show a small glenoid labrum tear, but arthroscopic surgery, where the doctor inserts instruments and a camera into the shoulder through small incisions, is the surest way to a definitive diagnosis.
Although a tear will not fix itself, strengthening the muscles around it can improve symptoms enough to relieve the pain. Anti-inflammatory medications and activity changes can also help. If those treatments don't work, arthroscopic surgery may be necessary. The doctor will trim the tear away and in some cases add stability with hardware or sutures.
August 12, 2015
Do calcium supplements cause calcium deposits and bone spurs in the body?
Having the right amount of calcium (and Vitamin D) in the diet is important for keeping bones healthy and strong. Supplements can help make up the difference between what's missing in your diet, but it's considered best to get it through foods rather than supplements. Still, a doctor may recommend calcium supplementation if there is concern that a patient's health is at risk because they aren't getting enough.
Calcium supplements won't cause bone spurs or any other type of calcium deposits in the body. Those deposits are the body's response to inflammation. When something is causing pain or inflammation in the body, it attempts to grow a protective shield to stop the inflammation from doing further harm. Bone spurs are an attempt to grow bone to fuse areas together that are causing problems. Calcium deposits on tendons or other structures are attempting to protect the body as well.
Some literature suggests that getting too much calcium through supplements can cause harm to the body, though, so it's important not to take more than the recommended amount. Current guidelines recommend that healthy adults get about 1,000 mg of calcium and 600 IU of Vitamin D daily, and elderly adults get about 1,200 mg of calcium and 800 IU of vitamin D daily. Again, that's the TOTAL recommended for each day of food and supplements combined. There is usually no need for supplementation if food is providing at least that amount.
If you have bone spurs or other calcifications in your body that are bothering you, or you just have pain in certain areas, an orthopedic doctor can help investigate the cause.
August 5, 2015
Alcohol in Moderation for Healthy Hips
Excessive alcohol consumption over time, often defined as alcoholism, can be a risk factor in disrupting the blood supply to the "ball" part of hip bone. Once the blood supply has gone from the bone, it dies, and the ball, or femoral head, must receive medical attention to avoid total collapse. The condition is called osteonecrosis of the hip. It affects more men than women and is most common among 40-65 year olds.
Alcohol is not the only suspected cause of bone death in the femoral head. Previous injuries can cause damage to the blood vessels in the bone. People who use corticosteroid medications long-term are also believed to be at a higher risk. Certain diseases and conditions, such as Crohn's disease, sickle cell disease, and several others, also may predispose someone to hip osteonecrosis.
Gradual onset of pain, from mild to intense over a period of months to up to a year is common. Pain can be present both in and adjacent to the hip joint and in the buttocks. In advanced stages, weight bearing and everyday movement of the joint can become difficult.
Nonsurgical treatments often do not work for patients with osteonecrosis of the hip. That's because it's a progressive condition that worsens over time. There are many surgical techniques that usually give better results:
• For early diagnosis, before collapse:
• Pressure relief (called core decompression) on the bone is a drilling of holes through the femur up to the head. This encourages blood supply to reestablish from the living section of the femur up into the dying head area. A bone graft to strengthen the weakened section of bone can help the area rebuild itself quite successfully. Many patients report complete relief of symptoms after recovering from this procedure.
• A bone graft from the patient's own leg bone containing a viable blood supply is called a vascularized fibula graft. This can be implanted into a hole drilled into the femoral head, where it can add circulation and strength to the dying area. When the condition is diagnosed early, this procedure can also offer a very successful recovery.
• For late diagnosis, after collapse:
• A total hip replacement is recommended at this stage. This procedure has a very high success rate (90-95%) for returning patients to a healthy, active lifestyle that is free from hip pain.
July 29, 2015
POP QUIZ: Which finger is most likely to develop arthritis?
There are many different types of arthritis. The most common are osteoarthritis (disease that causes cartilage to wear away) and rheumatoid arthritis (autoimmune disease that causes joint lining to swell). Both cause pain in the affected joints and if left untreated, worsen over time. Arthritis is more common in women than men, but millions of people of both sexes are afflicted.
Arthritis in the hands can be especially painful because we use them so much. And if you guessed that the thumb (at the joint closest to the wrist) is often the first place arthritis is felt, you were correct. Why makes that joint so vulnerable? It's one of the joints we use the most, it's the finger we most rely on for strength, and it has a wide range of motion.
Arthritis can also develop early in any finger joint as a result of a previous injury, such as a fracture or dislocation. Rheumatoid arthritis in the hands often progresses symmetrically, affecting the same fingers on both hands at the same time.
Symptoms of finger arthritis may include:
• Deformed/bent fingers or fingers stuck in position
• Bony nodules at the joint
• Pain/weakness/inability to perform fine motor skills or gripping tasks
• Grinding feeling in affected joint
• Loose joints
• Increased range of motion in surrounding joints
• Cysts on the joints closest to the fingernail, accompanied by irregularities in the fingernail
An orthopedic doctor specializing in the hand is best qualified to diagnose and treat this type of arthritis. The doctor can use health and family history, a physical exam, x-rays, and sometimes a bone scan or MRI to give a proper diagnosis you and rule out other conditions that may be mimicking the symptoms of arthritis. Once a definitive diagnosis of arthritis is made, he or she can customize a treatment program specific to the patient. This includes considering overall health, whether the dominant hand is affected, how daily activities will be impacted, and needs and goals in returning to a more active and independent lifestyle.
