Is My Hand Pain from Carpal Tunnel Syndrome or Something Else?

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Article featured on Spine-Health.

We all wake up sometimes with a numb and tingly hand. But ongoing hand pain and numbness can be a disabling problem that requires diagnosis and treatment.

Here are 3 of the main causes of hand pain and numbness—and tips for how you can tell them apart.

 Medical illustration of the palmar view of the hand. Transverse carpal ligament, flexor tendons, and median nerve are labeled.

Carpal tunnel syndrome

When hand pain is experienced, it’s common to first suspect carpal tunnel syndrome. This condition is caused by the narrowing of a bony passageway in your wrist, which irritates or compresses the median nerve that runs through it.

Symptoms tend to be in the thumb, index finger, or middle finger, along the path of the median nerve. The pain may wake you up at night or be worse in the morning. In the early stages, shaking your hand may bring relief.

Rheumatoid arthritis

Another possible cause of hand pain and numbness is rheumatoid arthritis.

Hand pain from rheumatoid arthritis tends to be different from carpal tunnel syndrome in 2 main ways:

  1. It causes pain and stiffness in the large knuckles or joints of the wrist, rather than along a nerve path.
  2. Its pain is symmetrical, meaning it will affect both hands simultaneously.

Cervical radiculopathy caused by spine conditions

While it may not seem obvious, your hand pain and/or tingling may actually be caused by a problem in your neck.

The nerves that give sensation to your hands originate in your cervical spine. When one or more of the 8 nerve roots that exit the cervical spine become irritated, it causes pain and other neurological symptoms down the nerve path. This is known as cervical radiculopathy.

The most common conditions that can trigger radiculopathy include:

  • Cervical herniated disc
  • Cervical spinal stenosis
  • Cervical degenerative disc disease
  • Cervical osteoarthritis

Cervical radiculopathy pain can be mildly achy or sharp and stabbing. It can also cause numbness and/or pins-and-needles tingling sensations. Symptoms can affect different sections of the hand depending on what level of the spine is the source of the irritated nerve.

Since carpal tunnel syndrome and cervical radiculopathy can both affect the median nerve, it’s important to note one key difference: Carpal tunnel syndrome pain will only affect the hand and wrist. Cervical radiculopathy from the C6 spine level (where the median nerve originates) will often cause pain and symptoms along the arm and in the bicep, as well as in the hand.

Aside from these 3 causes, hand pain can also be caused by a variety of other conditions, including diabetes and nutritional issues.

The best way to tackle hand pain that doesn’t resolve is to see your doctor, who can diagnose the correct cause and start a treatment plan. Many conditions that cause hand pain are more easily treated if they’re caught early.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Growing Pains – Are They Real?

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Article featured on Nationwide Children’s.

It’s the middle of the night and your child wakes up complaining of leg pain for the third time this week. As a parent, you worry that it might not just be the result of sports practice earlier that day. Is it something much, much worse that you could be overlooking?

“Relax,” says Elise Berlan, MD. The discomfort may simply be from “growing pains.” Medically, growing pains aren’t a big deal, but they can prompt tears, sleeplessness and concerns for all involved.

Here are some common questions about growing pains, how to help your child through them, and when it may be time to see your pediatrician.

What Are Growing Pains?

Children, from preschoolers to preteens, typically experience growing pains as a dull, throbbing ache in both of their legs or calf muscles. The pains come and go, can occur in the day or evening, and can even wake a child up from sleep.

Many people assume that growing pains start in the bones – but there isn’t any scientific evidence that the discomfort is related to bone growth. Some experts think what we know as “growing pains” could be because of a lower pain threshold to muscle strains that are caused by normal play.

Who Gets Growing Pains?

Twenty-five to forty percent of children will experience growing pains at some point in their lives, and are slightly more common in girls than boys. Growing pains seem to happen during the preschool years and again during preteen years, with most cases reported between the ages of three to five and the ages of eight to 12.

What Helps Relieve the Pain?

  • Heating pads
  • Massage
  • Cuddles and distraction with a movie or toy
  • Stretching
  • Ibuprofen or acetaminophen. Ibuprofen can upset the stomach, so give it with food or milk. Never give a child aspirin because it can cause a rare reaction called Reye syndrome.

