Rotator Cuff and Shoulder Conditioning Program

Rotator Cuff and Shoulder Conditioning Program

Article Featured on AAOS

After an injury or surgery, an exercise conditioning program will help you return to daily activities and enjoy a more active, healthy lifestyle. Following a well-structured conditioning program will also help you return to sports and other recreational activities.This is a general conditioning program that provides a wide range of exercises. To ensure that the program is safe and effective for you, it should be performed under your doctor’s supervision. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals.Strength: Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. Keeping these muscles strong can relieve shoulder pain and prevent further injury.Flexibility: Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury. Gently stretching after strengthening exercises can help reduce muscle soreness and keep your muscles long and flexible.Target Muscles: The muscle groups targeted in this conditioning program include:

  • Deltoids (front, back and over the shoulder)
  • Trapezius muscles (upper back)
  • Rhomboid muscles (upper back)
  • Teres muscles (supporting the shoulder joint)
  • Supraspinatus (supporting the shoulder joint)
  • Infraspinatus (supporting the shoulder joint)
  • Subscapularis (front of shoulder)
  • Biceps (front of upper arm)
  • Triceps (back of upper arm)

Length of program: This shoulder conditioning program should be continued for 4 to 6 weeks, unless otherwise specified by your doctor or physical therapist. After your recovery, these exercises can be continued as a maintenance program for lifelong protection and health of your shoulders. Performing the exercises two to three days a week will maintain strength and range of motion in your shoulders.

Getting Started

Warmup:Stretch: After the warm-up, do the stretching exercises shown on Page 1 before moving on to the strengthening exercises. When you have completeds the strengthening exercises, repeat the stretching exercises to end the program.

Do not ignore pain: You should not feel pain during an exercise. Talk to your doctor or physical therapist if you have any pain while exercising.

Ask questions: If you are not sure how to do an exercise, or how often to do it, contact your doctor or physical therapist.

1. Pendulum

Main muscles worked: Deltoids, supraspinatus, infraspinatus, subscapularis

Equipment needed: None

Repetitions: 2 sets of 10
Days Per Week: 5 to 6

Step-by-step directions

  • Lean forward and place one hand on a counter or table for support. Let your other arm hang freely at your side.
  • Gently swing your arm forward and back. Repeat the exercise moving your arm side-to-side, and repeat again in a circular motion.
  • Repeat the entire sequence with the other arm.

Tip: Do not round your back or lock your knees.

2. Crossover Arm Stretch

Main muscles worked: Posterior deltoid
You should feel this stretch at the back of your shoulderEquipment needed: NoneRepetitions: 4 each side
Days Per Week: 5 to 6Step-by-step directions

  • Relax your shoulders and gently pull one arm across your chest as far as possible, holding at your upper arm.
  • Hold the stretch for 30 seconds and then relax for 30 seconds.
  • Repeat with the other arm.

Tip: Do not pull or put pressure on your elbow.

3. Passive Internal Rotation

Main muscles worked: Subscapularis
You should feel this stretch at the front of your shoulderEquipment needed: Light stick, such as a yardstickRepetitions: 4 each side
Days Per Week: 5 to 6Step-by-step directions

  • Hold a stick behind your back with one hand, and lightly grasp the other end of the stick with your other hand.
  • Pull the stick horizontally as shown so that your shoulder is passively stretched to the point of feeling a pull without pain.
  • Hold for 30 seconds and then relax for 30 seconds.
  • Repeat on the other side.

Tip: Do not lean over or twist to side while pulling the stick.

4. Passive External Rotation

Main muscles worked: Infraspinatus, teres minor
You should feel this stretch in the back of your shoulderEquipment needed: Light stick, such as a yardstickRepetitions: 4 each side
Days Per Week: 5 to 6Step-by-step directions

  • Grasp the stick with one hand and cup the other end of the stick with the other hand.
  • Keep the elbow of the shoulder you are stretching against the side of your body and push the stick horizontally as shown to the point of feeling a pull without pain.
  • Hold for 30 seconds and then relax for 30 seconds.
  • Repeat on the other side.

Tip: Keep your hips facing forward and do not twist.

5. Sleeper Stretch

Main muscles worked: Infraspinatus, teres minor
You should feel this stretch in your outer upper back, behind your shoulderEquipment needed: NoneRepetitions: 4 reps, 3x a day
Days Per Week: DailyStep-by-step directions

  • Lie on your side on a firm, flat surface with the affected shoulder under you and your arm bent, as shown. You can place your head on a pillow for comfort, if needed.
  • Use your unaffected arm to push your other arm down. Stop pressing down when you feel a stretch in the back of your affected shoulder.
  • Hold this position for 30 seconds, then relax your arm for 30 seconds.

Tip: Do not bend your wrist or press down on your wrist.

6. Standing Row

Main muscles worked: Middle and lower trapezius
You should feel this exercise at the back of your shoulder and into your upper backEquipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Make a 3-foot-long loop with the elastic band and tie the ends together. Attach the loop to a doorknob or other stable object.
  • Stand holding the band with your elbow bent and at your side, as shown in the start position.
  • Keep your arm close to your side and slowly pull your elbow straight back.
  • Slowly return to the start position and repeat.

Tip: Squeeze your shoulder blades together as you pull.

7. External Rotation With Arm Abducted 90°

Main muscles worked: Infraspinatus and teres minor
You should feel this exercise at the back of your shoulder and into your upper backEquipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Make a 3-foot-long loop with the elastic band and tie the ends together. Attach the loop to a doorknob or other stable object.
  • Stand holding the band with your elbow bent 90° and raised to shoulder-height, as shown in the start position.
  • Keeping your shoulder and elbow level, slowly raise your hand until it is in line with your head.
  • Slowly return to the start position and repeat.

Tip: Make sure your elbow stays in line with your shoulder.

8. Internal Rotation

Main muscles worked: Pectoralis, subscapularis
You should feel this exercise at your chest and shoulderEquipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Make a 3-foot-long loop with the elastic band and tie the ends together. Attach the loop to a doorknob or other stable object.
  • Stand holding the band with your elbow bent and at your side, as shown in the start position.
  • Keep your elbow close to your side and bring your arm across your body.
  • Slowly return to the start position and repeat.

Tip: Keep your elbow pressed into your side.