In most cases, treating finger arthritis begins with nonsurgical therapies. Anti-inflammatory medication, injections with or without splinting, activity modification, and hand therapy can reduce the painful symptoms of the disease. Surgery may be an option if conservative therapies don't help. Keeping the original joint is usually preferred, although joint replacement is available for almost every joint in the hand and wrist. A surgeon with special training in these procedures is the best choice.
July 21, 2015
A Case for Ankle Replacement
Most talk about joint replacement focuses on the knees and hips. We don't hear as much about the smaller joints, especially something as complex as the ankle. But because ankle replacement hardware and surgical techniques have improved so much in the past ten years, more people are considering ankle replacement instead of ankle fusion surgery.
Ankle pain and range of motion problems alone don't make someone a good candidate for ankle replacement. In most cases, keeping the natural joint is best, as long as pain and restricted movement symptoms can be managed conservatively. This includes physical therapy to strengthen the ankle area, which can relieve pressure on the joint. Bracing, weight loss, activity modification, medications, injections, and even a regimen of elevating and icing and/or heating the ankle may also be effective.
Many people become concerned about changing their activities, but it may only be temporary. Often just reducing inflammation for a while can allow a person to then get back to doing their favorite things. If conservative therapies have been exhausted and the doctor determines that the person is a good surgical candidate, ankle joint replacement surgery, called total ankle arthroplasty, may be recommended.
The surgery takes about two and a half hours and the hospital stay can be 2-3 days under typical circumstances. The ankle must be elevated for much of the time in the hospital. Weight bearing is off limits for 3-6 weeks after the surgery, but doctor-prescribed range of motion exercises can start much sooner. Getting back to normal activities takes about six months, but it can be longer in some cases.
July 15, 2015
How effective is adult scoliosis treatment?
Scoliosis is curvature of the spine in the shape of the letter "S" or "C." It affects 2-3 percent of the US population. Many cases don't need surgery or even therapy. Having a doctor monitor the condition is enough for the majority of patients, and most people live perfectly healthy, active lives into adulthood despite having spine curvature. Women are much more likely than men to develop more severe scoliosis as they age. For any patient who is plagued with pain and other symptoms into adulthood, there are treatments that can help get them back to a healthy life.
Reducing pain is the main goal in treating adult scoliosis. This can be done using a combination of oral or injected medication, if necessary, and strengthening exercises. Physical therapy can be very effective, and aquatic therapy is also an excellent option. Doing strengthening exercises in a pool greatly reduces the stress on the spine. This allows patients to achieve better strength results with little to no pain.
Manipulation of the joints can also help keep mobility at high levels. It's recommended it be done only by a board certified orthopedic doctor specializing in the spine, because the neck area must be manipulated correctly in order to avoid injury. Bracing may be prescribed, but only in very rare cases to restrict movement and reduce stress on the spine.
For patients who do not respond to nonsurgical treatment, surgery may be recommended. Recovery from scoliosis surgery can take several months to a year. For that reason, only patients whose symptoms are keeping them from performing their daily activities are considered for surgery. A patient's overall health, their age in some cases, and their bone quality are also factors in deciding whether surgery is a good option.
July 9, 2015
A "Pop" Sound and Severe Pain at the Elbow
Men over age 30 have the highest risk of rupturing the biceps tendon at the elbow. This can happen when trying to lift up a box that's too heavy and straining the biceps to a state of extreme overload when the arms are straight, causing the tendon to suddenly disconnect from the forearm bone. It can also happen when forcefully throwing a heavy object. As soon as the arm outstretches to let the object fly, the overloaded/hyperextended biceps can pop off the bone. Most biceps ruptures tear completely away from the bone, although a small number only tear partially.
At the time of injury, there is severe pain. Swelling and bruising become visible shortly after. The biceps roll up the arm into a coil at the top near the shoulder, where a lump can be seen. It's important to seek medical attention when these symptoms occur. An evaluation can confirm the diagnosis, and an orthopedic doctor can review the different treatment options available:
ELECTING TO NOT HAVE SURGERY
Patients who are older or sedentary, in consultation with their orthopedic doctor, may elect not to have surgery. Patients whose health cannot endure having a small-to-medium surgery may also need to forego it. The arm can still function without the biceps attached. Turning the palm from down to up with any kind of force won't be possible, and the arm will lose a third or more of its strength. The arm can heal without surgery, but the biceps tendon will not restore itself. It will stay rolled up near the shoulder, shorten, and become less visible. By not having surgery, the patient needs to understand that the damage and reduced strength to the arm is permanent.
WAITING TO HAVE SURGERY
This is not recommended. The biceps tendon shortens and scars within 2-3 weeks after the injury. Surgical outcomes after this point are not as good and surgeries have more complications.
ELECTING SURGERY IMMEDIATELY
Active patients will likely want the biceps repaired. An orthopedic doctor specializing in the elbow and arm (upper extremity) is the best choice for a surgeon. He or she will likely be the most experienced with biceps tendon ruptures, since it's not a common injury. The surgeon will reattach the biceps tendon using metal hardware or stitches threaded through drilled holes in the forearm bone. Rehabilitation after surgery is gradual. The patient is often in a sling or cast at first, but moving the arm begins soon after surgery. Physical therapy is usually necessary. Healing from the surgery takes about 90 days, and it can be six months or more before the biceps tendon regains full strength.