When Should My Child See a Doctor?

Growing pains never affect a child’s joints, and the pain typically only lasts a few hours at a time. If your child is complaining of long-lasting joint pain or joint pain in the morning, or if the joints look red or swollen, then go see your pediatrician. Also make a doctor’s appointment if the pain is accompanied by limping, fever, rash, changes in appetite, weakness or tiredness.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

What Is Degenerative Arthritis?

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Article featured on MedicalNewsToday

Arthritis is an umbrella term for diseases that affect a person’s joints. Degenerative arthritis, also known as osteoarthritis, is a form of arthritis that develops due to aging or overuse.

Degenerative arthritis is the most common form of arthritis in the United States, where more than 32.5 million adults are living with the condition.

It is sometimes known as the “wear and tear” form of arthritis, as it often occurs due to the natural aging process. It can also develop as a result of an injury or the overuse of a particular joint.

In this article, we look at the causes, risk factors, symptoms, diagnosis, and treatment of degenerative arthritis.

Symptoms of degenerative arthritis

The symptoms of degenerative arthritis vary depending on where in the body a person develops the disease. They usually get worse over time rather than occurring suddenly, except in the case of injuries.

Regardless of which parts of the body the condition affects, common symptoms may include:

  • pain, often throbbing
  • dull aching
  • swelling
  • reduced flexibility
  • clicking or popping noises when a joint bends
  • stiffness
  • decreased range of motion

Typically, joint stiffness will present early in the morning or after periods of rest, and it will last for up to 30 minutes before loosening up again. The joint pain can either be predictable and low level, lasting for long periods, or take the form of intense unpredictable bursts of pain.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the parts of the body that OA most often affects include the:

  • fingers and thumbs
  • knees
  • hips
  • neck
  • lower back

As the condition progresses, people may find themselves unable to complete activities such as holding a coffee pot, going up steps, or walking long distances.

Causes of degenerative arthritis

People develop degenerative arthritis when the joint cartilage between bones becomes damaged or breaks down.

Often, the body activates a repair mechanism to attempt to remedy this damage. As part of this, bone spurs, or osteophytes, may grow within the joint at the end of the bone. These can then cause friction within the joint and lead to pain when the person uses it.

Risk factors

Certain factors may increase a person’s chance of developing degenerative arthritis. These include:

  • Age: Symptoms generally appear in adults over the age of 50 years, although they can occur earlier.
  • Sex: Females are more likely than males to develop OA.
  • Genetics: OA tends to run in families.
  • Weight: Having obesity can increase a person’s likelihood of developing OA, as the additional weight can place extra stress on the joints.
  • Overuse: Repetitively using the same joints, such as in sports or at work, can sometimes lead people to develop OA.

Some of these risk factors, such as weight, are modifiable, whereas a person cannot change others, such as age and genetics.

Diagnosis of degenerative arthritis

There is no single test to confirm the diagnosis of degenerative arthritis.

Instead, doctors will ask a series of questions about the person’s medical history, such as when the pain began and whether they have sustained any injuries to the affected joint or joints. They may also want to know when the pain occurs and what, if anything, makes it worse.

In addition, the doctor can use X-rays to check for bone spurs or other types of bone damage. They may also take samples of fluid from the joints to rule out infection or gout and run blood tests to exclude other possible causes.

Treatment for degenerative arthritis

Healthcare professionals may treat degenerative arthritis in various ways. Some people with the condition may receive a combination of treatments.

The main aims of treatment include:

  • reducing symptoms
  • improving joint function
  • preventing the condition from progressing further
  • maintaining or improving the person’s quality of life

Medications

Doctors prescribe medications to help reduce the pain and inflammation associated with degenerative arthritis.

Medications may include:

  • oral pain relievers, such as acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • oral anti-inflammatory medications
  • corticosteroid injections to relieve inflammation and pain
  • topical products, such as creams, sprays, or rubs, to soothe sore joints

Physical therapy

Combining physical therapy with increased activity levels can help a person manage degenerative arthritis symptoms. People should ensure that they only participate in low impact activities to prevent further damage to the joints.