9. External Rotation

Main muscles worked: Infraspinatus, teres minor, posterior deltoid
You should feel this stretch in the back of your shoulder and upper backEquipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Make a 3-foot-long loop with the elastic band and tie the ends together.
  • Attach the loop to a doorknob or other stable object.
  • Stand holding the band with your elbow bent and at your side, as shown in the start position.
  • Keeping your elbow close to your side, slowly rotate your arm outward.
  • Slowly return to the start position and repeat.

Tip: Squeeze your shoulder blades together when you pull your elbow back.

10. Elbow Flexion

Main muscles worked: Biceps
You should feel this exercise at the front of your upper armEquipment needed: Begin with a weight that allows 3 sets of 8 repetitions and progress to 3 sets of 12 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 3 sets of 8 repetitions.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Stand tall with your weight evenly distributed over both feet.
  • Keep your elbow close to your side and slowly bring the weight up toward your shoulder as shown.
  • Hold for 2 seconds.
  • Slowly return to the starting position and repeat.

Tip: Do not do the exercise too quickly or swing your arm.

11. Elbow Extension

Main muscles worked: Triceps
You should feel this exercise at the back of your upper armEquipment needed: Begin with a weight that allows 3 sets of 8 repetitions and progress to 3 sets of 12 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 3 sets of 8 repetitions.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Stand tall with your weight evenly distributed over both feet.
  • Raise your arm and bend your elbow with the weight behind your head.
  • Support your arm by placing your opposite hand on your upper arm.
  • Slowly straighten your elbow and bring the weight overhead.
  • Hold for 2 seconds.
  • Slowly lower your arm back down behind your head and repeat.

Tip: Keep your abdominal muscles tight and do not arch your back.

12. Trapezius Strengthening

Main muscles worked: Middle and posterior deltoid, supraspinatus, middle trapezius
You should feel this exercise at the back of your shoulder and into your upper backEquipment needed: Begin with a light enough weight to allow 3 to 4 sets of 20 repetitions without pain. As the exercise becomes easier to perform, add 2 to 3 pounds of weight, but do fewer repetitions. Progress to 3 sets of 15 repetitions at each weight increment, with the maximum weight approximately 5 to 7 pounds.Repetitions: 3 sets of 20
Days Per Week: 3 to 5Step-by-step directions

  • Place your knee on a bench or chair and lean forward so that your hand reaches the bench and helps support your weight. Your other hand is at your side, palm facing your body.
  • Slowly raise your arm, rotating your hand to the thumbs-up position and stopping when your hand is shoulder height, with your arm parallel to the floor.
  • Slowly lower your arm to the original position to a count of 5.

Tip: Use a weight that makes the last few repetitions difficult, but pain-free.

13. Scapula Setting

Main muscles worked: Middle trapezius, serratus
You should feel this exercise in your upper back, at your shoulder bladeEquipment needed: NoneRepetitions: 10
Days Per Week: 3Step-by-step directions

  • Lie on your stomach with your arms by your sides.
  • Place a pillow under your forehead for comfort, if required.
  • Gently draw your shoulder blades together and down your back as far as possible.
  • Ease about halfway off from this position and hold for 10 seconds.
  • Relax and repeat 10 times.

Tip: Do not tense up in your neck.

14. Scapular Retraction/Protraction

Main muscles worked: Middle trapezius, serratus
You should feel this exercise in your upper back at your shoulder bladeEquipment needed: Begin with a weight that allows 2 sets of 8 to 10 repetitions and progress to 3 sets of 15 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 2 sets of 8 to 10 repetitions.Repetitions: 2 sets of 10
Days Per Week: 3Step-by-step directions

  • Lie on your stomach on a table or bed with your injured arm hanging over the side.
  • Keep your elbow straight and lift the weight slowly by squeezing your shoulder blade toward the opposite side as far as possible.
  • Return slowly to the starting position and repeat.

Tip: Do not shrug your shoulder toward your ear.

15. Bent-Over Horizontal Abduction

Main muscles worked: Middle and lower trapezius, Infraspinatus, teres minor, posterior deltoid
You should feel this exercise at the back of your shoulder and into your upper backEquipment needed: Begin with a weight that allows 3 sets of 8 repetitions and progress to 3 sets of 12 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 3 sets of 8 repetitions.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

  • Lie on your stomach on a table or bed with your injured arm hanging over the side.
  • Keep your arm straight and slowly raise it up to eye level.
  • Slowly lower it back to the starting position and repeat.

Tip: Control the movement as you lower the weight.

16. Internal and External Rotation

Main muscles worked: Internal rotation: anterior deltoid, pectoralis, subscapularis, latissimus.
External rotation: posterior deltoid, infraspinatus, teres minor
You should feel this exercise in the front and back of your shoulder, your chest, and upper backEquipment needed: Begin with a light enough weight to allow 3 to 4 sets of 20 repetitions without pain. As the exercise becomes easier to perform, add 2 to 3 pounds of weight, but do fewer repetitions. Progress to 3 sets of 15 repetitions at each weight increment, with the maximum weight approximately 5 to 7 pounds.Repetitions: 3 to 4 sets of 20
Days Per Week: 3 to 5Step-by-step directions

  • Lie on your back on a flat surface.
  • Extend your arm straight out from the shoulder and bend the elbow 90° so that your fingers are pointed up.
  • Keeping your elbow bent and on the floor, slowly move your arm in the arc shown. Bring your elbow down to a 45° angle if you experience pain at 90°.

Tip: Use a weight that makes the last few repetitions difficult, but pain-free.

17. External Rotation

Main muscles worked: Infraspinatus, teres minor, posterior deltoid
You should feel this stretch in the back of your shoulder and upper backEquipment needed: Begin with weights that allow 2 sets of 8 to 10 repetitions (approximately 1 to 2 pounds), and progress to 3 sets of 5 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 2 sets of 8 to 10 repetitions.Repetitions: 2 sets of 10
Days Per Week: 3Step-by-step directions

  • Lie on your side on a firm, flat surface with your unaffected arm under you, cradling your head.
  • Hold your injured arm against your side as shown, with your elbow bent at a 90° angle.
  • Keep your elbow against your side and slowly rotate your arm at the shoulder, raising the weight to a vertical position.
  • Slowly lower the weight to the starting position to a count of 5.