July 2, 2015
"Can I get knee replacements more than once?"
Having knee replacement surgery a second time is called revision total knee replacement. This surgery is still uncommon compared to first-time knee replacement, but it can still be necessary for several reasons:
• The younger a patient is when they have knee replacement, the more likely the hardware will wear out during their lifetime. Accidents, longer lifespans, and more intense athletic activity beginning at a younger age and continuing into older age all contribute to this.
• Knee replacements are mechanical devices, and they can wear out, break, or loosen.
• After knee replacement surgery, patients are advised to stay away from high impact sports and exercises that would twist or torque the knees beyond normal everyday activities. Not everyone heeds this advice, and some people require knee revision surgery sooner than expected.
• Obesity can also cause knee hardware to fail sooner.
• An auto accident, bad fall, or other trauma can damage the knee hardware and/or the surrounding bone and tissues.
• Very rarely, infection can result when the body attacks small plastic particles from an aging knee replacement.
There is a very high success rate (approx. 90%) for people undergoing first-time knee replacement. These people report having a lot less pain, and that have a high level of satisfaction returning to many of their favorite activities.
In general, though, statistics are poorer (approx. 70%) for those undergoing knee revision. That's because knee revision surgery is much more complex. Surgeons performing it must know exactly why and how the original implant has failed. They must have knowledge of and experience with specialized procedures and tools to fix, adjust, remove, and replace parts of the original hardware and in some cases bone cement. The patient must be healthy enough to undergo the surgery. Things like quality of bone and the strength of tissues surrounding the knee replacement are important factors. Statistically, infection rates are also slightly higher because the surgery takes longer than first-time replacement.
Looking to the future, advances in medical technology are producing better knee replacement hardware, better surgical techniques, and in the more distant future, alternatives that could help repair knees without replacing them. Knee replacement hardware today has better range of motion, a more natural fit, and more durability than one manufactured 15-20 years ago or more.
June 24, 2015
"I'm training for a long race and the ball of my foot hurts!"
Runners, cyclists, and any athlete who suddenly increases their training regimen may put themselves at risk for sesamoiditis of the foot. Ballet dancers are particularly susceptible. Sesamoid bones are attached only to tendons and are found around some joints throughout the body. The largest sesamoid is the kneecap. Sesamoids act like a pulley that slides over the joint, protecting and strengthening it. There are also two sesamoid bones just under the big toe where it meets the foot, allowing us to put more force on the area without causing pain and instability.
Common symptoms of sesamoid issues are:
• Pain and swelling in the ball of the foot
• Pain when moving the big toe in different directions
• Trouble bending the big toe
• Pain in big toe when pressed down toward floor
Sesamoid problems most often stem from the inflammation of the tendons attached to the bone. When they swell, it puts pressure on the surrounding nerves and causes pain. It's rare to have a broken sesamoid, and even rarer to have a sesamoid bone with reduced blood supply.
An orthopedic doctor specializing in the foot is the best practitioner to diagnose and treat sesamoid problems. He or she can rule out more serious conditions as well. Your doctor will talk to you about your medical and incident history, perform a physical exam, and likely take x-ray and MRI images of your foot to in order to correctly diagnose the problem.
Surgery is usually not required to fix sesamoid problems. Temporary activity modification, shoe modification, taping, bracing, anti-inflammatory medication, injections, rest, ice, and some physical therapy modalities have all been shown to help effectively. If none of these treatments work, your orthopedic doctor may recommend surgical removal of the sesamoid bone.
June 19, 2015
"My shoulder hurts when I lift my arm above it!"
There can be many reasons for this type of shoulder pain. One common cause is calcific tendinitis. This condition happens when a lump of calcium forms on one of the tendons in the shoulder area. Besides pain from lifting the arm above the shoulder, it can also be painful to lie on that shoulder. The pain can disrupt sleep and activities.
If you see your orthopedic doctor with these symptoms, he or she will perform a thorough physical examination of the shoulder and talk with you about previous injuries or strains to your shoulder and about your physical habits and athletic activities. It's also likely that your doctor will take x-ray and MRI images, both of which can show calcific deposits.
The body concentrates calcium in the wrong place for a few different reasons, and researchers haven't pinpointed any single reason for calcific tendinitis. Not surprisingly, without a definitive cause, there is also no single treatment that will work for everyone. Some people respond to a temporary reduced-calcium diet. Others find relief with sound-wave therapy. Still others may do well with medications and physical therapy. This treatment program can lessen inflammation and improve the biomechanics of shoulder movement. The calcium lump stays but the pain may be reduced or eliminated.
The most successful treatment for most people with calcific tendinitis who do not respond to the conservative therapies above is slightly more invasive. An orthopedic doctor anesthetizes the area and inserts an ultrasound-guided needle to poke holes in the deposit. As the calcium breaks up, the doctor aspirates it from the deposit area. Some studies have shown that 75% of patients are significantly helped with this procedure.
June 17, 2015
"Can an orthopedic doctor help with autoimmune disorders?"
Millions of people in the United States are afflicted with autoimmune disorders, which occur when the body attacks its own healthy tissues. Women are affected more than men. Since our joints are the shock absorbers in our bodies, they can be very painful targets of an autoimmune attack.
While autoimmune disorders can be tricky to diagnose and treat at the root, there are ways to relieve or lessen the pain that they cause. Among the most common autoimmune disorders our patients need care for are rheumatoid arthritis and polymyalgia rheumatica, both of which can severely affect the muscles and joints.
Treatment for these and other conditions affecting the bones, muscles, and joints begins by getting the right diagnosis. After that, an orthopedic doctor will work with you to plan a treatment program based on your symptoms and your lifestyle needs. Less severe symptoms may be managed with conservative therapies such as rest, ice or heat, medications, activity changes, injections, or physical therapy. If an autoimmune disease has progressed to a more destructive point, you and your doctor may discuss surgical options to restore or replace damaged or deformed tissue or bone. At any point, we will also be happy to consult with other doctors overseeing your care.
It's our hope that autoimmune disorders will be eradicated soon and also that treatments until then will continue to improve. We want all of our patients to live pain free and be able to do what they love.
June 8, 2015
"I have a sudden pain in my hip and groin!"
Sudden pain that doesn't go away is usually caused by a single event and is probably an injury. The twisting, cutting, and pivoting movements in some intense sports are often the culprits.
Pain in the groin area, right next to the hip joint, may be what is commonly called a sports hernia. A sports hernia is not actually a hernia at all, however. Its real name is "athletic pubalgia," which is a tear of the soft tissues in the lower abdomen and the upper leg where they attach to the pelvis near the groin. The condition is more common in men than women.
Athletic pubalgia can eventually lead to a regular hernia with underlying organs pushing out, but most people seek treatment before this happens. Failure to seek treatment can result in terrible pain and can prevent someone from returning to their sport.
Treatment for athletic pubalgia is usually nonsurgical. Rest from the extreme sport that caused it is the most important part of recovery. Ice, physical therapy, and anti-inflammatory medications are also essential. Returning to sports should be done cautiously at first. If the pain returns, surgery may be necessary to repair the torn tissues.
Surgical options include endoscopic or open tendon repair, cutting of a nerve that causes the pain, or even the cutting of a tight tendon so it can grow back longer, be under less pressure, and give the athlete greater range of motion.
May 28, 2015
"I fell on my hand and it won't stop hurting!"
Any time pain doesn't go away after a fall or other type of trauma, see a doctor sooner rather than later. The hands and wrists are especially tricky areas to diagnose because of the many bones, nerves, tissues, and tendons in such a small area. One common type of injury that happens after falling on an outstretched hand is a scaphoid fracture.
The scaphoid bone sits just above the thumb. To find this tiny bone, put your thumb in the "hitchhiker's" position. The scaphoid sits in the hollow area created at the base of the thumb. Parts of it have poor blood supply naturally, so when it's injured, it's important to see a doctor right away. Catching this type of fracture early can keep the wrist from healing improperly and becoming a site of lifelong pain and problems.
Symptoms usually include:
• Pain and swelling at the base of the thumb
• Pain while moving the thumb
• Pain when gripping something
A sprained thumb is actually rare. Any pain that persists in this area warrants medical attention, as it has a higher likelihood of being a fracture than a sprain.
Seeing an orthopedic doctor who specializes in hand, wrist, and elbow problems is advised. Since the scaphoid is so small, a doctor without experience diagnosing this type of fracture can easily miss it on an x-ray. A specialist will take an x-ray and likely take an MRI to assess additional damage to surrounding tissues and structures, and to see smaller fractures that did not show on the x-ray.
Scaphoid fractures are notorious for healing improperly. This is another reason to see an experienced specialist. He or she will know what type of treatment to recommend and can give you precise instructions for caring for your injury. This can greatly minimize the recovery complications and promote proper healing.
Because healing after a scaphoid fracture can cause so many complications, this has become an area of new medical solutions. Use of hardware, bone grafts, blood vessel grafts, arthroscopy, protein injections, and more are being used to improve outcomes.
May 26, 2015
"An ankle doctor can help with knee problems?"
Limited ankle range of motion and a host of other ankle problems can cause a chain reaction up the body, causing knee pain, hip pain, and even back pain. It's especially important for those who have had an ankle injury to dedicate themselves to getting their ankle health back. If possible, any swelling, stiffness, or range of motion issues need to be worked out during the initial post-injury physical therapy your doctor prescribes.
After the therapy is done, patients can also benefit greatly by:
• Staying active
• Stretching their calf muscles (Achilles tendon) once a day or more
• Making "ankle circles" part of their before and after exercise routine
• Writing the alphabet with each foot:
Sit on a high, sturdy platform and put one leg on a stool or chair. Dangle the other leg, and write each letter of the alphabet in the air using that foot. Keep the hips and knees still while using only the ankle joint to complete the motions. Switch legs and repeat.
• Doing calf raises 2-3 times a week
An orthopedic doctor specializing in the ankle area is the best resource for properly diagnosing and treating ankle problems. He or she can answer your questions and will work with you to find the best treatment program for you.
May 14, 2015
Leg and back pain: Sciatica OR Piriformis Syndrome?
The sciatic nerve is the biggest and longest nerve in our bodies, made of five nerves that come together in the lower spine and run down the back of the legs to the toes. It's as big around as an adult's thumb at its widest point.