Tip: Do not let your body roll back as you raise the weight.

18. Internal Rotation

Main muscles worked: Subscapularis, teres major
You should feel this stretch in the front of your shoulderEquipment needed: Begin with weights that allow 2 sets of 8 to 10 repetitions (approximately 1 to 2 pounds), and progress to 3 sets of 5 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 2 sets of 8 to 10 repetitions.Repetitions: 2 sets of 10
Days Per Week: 3Step-by-step directions

  • Lie on a firm, flat surface on the side of your affected arm.
  • Place a pillow or folded cloth under your head to keep your spine straight.
  • Hold your injured arm against your side as shown, with your elbow bent at a 90° angle.
  • Keep your elbow bent and against your body and slowly rotate your arm at the shoulder, raising the weight to a vertical position.
  • Slowly lower the weight to the starting position.

Tip: Do not let your body roll back as you raise the weight.

Dr. Ernesto Otero-Lopez and Team Celebrate 100th Robotic Surgery in SW United States

Dr. Ernesto Otero-Lopez and Team Celebrate 100th Robotic Surgery in SW United States

Albuquerque, NM – On Tuesday, November 19th, 2019, Dr. Ernesto Otero-Lopez (a spine surgeon with New Mexico Orthopaedic Associates) and his skilled surgical team including Kari LaVigne, PA-C became the first in the Southwestern US (and the third on the West Coast) to complete 100 surgeries utilizing the ExcelsiusGPS®.  This revolutionary robotic navigation platform is designed to streamline the surgical workflow and reduce radiation exposure. It is the world’s first technology to combine a rigid robotic arm and full navigation capabilities into one adaptable platform for accurate trajectory alignment in spine surgery. This advanced technology enhances the safety and improves efficiency for patients, staff and surgeons in the operating room.

Dr. Ernesto Otero-Lopez and Team Celebrate 100th Robotic Surgery in SW United States

It has been an exciting experience to integrate robotic navigation technology into my spine practice and further advance minimally invasive spine techniques that allow patients to get back to their life more quickly. I look forward to the exciting opportunities and undoubtable impact ExcelsiusGPS® will bring to the field of spine surgery, robotics, and navigation” – Ernesto Otero-Lopez, MD

About New Mexico Orthopaedic Associates

NMOA, an independently owned physician group, has been serving patients for over 30 years with highly trained orthopaedic, sports medicine and spine care physicians, working together in New Mexico’s only medical practice that offers diagnosis, treatment, surgery and rehabilitation within one group.

About Globus Medical

Globus Medical, Inc. is a leading musculoskeletal implant manufacturer driving significant technological advancements across a suite of spinal products. Founded in 2003, Globus’ single-minded focus on advancing spinal surgery has made it the fastest growing company in the history of orthopedics. Globus is driven to utilize superior engineering and technology to achieve pain free, active lives for all patients with spinal disorders.

Adult Acquired Flatfoot

Article Featured on AAOS

A variety of foot problems can lead to adult acquired flatfoot deformity (AAFD), a condition that results in a fallen arch with the foot pointed outward.

Most people — no matter what the cause of their flatfoot — can be helped with orthotics, braces and physical therapy. In patients who have tried these treatments without any relief, surgery can be a very effective way to help with the pain and deformity.

This article provides a brief overview of the problems that can result in AAFD.

Adult acquired flatfoot

One of the more common signs of flatfoot is the “too many toes” sign. Even the big toe can be seen from the back of this patient’s foot. In a normal foot, only the fourth and fifth toes should be visible.

Symptoms

Depending on the cause of the flatfoot, a patient may experience one or more of the different symptoms below:

  • Pain along the course of the posterior tibial tendon which lies on the inside of the foot and ankle. This can be associated with swelling on the inside of the ankle.
  • Pain that is worse with activity. High intensity or impact activities, such as running, can be very difficult. Some patients can have difficulty walking or even standing for long periods of time.
  • When the foot collapses, the heel bone may shift position and put pressure on the outside ankle bone (fibula). This can cause pain on the outside of the ankle. Arthritis in the heel also causes this same type of pain.
  • Patients with an old injury or arthritis in the middle of the foot can have painful, bony bumps on the top and inside of the foot. These make shoewear very difficult. Occasionally, the bony spurs are so large that they pinch the nerves which can result in numbness and tingling on the top of the foot and into the toes.
  • Diabetics may only notice swelling or a large bump on the bottom of the foot. Because their sensation is affected, people with diabetes may not have any pain. The large bump can cause skin problems and an ulcer (a sore that does not heal) may develop if proper diabetic shoewear is not used.

Cause

As discussed above, many health conditions can create a painful flatfoot.

Posterior Tibial Tendon Dysfunction (PTTD)

Damage to the posterior tibial tendon is the most common cause of AAFD. The posterior tibial tendon is one of the most important tendons of the leg. It starts at a muscle in the calf, travels down the inside of the lower leg and attaches to the bones on the inside of the foot.

The main function of this tendon is to hold up the arch and support your foot when you walk. If the tendon becomes inflamed or torn, the arch will slowly collapse.

Anatomy of the foot

The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot.

Women and people over 40 are more likely to develop problems with the posterior tibial tendon. Other risk factors include obesity, diabetes, and hypertension. Having flat feet since childhood increases the risk of developing a tear in the posterior tibial tendon. In addition, people who are involved in high impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use.

Arthritis

Inflammatory arthritis, such as rheumatoid arthritis, can cause a painful flatfoot. This type of arthritis attacks not only the cartilage in the joints, but also the ligaments that support the foot. Inflammatory arthritis not only causes pain, but also causes the foot to change shape and become flat.

The arthritis can affect the back of the foot or the middle of foot, both of which can result in a fallen arch.

Injury

An injury to the ligaments in the foot can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from moving. If the ligaments are torn, the foot will become flat and painful. This more commonly occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot.

In addition to ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity.

Diabetic Collapse (Charcot Foot)

People with diabetes or with a nerve problem that limits normal feeling in the feet, can have arch collapse.

This type of arch collapse is typically more severe than that seen in patients with normal feeling in their feet. This is because patients do not feel pain as the arch collapses. In addition to the ligaments not holding the bones in place, the bones themselves can sometimes fracture and disintegrate – without the patient feeling any pain. This may result in a severely deformed foot that is very challenging to correct with surgery. Special shoes or braces are the best method for dealing with this problem.

Summary

Adult acquired flatfoot is one of the most common problems affecting the foot and ankle. Treatment ranges from nonsurgical methods — such as orthotics and braces — to surgery. Your doctor will create a treatment plan for you based on what is causing your AAFD.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

5 Common Causes of Hip Pain in Women

5 Common Causes of Hip Pain in Women

Article Featured on EverydayHealth | By Beth W. Orenstein, Medically Reviewed by Justin Laube, MD

Hip pain in women can result from wear and tear, overuse, and a few other causes. Here are the most common culprits.

Does your hip hurt? As with other types of chronic pain, women tend to experience it more than men. But because hip pain can have a number of different causes, determining the correct one is the key to getting the best treatment.

The Diagnosis: Is It Your Hip?

When you tell your doctor your hip hurts, the first thing she should do is confirm that your hip is actually the problem. Women might say they have hip pain, but what they may mean is that they have pain in the side of the upper thigh or upper buttock, or they may be experiencing lower back pain, says Stephanie E. Siegrist, MD, an orthopedic surgeon in Rochester, New York, and a spokeswoman for the American Academy of Orthopaedic Surgeons. Hip pain is often felt in the groin or on the outside of the hip directly over where the hip joint (a ball-and-socket joint) is located.

Causes of Hip Pain in Women

When a female patient comes to Dr. Siegrist complaining of hip pain, she considers the patient’s age, build, and activity level. If the patient is a thin 20-year-old runner or a heavy, sedentary 80-year-old grandmother, “the possibilities at the top of my list will be different,” she says.

Among the most common causes of hip pain in women are:

1. Arthritis Chronic hip pain in women is often due to arthritis, particularly osteoarthritis, the wear-and-tear kind that affects many people as they age. “The ball-and-socket joint starts to wear out,” Siegrist says. Arthritis pain is often felt in the front of your thigh or in the groin, because of stiffness or swelling in the joint.

2. Hip fractures Hip fractures are common in older women, especially those with osteoporosis (decreased bone density). Symptoms of a hip fracture include pain when you straighten, lift, or stand on your leg. Also, the toes on your injured side will appear to turn out, a sign that can aid your doctor’s preliminary diagnosis.

3. Tendinitis and bursitis Many tendons around the hip connect the muscles to the joint. These tendons can easily become inflamed if you overuse them or participate in strenuous activities. One of the most common causes of tendinitis at the hip joint, especially in runners, is iliotibial band syndrome — the iliotibial band is the thick span of tissue that runs from the outer rim of your pelvis to the outside of your knee.

Another common cause of hip pain in women is bursitis, says Marc Philippon, MD, an orthopedic surgeon in Vail, Colorado. Fluid-filled sacs called bursae cushion the bony part of the hip that is close to the surface. Like the tendons, these sacs can become inflamed from irritation or overuse and cause pain whenever you move the hip joint.

4. Hernia In the groin area, femoral and inguinal hernias — sometimes referred to as sports hernias — can cause anterior (frontal) hip pain in women. Pregnant women can be susceptible to inguinal hernias because of the added pressure on the wall of their abdomen.

5. Gynecological and back issues “Hip pain in women can have gynecological causes,” Siegrist says. “It’s important not to just assume that the pain is caused by arthritis, bursitis, or tendinitis. Depending on your age and other health issues, the pain in your hip could be coming from some other system.”

Endometriosis (when tissue similar to the uterus lining tissue grows outside the uterus) can cause pelvic tenderness, which some women describe as hip pain. Pain from the back and spine also can be felt around the buttocks and hip, Siegrist says. Sciatica, a pinched nerve, typically affects one side of the body and can cause pain in the back of the right or left hip — the pain from sciatica can start in your lower back and travel down to your buttocks and legs.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Biceps Tendon Tear at the Shoulder

Biceps Tendon Tear at the Shoulder

Tendons attach muscles to bones. Your biceps tendons attach the biceps muscle to bones in the shoulder and in the elbow. If you tear the biceps tendon at the shoulder, you may lose some strength in your arm and have pain when you forcefully turn your arm from palm down to palm up.

Many people can still function with a biceps tendon tear, and only need simple treatments to relieve symptoms. If symptoms cannot be relieved by nonsurgical treatments, or if a patient requires complete recovery of strength, surgery to repair the torn tendon may be required.

Anatomy

Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

Biceps tendon

There are two attachments of the biceps tendon at the shoulder joint.

The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade.

The upper end of the biceps muscle has two tendons that attach it to bones in the shoulder. The long head attaches to the top of the shoulder socket (glenoid). The short head attaches to a bump on the shoulder blade called the coracoid process.

Description

Biceps tendon tears can be either partial or complete.

  • Partial tears. Many tears do not completely sever the tendon.
  • Complete tears. A complete tear will split the tendon into two pieces.

In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes when lifting a heavy object.

Biceps tendon tear

Illustration shows a complete tear of the long head at its attachment point in the glenoid.

The long head of the biceps tendon is more likely to be injured. This is because it is vulnerable as it travels through the shoulder joint to its attachment point in the socket. Fortunately, the biceps has two attachments at the shoulder. The short head of the biceps rarely tears. Because of this second attachment, many people can still use their biceps even after a complete tear of the long head.

When you tear your biceps tendon, you can also damage other parts of your shoulder, such as the rotator cuff tendons.

Cause

There are two main causes of biceps tendon tears: injury and overuse.

Injury

If you fall hard on an outstretched arm or lift something too heavy, you can tear your biceps tendon.

Overuse

Many tears are the result of a wearing down and fraying of the tendon that occurs slowly over time. This naturally occurs as we age. It can be worsened by overuse – repeating the same shoulder motions again and again.

Overuse can cause a range of shoulder problems, including tendinitis, shoulder impingement, and rotator cuff injuries. Having any of these conditions puts more stress on the biceps tendon, making it more likely to weaken or tear.

Risk Factors

Your risk for a tendon tear increases with:

  • Age. Older people have put more years of wear and tear on their tendons than younger people.
  • Heavy overhead activities. Too much load during weightlifting is a prime example of this risk, but many jobs require heavy overhead lifting and put excess wear and tear on the tendons.
  • Shoulder overuse. Repetitive overhead sports, such as swimming or tennis, can cause more tendon wear and tear.
  • Smoking. Nicotine use can affect nutrition in the tendon.
  • Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness.