Since it goes through so many active parts of our body, it can get compressed or damaged in different ways. This results in a variety of conditions. Two of the most common are sciatica and piriformis syndrome. Here are the basic differences:
Sciatica pain starts in the low back and radiates down the leg. It's caused by bulging discs in the low back that compress the sciatic nerve. Bending forward usually makes the pain and the condition worse. Treatments focus on getting the discs to go back into place by strengthening the core and reducing inflammation in the area.
Piriformis syndrome pain stays in the hip and buttock area and does not usually radiate further. It's caused by inflammation in the piriformis muscle deep inside and toward the back of the hip. The sciatic nerve runs close to, or in some people, right through this muscle. When it the muscle swells, the nerve gets compressed and causes pain. Treatments focus on reducing inflammation of the muscle and stretching it.
With both conditions (and like most orthopedic problems) surgery is usually not necessary. You and your orthopedic doctor can discuss all the options for you and find a treatment plan that works with your lifestyle and fitness goals.
May 7, 2015
"It hurts to lean on my elbow!"
The tip of the elbow is naturally padded so that when you lean on a tabletop or crawl on your elbows, it doesn't hurt. But after prolonged leaning or crawling, pain can set in. This can take many months or even longer. People who lean on their desks all day and plumbers and heating/air technicians are especially at risk for developing pain in the elbow.
The pointy bone at the tip of the elbow is called the Olecranon. A bursa, which is a slippery sac with a small amount of lubricating fluid in it, supplies padding between the bone and the skin. When too much pressure is applied to the area, the bursa fills with extra fluid and becomes larger, inflamed, and sometimes infected. This is what causes the pain. The condition is called Olecranon bursitis.
• Swelling at the tip of the elbow
• Pain when leaning on the elbow
• Pain when bending the elbow
• Swelling that limits elbow motion
• Elbow skin becomes red and warm (infection)
• Pus coming out of an elbow wound (infection)
• Prolonged leaning on elbows
• Elbow injury such as a traumatic blow
• Rheumatoid arthritis
• Bone spur or loose bone or cartilage fragment at the tip of the elbow
• Insect bite, scrape, or puncture wound that allows bacteria to enter and infect the bursa
The right treatment for Olecranon bursitis depends on what's causing the bursa to swell. An infection may require the doctor to extract fluid from the bursa to determine what type of antibiotics to prescribe. If the doctor suspects a bone spur or loose fragment is causing the condition, he or she may order an x-Ray. When prolonged pressure on the elbow has caused the bursa to swell, treatments such as elbow pads, activity modification, and medications can be helpful. Cortisone injections may be an option for pain that persists after other anti-inflammatory medications have failed.
Sometimes conservative treatments don't work. In those cases, your doctor may recommend surgical removal of the bursa. A new bursa will grow in its place after a few months. Loose bodies and bone spurs can also be removed surgically, allowing the bursa to return to normal function.
An orthopedic doctor specializing in elbow and arm problems is well equipped to give the right diagnosis and treatment for Olecranon bursitis. Together you can create a treatment program that works with your needs and the needs of anyone who may be caring for you while your activities are restricted or you're recovering from a procedure.
April 24, 2015
Allograft vs. Autograft: Ask Your Surgeon
Quite a few orthopedic surgeries require some type of transplant to help close a gap to replace destroyed bone or tissue. These transplants most commonly come from either the patient's own body (autograft) or a cadaver (allograft). Some synthetic tissue substitutes or tissue structures made from animal collagen are also available. There is at least one alternative using amniotic tissue from living donors as well.
Because orthopedic procedures are common in the U.S., so are tissue and bone transplants. Some estimates put the number at more than one million each year.
If you need surgery, you can ask your orthopedic doctor if he or she will need to insert new tissue into the area you're having fixed. Your doctor can explain the risks and benefits associated with each type of transplant:
• No rejection issues, since they come from the patient's own body
• Two surgical procedures instead of one, since the site where the tissue or bone is harvested from becomes a second injury
• Possible weakness or problems from the harvest site
• Extra recovery after surgery in caring for two surgical sites
• Only one surgery site from which to recover
• Possible rejection issues, since the tissue is from another person's body
• Very small risk of disease transfer (Ask your surgeon to about the sterilization and disease screening procedures of the tissue you're receiving)
Synthetic, Animal-derived, and Live Human Amniotic-derived Structures
• Ask your doctor if you are a candidate for any of these
Tissue transplants normally assimilate into the body and cannot be precisely removed after time has passed, as opposed to a piece of medical hardware.
April 20, 2015
"I have pain in the back of my hip. Is it time to consider hip replacement?"
Pain in the back of the hip can be deceiving. Many patients with that symptom come into our office thinking they have a hip problem, when many times the diagnosis is a back problem. Often the pain is radiating out of a pinched nerve in the spine, and if that's the case, it's actually time to see a spine specialist.
Other types of hip pain don't mean a hip replacement or other surgery is inevitable, either. Once a diagnosis of a hip problem is confirmed, there are many types of conservative, non-operative therapies to delay or avoid a hip replacement:
Anti-inflammatory medications, RICE (Rest, Ice, Compression, and Elevation), heat and stretching, weight loss, low-impact cardiovascular exercise, and judicious use of cortisone injections can be extremely effective. Newer research is scant and the reports only anecdotal, but Platelet Rich Plasma injections and stem cell therapy with the patient's own stem cells have shown a lot of promise and are the "hottest" areas of trial and research in this area.
April 10, 2015
Wrist Pain and Overextension from Racquet Sports
Racquet sports, weightlifting, downhill skiing, canoeing, rowing, and even pulling a rake along hard ground repetitively can irritate the tendons in the wrist. As the wrist and thumb curl inward, parts of the wrist tendons rub against the thumb bones, and the area gets inflamed. This can become painful over time and is called Intersection Syndrome.
An orthopedic doctor specializing in the hand and wrist is experienced and qualified in properly diagnosing this condition. Intersection Syndrome can be detected with a physical examination and does not always require x-ray or MRI imaging unless the doctor needs to rule out an internal mass or other deformity or injury as the cause.
Treatment in most cases is to improve wrist positioning during the activity that is causing the pain. A hand therapist can demonstrate proper form and, with guidance from the diagnosing orthopedic doctor, can also treat patients with strengthening, pain relieving, and range of motion exercises. The doctor may also prescribe medications, hot or cold therapy, injections, massage, splints, or surgery. Surgery is only necessary in serious, extremely painful situations when the tendon needs to be released. It can be performed on an outpatient basis and there are a variety of options for anesthetizing the wrist.
April 1, 2015
Why Some People Can Walk on a Broken Ankle
A broken ankle is one or more fractures of one or both of the lower portion of the lower leg bones, the fibula and the tibia. A trip or fall, car accident, or an ankle rotation or roll are the most common causes of ankle fractures.
Broken ankles can happen at any age but are often more severe in older people due to issues with lower bone density. Along with the fractures, tendons and ligaments are usually damaged, which causes instability until healing is complete.
Someone who breaks an ankle and can still walk on it likely has a hairline fracture with very little to no damage to the surrounding tendons and ligaments; however, even this type of break needs medical attention.
Symptoms of a broken ankle may include:
• immediate sharp, severe pain at the ankle joint or just above
• swelling and bruising
• tenderness when touched
• inability to put weight on the foot
• visible bumps or protrusions in the ankle area
Medical attention is advised if a person has these symptoms. Failure to treat a broken ankle can result in deformity, instability, loss of strength and agility, reduced range of motion, arthritis, chronic pain, and more.
Treatments for a broken ankle do not always require surgery, but it's recommended in many cases. Fractures without displacement may only need a cast. Physical therapy is essential during recovery to restore stability, strength, and range of motion.
March 26, 2015
"I have headaches. How can an orthopedic doctor help me?"
Headaches and other symptoms can be signs of neck problems. Because the neck is made to move the head in many directions, it's also vulnerable to wear and tear and degeneration from aging, pinched nerve issues, herniated discs, and injuries such as whiplash and trauma from sports and falls.
Common symptoms of neck problems include:
• neck pain
• pain radiating down the back and into the arms
• difficulty moving the neck in some directions and/or to full rotation
• stiffness in the neck
• muscle weakness in the hand, arm, or shoulder
• tingling, numbness, or prickling sensations in the hand, forearm, or fingers
In less common cases, bladder and bowel issues and changes in walking can occur from a problem in the neck. This usually requires immediate medical attention.
An orthopedic doctor is well-trained and experienced in diagnosing problems stemming from the neck area. He or she will take a full health history, ask several questions about your current symptoms, and perform a thorough physical exam. The orthopedic doctor is also likely to use neck and reflex testing and MRI and/or x-ray imaging to determine the cause of your symptoms. Once a diagnosis is found, the doctor can help you understand your particular condition. Together, the two of you can plan the right treatment course for you and any of your family members who will be affected by your care.
Treatment for symptoms from neck problems is usually nonsurgical. Patients who receive medication, injections, physical therapy, hot/cold treatments, or even a pressure-relieving collar can experience improvements in a short time period. For those who don't respond to nonsurgical treatment or have a more serious problem, surgery may be the best option. There are a variety of effective surgical techniques and procedures available.
March 13, 2015
Elbow Problems Need Expert Follow-up
Did your elbow land you in the emergency room or urgent care? If it did, the doctors there probably identified the major problems with it before sending you home. The more subtle problems that can cause trouble down the line may not have been on their list or presenting at all, though.
Soft tissue damage, nerve damage, and other seemingly small issues can develop into bigger ones, leading to elbow instability and other painful conditions later on. An orthopedic doctor who specializes in detecting these subtleties before they become serious can put you on the right track to healing properly. Early detection makes a big difference.
February 27, 2015
Which exercises are bad for knees?
Studies show that regular exercise over a lifetime actually keeps knee cartilage healthier. That said, there are certain types of exercises and sports that wear down the spongy cartilage in the knee faster than others...
At the gym, avoiding deep squats, lunges, and full-arc knee extensions will keep your knees healthier. In sports, tennis, basketball, soccer, football, volleyball, and any other sport that has a lot of twisting and turning at high speeds puts the knees at risk for cartilage wear and injuries. Having a prior injury to a joint makes it more likely to develop osteoarthritis sooner. Exercising too much, too fast, too soon, or all three is also a recipe for knee problems.