Symptoms

  • Sudden, sharp pain in the upper arm
  • Sometimes an audible pop or snap
  • Cramping of the biceps muscle with strenuous use of the arm
  • Bruising from the middle of the upper arm down toward the elbow
  • Pain or tenderness at the shoulder and the elbow
  • Weakness in the shoulder and the elbow
  • Difficulty turning the arm palm up or palm down
  • Because a torn tendon can no longer keep the biceps muscle tight, a bulge in the upper arm above the elbow (“Popeye Muscle”) may appear, with a dent closer to the shoulder.

Doctor Examination

Medical History and Physical Examination

After discussing your symptoms and medical history, your doctor will examine your shoulder. The diagnosis is often obvious for complete ruptures because of the deformity of the arm muscle (“Popeye Muscle”).

Biceps tendon tear

A biceps tendon tear is made more obvious by contracting the muscle (“Popeye Muscle”).

Partial ruptures are less obvious. To diagnose a partial tear, your doctor may ask you to bend your arm and tighten the biceps muscle. Pain when you use your biceps muscle may mean there is a partial tear.

It is also very important that your doctor identify any other shoulder problems when planning your treatment. The biceps can also tear near the elbow, although this is less common. A tear near the elbow will cause a “gap” in the front of the elbow. Your doctor will check your arm for damage to this area.

In addition, rotator cuff injuries, impingement, and tendinitis are some conditions that may accompany a biceps tendon tear. Your doctor may order additional tests to help identify other problems in your shoulder.

Imaging Tests

  • X-rays. Although x-rays cannot show soft tissues like the biceps tendon, they can be useful in ruling out other problems that can cause shoulder and elbow pain.
  • Magnetic resonance imaging (MRI). These scans create better images of soft tissues. They can show both partial and complete tears.

Treatment

Nonsurgical Treatment

For many people, pain from a long head of biceps tendon tear resolves over time. Mild arm weakness or arm deformity may not bother some patients, such as older and less active people.

In addition, if you have not damaged a more critical structure, such as the rotator cuff, nonsurgical treatment is a reasonable option. This can include:

  • Ice. Apply cold packs for 20 minutes at a time, several times a day to keep down swelling. Do not apply ice directly to the skin.
  • Nonsteroidal anti-inflammatory medications. Drugs like ibuprofen, aspirin, or naproxen reduce pain and swelling.
  • Rest. Avoid heavy lifting and overhead activities to relieve pain and limit swelling. Your doctor may recommend using a sling for a brief time.
  • Physical therapy. Flexibility and strengthening exercises will restore movement and strengthen your shoulder.

Surgical Treatment

Surgical treatment for a long head of the biceps tendon tear is rarely needed. However, some patients who develop cramping of the muscle or pain, or who require complete recovery of strength, such as athletes or manual laborers, may require surgery. Surgery may also be the right option for those with partial tears whose symptoms are not relieved with nonsurgical treatment.

Procedure. Several new procedures have been developed that repair the tendon with minimal incisions. The goal of the surgery is to re-anchor the torn tendon back to the bone. Your doctor will discuss with you the options that are best for your specific case.

Complications. Complications with this surgery are rare. Re-rupture of the repaired tendon is uncommon.

Rehabilitation. After surgery, your shoulder may be immobilized temporarily with a sling.

Your doctor will soon start you on therapeutic exercises. Flexibility exercises will improve range of motion in your shoulder. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan.

Be sure to follow your doctor’s treatment plan. Although it is a slow process, your commitment to physical therapy is the most important factor in returning to all the activities you enjoy.

Surgical Outcome. Successful surgery can correct muscle deformity and return your arm’s strength and function to nearly normal.

8 Ways to Prevent Knee Problems Before They Begin

8 Ways to Prevent Knee Problems Before They Begin

Article Featured on Active Implants

As the largest joint in your body, the knee is a common source of pain and injury. Protect your knees now, and they’ll keep you stepping strong for years to come. Here are some tips to help you keep your knees in tip-top shape.

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3 Lifestyle Choices for Healthier Knees

3 Lifestyle Choices for Healthier Knees

Article Featured on Active Implants

The knee is one of the largest, most complex joints in the human body and the most common joint injured. While several common causes for knee pain exist, many lifestyle choices may reduce pain and postpone or eliminate the need for knee surgery in the future. Here are 3 tips for maintaining healthy knees and a healthier life:

Take care of your overall health

Taking better care of your physical and mental health will not only make for a happier and more fulfilled life, but can also improve the strength of your knees. Studies have shown that ailments such as back pain and depression have been linked to knee pain, so making even the simplest of changes like strengthening your core and losing weight can help stave off the prospect of knee surgery. Did you know losing 10 pounds relieves about 40 pounds of pressure on your knees?

Drink more water

Water is not only vital to healthy bones and skin, it is also vital to knee health. The cartilage in our knees is made up of mostly water – up to 80 percent when we’re properly hydrated. But as we get older, the water content gets lower, resulting in unhealthy cartilage and possibly degenerative joint disease. Lack of water can also lead to dehydration, which can drain your energy and make you tired. So drink up! The Institute of Medicine recommends an adequate intake is roughly about 13 cups of total beverages a day for men, and 9 cups of total beverages a day for women.

Keep moving

Knee cartilage depends on movement to stay healthy and heal. Aim to be active up to 30 minutes a day, five days a week doing any of your favorite knee-safe activities like walking, yoga, swimming or low-impact aerobics. Consider adding in knee exercises to your routine, such as marching, sit to stand/stand to sit, hamstring curls, heel raises and squats for added knee strengthening.

Even after making these healthy lifestyle choices, you may still experience knee pain or injury. If your pain gets to the point that you are unable to enjoy your favorite activities or if it affects your quality of life, it’s time to see a doctor to determine the cause of pain and choose a treatment plan that’s right for you.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Causes and treatments for pain in the arch of the foot

Causes and treatments for pain in the arch of the foot

The arch of the foot is an area along the bottom of the foot between the ball and the heel. Pain in the arch of the foot is a common problem, especially among athletes. The arch is made up of three separate arches that form a triangle. Each arch is made up of bones, ligaments, and tendons.