The knees are great shock absorbers when they're healthy. With each running or jumping step, a person puts pressure at least four times their body weight on the knee. That's 600 pounds of pressure for the knee of a 150-pound person. To keep that process pain-free, exercise smart:
• Warm up before exercising
• Vary workout intensity from day to day
• Strength train to build lean muscle weight, which stabilizes joints
• Keep body fat within the healthy range recommended by your doctor; extra fat stresses joints
• After an injury, recover fully and get medical guidance before returning to activities
• After a period of time off, re-assess your abilities and return to activities gradually and at the right level
• Listen to your body, especially if pain develops and it doesn't go away
• Pay attention to your body mechanics–not everyone is cut out to run marathons or play tackle football
• Know your genetic history–someone who has osteoarthritis in the family can find a fitness routine that reduces the risk of pain
• Avoid high-heeled shoes, which often stress the knees in the place where osteoarthritis develops
If you're having trouble finding the best ways to keep your knees healthy, it may be time to consult an orthopedic doctor. He or she is the most knowledgeable resource on the subject and will perform a full examination and prescribe the right treatments and exercises for you.
February 20, 2015
"I have a heel spur—does it have to be removed?"
As a general rule, an experienced orthopedic doctor doesn't treat conditions. He or she treats symptoms. If you're having foot pain and x-rays or examination reveal that you have a heel spur, it's likely not the cause of the problem and won't have to be removed. Plantar fasciitis is often the culprit of foot pain on the bottom of the foot in the heel area.
Plantar fasciitis is the inflammation of the tendons running along the bottom of the foot. Damage or tears to the tendons are caused by stress. There are many reasons why this could happen:
• Tight calf muscles
• High arches
• Running frequently or running long distances
• Sudden increase in athletic activity
• New exercise routine
The pain from plantar fasciitis can be quite intense, and it's important to get treatment when that happens. An orthopedic doctor and surgeon specializing in the foot area is the most knowledgeable and experienced resource. He or she can correctly diagnose foot pain conditions and recommend many sound and proven treatment options.
The most common form of treatment for plantar fasciitis is stretching the calf and foot muscles. Other less invasive treatments include medication, physical therapy, shockwave treatment, and custom shoe orthotics. Surgery is rare and is only considered if these treatments don't work.
February 13, 2015
"My shoulder makes popping and clicking sounds!"
Not every pop or click is cause for concern. A shoulder that's cold and tight may just be making some cracking sounds as it warms up, releasing gas from the joint (like knuckle cracking). In this case, as the shoulder becomes warmer and looser, the sounds usually go away.
As people age, the chances that osteoarthritis is causing those sounds becomes more common. The first signs of the condition may be just clicking, snapping, or popping sounds and no pain at all. Osteoarthritis can and often does become a painful condition, though, and seeing an orthopedic doctor/surgeon for advice on how to slow its progress or relieve the pain is a good idea. In the early stages of osteoarthritis, the doctor can prescribe non-invasive remedies such as exercises, activity modification, and icing to strengthen the shoulder and keep inflammation and pain at bay for longer.
Shoulder noises can also be a result of a minor cartilage tear or a problem with the muscles in the shoulder. If pain radiates in either direction, the arm can't be lifted above the shoulder, or normal motions and exercises cause pain, see the doctor. These symptoms often indicate an injury that will get worse, not better, without treatment.
February 3, 2015
If you suspect an injury, it's okay to see a doctor early!
In some cases, feeling pain after a sudden movement during sports or activities means an injury has happened. This type of pain is different than aching muscles after overworking, or gradual onset of joint or tendon pain. Sometimes the injury that's just occurred will feel better and heal on its own, with no negative effects.
Other times the injury starts to feel better, but without an orthopedic doctor to guide the healing, it may not heal properly. There can be other symptoms that last beyond the pain, such as swelling, weakness, instability, or limited range of motion. Over time, these unchecked symptoms can lead to more serious or even permanent damage.
An orthopedic doctor is more likely to properly diagnose and treat sports and activity injuries than another type of doctor. Here are just some of the injuries that may seem mild but can lead to complications if untreated or misdiagnosed:
• ACL tears
• "Slipped hip" in growing teens
• Hip stress fractures
• Upper-thumb-meets-wrist bone (scaphoid) fracture
• "Skier's Thumb"
• Achilles Tendon Rupture
• Inner foot tendon (posterior tibial tendon) rupture
January 29, 2015
Teens Can Get a Pelvis Fracture, Too
Athletic teenagers who have sudden pelvic pain during intense sports may describe symptoms similar to that of a pulled muscle. It may be a small pelvis fracture instead: the hamstring muscle attached to the pelvis has pulled away and taken a small piece of bone with it. Prompt medical attention is advised. An x-ray and examination by an orthopedic specialist is the best way to properly diagnose this injury. It will normally heal without surgery but still needs treatment. Patients will often need crutches for 10-12 weeks and may also need blood thinners to protect from blood clots. Physical therapy can be prescribed to help the teen athlete return to sports.
Elderly people with osteoporosis are also susceptible to pelvic fractures, especially after a fall during normal everyday activities. Because their bone density is lower, the bones are brittle and can break after even a moderate fall. Just like the teen athlete's fracture, this type of fracture will heal best if the patient is treated promptly. Surgery is also usually not necessary.
The most common type of pelvic fracture is from high-speed trauma, such as that from a car accident or fall from a height. Accidents that crush the pelvic area are particularly dangerous. Immediate medical attention is required in all of these trauma situations. Severe damage to the pelvis and internal organs often leads to excessive bleeding, which can put the patient at risk of going into shock. Surgery is usually necessary to restore the patient to function and health, and recovery may take a long time.
An orthopedic doctor is a fantastic resource to consult for any type of pelvic injury. He or she can properly diagnose the injury and will be especially helpful in constructing a strength and recovery plan that is tailored specifically to the patient's athletic goals and lifestyle needs.
January 23, 2015
Hands That Hurt in the Morning
The chances of experiencing arthritis symptoms in the hands increase with age. That's because the most common form of arthritis, osteoarthritis, is from "wear and tear" on the joints. Joints have several components, but it's the absence of healthy cartilage that causes the pain associated with arthritis. Age, disease, or injury are the usual cartilage-damaging culprits.
There are several symptoms of arthritis in the hands:
• Pain and stiffness: after an activity that stresses the affected joint, on rainy days, and/or in the morning hours
• Heat radiating from the joint
• Joint "looseness"
• Grating or grinding feeling
• Cysts on the skin that may also cause fingernail deformities
There are more than 100 types of arthritis, but an experienced orthopedic hand doctor and surgeon can give the correct diagnosis by conducting an examination and taking x-rays. A bone scan helps detect less advanced arthritis when symptoms are present and x-rays appear normal. MRI imaging is useful in some cases but is not usually necessary.
Arthritis is easier to treat when symptoms are less advanced. Patients in the early stages usually have the option of anti-inflammatory medications, injections, and part-time splinting to slow the progress and relieve the symptoms of arthritis.
People with more advanced arthritis may see little benefit from those types of treatments, and surgery may be discussed at that time. Some patients are good candidates for joint fusion, although almost all of the major joints in the hand and wrist can now be surgically replaced. Fusion should eliminate pain but limits motion. Replacement restores motion and function and should also eliminate arthritis pain. Other surgical options include cartilage reconstruction and replacement, and more recently, stem-cell treatments using the patients own stem cells.
January 16, 2015
"My ankle doesn't bend all the way up!"
A condition called equinus is often diagnosed when a patient's ankle doesn't bend far enough (less than 10 degrees) in the upward direction toward the leg. It can happen in both ankles but is usually worse in one. Some people with the condition walk on their toes to compensate, so equinus is names after horses (equines), who are toe-walkers.
Equinus can be caused by:
• Tight calf muscles that develop over time or circumstance
• A congenital condition (tight or short calf muscles present at birth)
• Wearing a cast or being on crutches
• Wearing high-heeled shoes
• A "floating" bone fragment from an injury that inhibits ankle motion
• Diabetes (Can cause Achilles' tendon to tighten)
• Neurological disorders involving calf muscle spasms
Equinus can cause all kinds of secondary problems, depending on how a patient compensates for the limited range of motion:
• Plantar fasciitis
• Arch pain
• Arthritis in the middle of the foot
• Pressure sores, pain, or calluses on the ball of the foot
• Ankle pain
• Calf cramps
• Shin splints
Most patients see a doctor for the above symptoms without realizing they have equinus. An orthopedic doctor specializing in the foot and ankle area is best qualified to diagnose and treat the condition. The doctor will perform a thorough examination and take images to look for bone fragments.
Physical therapy is recommended in most cases because it's very effective at stretching the calf muscles. Other treatments may include custom orthotics, arch supports or heel lifts, splinting, anti-inflammatory medications, and activity modification. Most patients do not need surgery to get relief from equinus, but those with a "floating" bone fragment or tight tendon are most likely to need it.
January 9, 2015
"I have back pain! At what point should I see an orthopedic spine doctor?"
The most common cause of back pain is "axial" in nature: it comes on after doing a certain activity or sport, or sitting for long periods. It feels dull or achy, but the pain is tolerable. It is relieved by rest and doesn't require much, if any, special effort to get rid of it.
Other types of back pain don't adhere to these same patterns. They might also feel dull or achy but perhaps don't go away with rest. They might also have happened after a certain sport or activity but they get worse instead of better. Some back pain travels down to the buttocks down the leg, or out to an arm instead of staying in the back. Pain might feel more intense or "shooting" in nature. It interferes with daily activities and exercise. These are all indications that something more serious may be going on.
An orthopedic spine doctor is often the best first stop when any of these things are occurring. They have specialized knowledge about the spine and how all the body systems work together. They can identify the root causes of back pain with a careful, in-depth examination, by taking MRI and/or x-ray images, and by getting your health history. Once a diagnosis is clear, you and your doctor can decide on a treatment course that will work for you. Together you'll set goals and even though every recovery is different, your doctor can help you set expectations for returning to normal life and your favorite activities.
Treatments for back pain vary widely depending on the situation. Most people don't require surgery but instead benefit from activity modification, anti-inflammatory medications, injections, or physical therapy. When surgery is necessary, advanced surgical techniques offer minimally invasive ways to fix, reconstruct, or even regenerate areas of the spine. (Orthopedic doctors are also called orthopedic surgeons because they do perform surgery sometimes, but only on a very low percentage of the people who see them. They're actually doctors who specialize in orthopedic problems and often sub-specialize in a particular area, in this case, the spine.)