There are many potential causes of pain in the arch of the foot. Keep reading for more information on these causes, as well as the possible treatments.

Causes

The two most common causes of pain in the arch of the foot involve injury and structural issues. Structural issues typically refer to high or low arches or other abnormalities in the foot and surrounding area.

In both cases, several factors can trigger or aggravate these issues, including:

  • aging
  • overuse
  • weight gain
  • physical stress
  • neurological conditions

Causes of pain in the arch of the foot include:

Overpronation

Overpronation refers to how a person’s foot moves while walking, running, or jogging. A person who overpronates strikes the ground with the outer portion of the heel first. As the person completes the step, the foot rolls too far onto the arch. The extra pressure causes the arch to flatten.

Long term, overpronation can damage the tendons, muscles, and ligaments. This damage can lead to pain in the arch, knee, hip, or back. It may also cause hammertoe and calluses. A person who overpronates often benefits from extra support when walking. Support can include stability shoes and prescription arch supports.

Plantar fasciitis

Plantar fasciitis is a degenerative condition of the plantar fascia and a common causes of heel pain. The plantar fascia is a ligament that connects the back of the foot to the front.

Common causes of plantar fasciitis include:

  • injury
  • overuse
  • inflammation

Anyone can get plantar fasciitis, but activities such as running can increase the risk. If a person has plantar fasciitis, they often feel pain when waking up. The pain typically gets worse throughout the day with walking and standing. In addition to arch pain, a person may feel stiffness in the heel or ball of their foot.

People with plantar fasciitis may need to stop doing activities such as running to let the foot heal. They can also consider wearing support shoes or using inserts to help take pressure off the arch.

Cavus foot

Cavus foot is a structural abnormality that causes a high arch. Causes of cavus foot include:

  • genetics
  • stroke
  • cerebral palsy
  • Charcot-Marie-Tooth disease

If a person has cavus foot, they may feel pain when walking or standing. They may also have reduced stability, which can lead to ankle sprains and injuries.

A person may have other issues related to cavus foot, including:

  • claw toe
  • hammertoe
  • calluses

People with cavus foot can consider support shoes or inserts to help stabilize their feet and avoid pain and possible injury.

Posterior tibial tendon dysfunction

The posterior tibial tendon connects one of the calf muscles to the inner part of the foot. Posterior tibial tendon dysfunction (PTTD) occurs when this tendon is injured or inflamed. If the posterior tibial tendon cannot support the arch, a person may feel pain there as a result.

PTTD pain typically occurs in the inner part of the ankle and back of the calf. The pain usually occurs while running or walking briskly and goes away once a person stops. An ankle brace or specially designed inserts can help correct PTTD.

Flat feet

Flat feet can occur in children or adults. In many cases, flat feet cause no issues, but they can also cause a person to experience pain in the arch, other areas of the foot, legs, ankles, and back.

A person may not realize they have flat feet until symptoms occur. A doctor may recommend using supportive shoes or inserts to help provide additional support for the arch.

Treatment

In some cases, home treatments and stretching are not enough to relieve pain. If this is the case, a doctor or podiatrist may recommend one or more of the following:

  • physical therapy
  • night splints
  • braces
  • casts
  • surgery
  • cortisone injections
  • prescription pain relievers (prescription non-steroidal anti-inflammatory medications)
  • prescription orthotics, support shoes, or inserts

Home remedies and stretches

While undergoing treatment, a person should still consider home remedies and stretches to help alleviate the pain. A person should not attempt these if a doctor advises them not to move the foot.

Some home remedies include:

  • Resting: Stop or significantly reduce doing any activity that aggravates the arch.
  • Applying ice: Apply an ice pack wrapped in a cloth to the arch and other tender areas to help reduce swelling.
  • Wearing socks: Avoid walking around in bare feet.
  • Using support: Consider using cushions, inserts, and support shoes.
  • Splinting: Ask a doctor about splinting the foot at night to help keep it supported while sleeping.
  • Using medication: Try over-the-counter pain relievers, such as ibuprofen.

In addition, there are a few different techniques a person can do to help alleviate pain and make the arch less prone to injury. These include:

Foot Stretch

To perform this stretch:

  • sit down
  • place the foot on the opposite thigh
  • hold the toes with one hand while pushing in and down on the heel with the other
  • gently push the toes towards the heel and hold for 3–5 minutes

Calf stretch

When a person stretches their calves, they can relieve pain and pressure on the arch of the foot. To perform a calf stretch:

  • stand facing the wall and place both hands shoulder width apart on the wall
  • take a step back with one foot
  • bend the front knee forward while keeping the back knee straight and the heel on the floor
  • hold the stretch for 20–30 seconds, repeat three times and then switch legs

Roller or ball foot massage

A person can use a small tennis ball or foam roller to perform a massaging stretch on the foot. This technique is easiest to do while sitting. To use this technique, a person should:

  • take off their shoes and sit in a chair
  • place the ball or roller under the arch of the foot
  • roll it back and forth from the ball of the foot to the heel over the arch

About the arch of the foot

The arch is responsible for several functions in the foot. Some things the arch does include:

  • helps bear weight
  • helps stabilize movements
  • allows the foot to adapt to changes in the terrain as a person walks or runs
  • helps absorb shock
  • helps maintain balance

A person may feel an injury to the arch directly in the area. It is also possible to feel pain or discomfort in other areas, including the:

  • heel
  • ball of foot
  • top of foot
  • hips
  • legs
  • knees
  • back
  • ankles

In some cases, a person may feel the worst pain in the morning. However, most people will experience worse pain during activities, including standing, that directly involves the feet.

When to see a doctor

For occasional pain, resting, ice, and stretching are usually sufficient. However, if the pain does not go away after a few days, is severe, or frequently comes back, a person should talk to a doctor.

A doctor may refer a person to an orthopedic surgeon who specializes in the feet and ankles or a podiatrist, who is a foot specialist. They can examine the person’s foot, how they walk, and other factors to determine what the underlying issue is.

An examination may include:

  • looking for inflammation, tenderness, swelling, deformities,
  • checking balance, coordination, reflexes, sensation, and muscle tone
  • tests such as X-rays, CT scans, MRIs, or ultrasounds

Once a doctor determines the underlying cause of the pain, they will recommend treatments that specifically target the underlying cause and help alleviate pain.

Summary

Arch pain is a common problem, especially among athletes. In many cases, a person can stretch, rest, and ice the arch of their foot until the pain goes away.

Problems with the arch of the foot can also cause pain in different parts of the body, including the ankle, heel, legs, knee, and back. It is essential to treat the problem early to ensure that foot problems do not lead to back or knee injuries.

If the pain persists, gets worse, or is chronic, a person should talk to their doctor about additional treatment options.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Kyphosis (Roundback) of the Spine

Article Featured on AAOS

Kyphosis is a spinal disorder in which an excessive outward curve of the spine results in an abnormal rounding of the upper back. The condition is sometimes known as “roundback” or—in the case of a severe curve—as “hunchback.” Kyphosis can occur at any age, but is common during adolescence.

In the majority of cases, kyphosis causes few problems and does not require treatment. Occasionally, a patient may need to wear a back brace or do exercises in order to improve his or her posture and strengthen the spine. In severe cases, however, kyphosis can be painful, cause significant spinal deformity, and lead to breathing problems. Patients with severe kyphosis may need surgery to help reduce the excessive spinal curve and improve their symptoms.

Anatomy

Your spine is made up of three segments. When viewed from the side, these segments form three natural curves.

The “c-shaped” curves of the neck (cervical spine) and lower back (lumbar spine) are called lordosis. The “reverse c-shaped” curve of the chest (thoracic spine) is called kyphosis.

This natural curvature of the spine is important for balance and helps us to stand upright. If any one of the curves becomes too large or too small, it becomes difficult to stand up straight and our posture appears abnormal.

Side view of the spine

When viewed from the side, a normal spine has three gentle curves.

Other parts of your spine include:

Vertebrae. The spine is made up of 24 small rectangular-shaped bones, called vertebrae, which are stacked on top of one another. These bones create the natural curves of your back and connect to create a canal that protects the spinal cord.

Vertebrae and intervertebral disks

Vertebrae and intervertebral disks in a healthy spine.

Intervertebral disks. In between the vertebrae are flexible intervertebral disks. These disks are flat and round and about a half inch thick. Intervertebral disks cushion the vertebrae and act as shock absorbers when you walk or run.

Description

Although the thoracic spine should have a natural kyphosis between 20 to 45 degrees, postural or structural abnormalities can result in a curve that is outside this normal range. While the medical term for a curve that is greater than normal (more than 50 degrees) is actually “hyperkyphosis,” the term “kyphosis” is commonly used by doctors to refer to the clinical condition of excessive curvature in the thoracic spine that leads to a rounded upper back.

Kyphosis can affect patients of all ages. The condition, however, is common during adolescence—a time of rapid bone growth.

Kyphosis can vary in severity. In general, the greater the curve, the more serious the condition. Milder curves may cause mild back pain or no symptoms at all. More severe curves can cause significant spinal deformity and result in a visible hump on the patient’s back.

Types of Kyphosis

There are several types of kyphosis. The three that most commonly affect children and adolescents are:

  • Postural kyphosis
  • Scheuermann’s kyphosis
  • Congenital kyphosis

Postural Kyphosis

Postural kyphosis, the most common type of kyphosis, usually becomes noticeable during adolescence. It is noticed clinically as poor posture or slouching, but is not associated with severe structural abnormalities of the spine.

The curve caused by postural kyphosis is typically round and smooth and can often be corrected by the patient when he or she is asked to “stand up straight.”

Postural kyphosis is more common in girls than boys. It is rarely painful and, because the curve does not progress, it does not usually lead to problems in adult life.

Scheuermann’s Kyphosis

Scheuermann’s kyphosis is named after the Danish radiologist who first described the condition.

Like postural kyphosis, Scheuermann’s kyphosis often becomes apparent during the teen years. However, Scheuermann’s kyphosis can result in a significantly more severe deformity than postural kyphosis—particularly in thin patients.

Scheuermann’s kyphosis is caused by a structural abnormality in the spine. In a patient with Scheuermann’s kyphosis, an x-ray from the side will show that, rather than the normal rectangular shape, several consecutive vertebrae have a more triangular shape. This irregular shape causes the vertebrae to wedge together toward the front of the spine, decreasing the normal disk space and creating an exaggerated forward curvature in the upper back.

Illustration and x-ray of vertebral wedging

Illustration and x-ray show the vertebral wedging that occurs in patients with Scheuermann’s kyphosis. (Right) Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010

The curve caused by Scheuermann’s kyphosis is usually sharp and angular. It is also stiff and rigid; unlike a patient with postural kyphosis, a patient with Scheuermann’s kyphosis is not able to correct the curve by standing up straight.

Scheuermann’s kyphosis usually affects the thoracic spine, but occasionally develops in the lumbar (lower) spine. The condition is more common in boys than girls and stops progressing once growing is complete.

Scheuermann’s kyphosis can sometimes be painful. If pain is present, it is commonly felt at the highest part or “apex” of the curve. Pain may also be felt in the lower back. This results when the spine tries to compensate for the rounded upper back by increasing the natural inward curve of the lower back. Activity can make the pain worse, as can long periods of standing or sitting.

Clinical photos of a boy with severe kyphosis

Clinical photos taken from the side and front of an adolescent male with an abnormally rounded upper back. His severe kyphosis is most obvious when bending forward. Courtesy of Texas Scottish Rite Hospital for Children

Congenital Kyphosis

Congenital kyphosis is present at birth. It occurs when the spinal column fails to develop normally while the baby is in utero. The bones may not form as they should or several vertebrae may be fused together. Congenital kyphosis typically worsens as the child ages.

Patients with congenital kyphosis often need surgical treatment at a very young age to stop progression of the curve. Many times, these patients will have additional birth defects that impact other parts of the body such as the heart and kidneys.

Clinical photo and MRI of a child with congenital kyphosis

(Left) Clinical photo of a child with congenital kyphosis in his thoracic spine. (Right) An MRI of his spine shows spinal cord compression. This can lead to neurological symptoms like weakness and numbness in the legs. Courtesy of Texas Scottish Rite Hospital for Children

Symptoms

The signs and symptoms of kyphosis vary, depending upon the cause and severity of the curve. These may include:

  • Rounded shoulders
  • A visible hump on the back
  • Mild back pain
  • Fatigue
  • Spine stiffness
  • Tight hamstrings (the muscles in the back of the thigh)

Rarely, over time, progressive curves may lead to:

  • Weakness, numbness, or tingling in the legs
  • Loss of sensation
  • Shortness of breath or other breathing difficulties

Doctor Examination

Mild kyphosis often goes unnoticed until a scoliosis screening at school—and this prompts a visit to the doctor. If changes to the patient’s back are noticeable, however, it is usually quite troubling for both the parents and the child. Concern about the cosmetic appearance of the child’s back is often what leads the family to seek medical help.

Physical Examination

Your doctor will begin by taking a medical history and asking about your child’s general health and symptoms. He or she will then examine your child’s back, pressing on the spine to determine if there are any areas of tenderness.

In more severe cases of kyphosis, the rounding of the upper back or a hump may be clearly visible. In milder cases, however, the condition may be harder to diagnose.

During the exam, your doctor will ask your child to bend forward with both feet together, knees straight, and arms hanging free. This test, which is called the “Adam’s forward bend test,” enables your doctor to better see the slope of the spine and observe any spinal deformity.

Clinical photo of Adam's forward bend test

To assess for a curve, your doctor will ask your child to bend forward at the waist.
Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010

Your doctor may also ask your child to lay down to see if this straightens the curve—a sign that the curve is flexible and may be representative of postural kyphosis.

Tests

X-rays. These studies provide images of dense structures, such as bone. Your doctor may order x-rays from different angles to determine if there are changes in the vertebrae or any other bony abnormalities.

X-rays will also help measure the degree of the kyphotic curve. A curve that is greater than 50 degrees is considered abnormal.

Pulmonary function tests. If the curve is severe, your doctor may order pulmonary function tests. These tests will help determine if your child’s breathing is restricted because of diminished chest space.

Other tests. In patients with congenital kyphosis, progressive curves may lead to symptoms of spinal cord compression, including pain, tingling, numbness, or weakness in the lower body. If your child is experiencing any of these symptoms, your doctor may order neurologic tests or a magnetic resonance imaging (MRI) scan.

Treatment

The goal of treatment is to stop progression of the curve and prevent deformity. Your doctor will consider several things when determining treatment for kyphosis, including:

  • Your child’s age and overall health
  • The number of remaining growing years
  • The type of kyphosis
  • The severity of the curve

Nonsurgical Treatment

Nonsurgical treatment is recommended for patients with postural kyphosis. It is also recommended for patients with Scheuermann’s kyphosis who have curves of less than 75 degrees.

Nonsurgical treatment may include:

Observation. Your doctor may recommend simply monitoring the curve to make sure it does not get worse. Your child may be asked to return for periodic visits and x-rays until he or she is fully grown.

Unless the curve gets worse or becomes painful, no other treatment may be needed.

Physical therapy. Specific exercises can help relieve back pain and improve posture by strengthening muscles in the abdomen and back. Certain exercises can also help stretch tight hamstrings and strengthen areas of the body that may be impacted by misalignment of the spine.

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, including aspirin, ibuprofen and naproxen, can help relieve back pain.

Bracing. Bracing may be recommended for patients with Scheuermann’s kyphosis who are still growing. The specific type of brace and the number of hours per day it should be worn will depend upon the severity of the curve. Your doctor will adjust the brace regularly as the curve improves. Typically, the brace is worn until the child reaches skeletal maturity and growing is complete.

X-rays of a kyphotic spinal curve before and after bracing

(Left) This patient has a 65° curve in the thoracic spine. (Right) Although it cannot be seen on x-ray, the patient is now wearing a back brace that has helped to reduce the excessive curve.
Reproduced from Pizzutillo PD: Nonsurgical treatment of kyphosis. Instructional Course Lectures, Pediatrics. Rosemont IL, American Academy of Orthopaedic Surgeons, 2006, pp. 181-187.

Surgical Treatment

Surgery is often recommended for patients with congenital kyphosis.

Surgery may also be recommended for:

  • Patients with Scheuermann’s kyphosis who have curves greater than 75 degrees
  • Patients with severe back pain that does not improve with nonsurgical treatment

Spinal fusion is the surgical procedure most commonly used to treat kyphosis.

The goals of spinal fusion are to:

  • Reduce the degree of the curve
  • Prevent any further progression
  • Maintain the improvement over time
  • Alleviate significant back pain, if it is present

Surgical Procedure

Spinal fusion is essentially a “welding” process. The basic idea is to fuse together the affected vertebrae so that they heal into a single, solid bone. Fusing the vertebrae will reduce the degree of the curve and, because it eliminates motion between the affected vertebrae, may also help alleviate back pain.

During the procedure, the vertebrae that make up the curve are first realigned to reduce the rounding of the spine. Small pieces of bone—called bone graft—are then placed into the spaces between the vertebrae to be fused. Over time, the bones grow together—similar to how a broken bone heals.

Before the bone graft is placed, your doctor will typically use metal screws, plates and rods to increase the rate of fusion and further stabilize the spine.

Exactly how much of the spine is fused depends upon the size of your child’s curve. Only the curved vertebrae are fused together. The other bones in the spine can still move and assist with bending, straightening, and rotation.

X-rays of a kyphotic curve before and after spinal fusion

(Left) Preoperative x-ray of a 17-year-old boy with a painful 80° curve caused by Scheuermann’s kyphosis. (Right) After spinal fusion and stabilization with plates and screws, the curve has been reduced to 38°.
Reproduced from Wood KB, Melikian R, Villamil F: Adult Scheuermann kyphosis: valuation, management, and new developments. J Am Acad Orthop Surg 2012; 20:113-121

Long-Term Outcomes

If kyphosis is diagnosed early, the majority of patients can be treated successfully without surgery and go on to lead active, healthy lives. If left untreated, however, curve progression could potentially lead to problems during adulthood. For patients with kyphosis, regular check-ups are necessary to monitor the condition and check progression of the curve.

Getting the Most Out of Your Doctor's Visit

Getting the Most Out of Your Doctor’s Visit

Article Featured on AAOS

Your visit with an orthopaedic surgeon is an important meeting that can be most effective if you plan ahead. Research shows that patients who are more involved with their care get better results.

The following checklist will help you become more active in your healthcare and get the most out of each office visit.

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