Maintaining an active lifestyle may help by:

  • reducing pain
  • improving function
  • increasing muscle and bone strength
  • improving mood
  • increasing quality of life
  • preventing falls by improving balance

It can also help a person maintain a moderate weight, which experts advise people with OA to try to do.

Surgery

Some people may need surgery if other treatments prove ineffective or the damage to the joint is extensive.

This surgery could be in the form of an osteotomy, during which a surgeon removes or reshapes part of the damaged bone.

Alternatively, a person may have a partial or total joint replacement, which involves a surgeon partially or entirely removing the joint and replacing it with a synthetic one.

Nonmedical options

Maintaining a moderate weight can help remove the added stress that excess body weight can put on the joints. People can do this by following a nutritious, well-balanced diet and engaging in regular, low impact physical activity.

Hot and cold therapies may also help relieve pain and stiffness in the joints. People should alternate the application of hot and cold compresses to the areas over the affected joints.

However, a person should always wrap an ice pack in a cloth first so that they are not applying it directly to their skin.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Why Does My Elbow Hurt?

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Article featured on WebMD

Your elbow lets you throw, lift, swing, and hug, for starters. You can do all this because it’s not a simple joint. And that means there are a lot of ways things can go wrong. Your elbow’s a joint formed where three bones come together — your upper arm bone, called the humerus, and the ulna and the radius, the two bones that make up your forearm.Each bone has cartilage on the end, which helps them slide against each other and absorb shocks. They’re lashed into place with tough tissues called ligaments. And your tendons connect your bones to muscles to allow you to move your arm in different ways.If anything happens to any of these parts, not to mention the nerves and blood vessels around them, it can cause you pain.Here are some of the different ways your elbow can hurt:

One-time Injuries

Some injuries, hopefully, are one-off events, like when you fall or get hit hard while playing a sport.

  • Dislocated elbow. When one of the bones that forms the elbow gets knocked out of place, you have a dislocated elbow. One of the more common causes is when you put your hand out to catch yourself during a fall. It can also happen to toddlers when you swing them by their forearms — that’s called nursemaid’s elbow. If you think you or your child has a dislocated elbow, call your doctor right away.
  • Fractured elbow: If one of your arm bones breaks at the elbow, you have a fracture. Usually, this happens with a sudden blow, as you might get in a contact sport or a car accident. And don’t be fooled if you can still move your elbow afterward. If you’re in pain and it doesn’t look right, it could be broken. You’ll need medical attention.
  • Strains and sprains: File these under, “Oof, I think I pushed it a little too far.” When muscles get stretched or torn, it’s called a strain. When it’s ligaments, it’s a sprain.
You can get a strain when you put too much pressure on your elbow muscles, like when you lift heavy objects or overdo it with sports.Elbow sprains are common in athletes who throw, use racquets, or play contact sports.Both are treated with rest, ice and — once the pain is gone — stretching and strength exercises.

Wear-and-Tear Injuries

Other injuries occur over time, as you repeat certain actions and put wear and tear on your elbow. You can injure yourself playing sports or in any number of work settings, from a factory to an office.

  • Bursitis: Often caused by repeating the same motion over and over, you can also get bursitis from an accident or infection. Bursa are small sacs with fluid in them. You have them in your joints to help cushion your bones, tendons, and muscles. They also help skin slide over bone. But they can get swollen and cause you pain. Often, bursitis is simply treated with pain medicine and starts to get better within a few weeks.
  • Tennis elbow and golfer’s elbow: These are both types of tendinopathy or tendinosis, which means you have damage in the tendons around your elbow from overuse. Despite the names, the injuries aren’t limited to golfers or tennis players. You’re just more likely to get them based on the arm motions used in those sports. The main difference between the two is that tennis elbow affects the outside of your elbow, while golfer’s elbow affects the inside.
  • Trapped nerves: You might be familiar with carpal tunnel syndrome, where a nerve that passes through your wrist gets squeezed and causes some wrist and arm issues. You can have similar problems in your elbow.
  • If you have radial tunnel syndrome, you have a similar issue with the radial nerve as it passes through the radial tunnel near the outside of your elbow. You may have burning or numbness on your outside forearm and elbow.
  • Stress fractures: With a stress fracture, you have a small crack in one of your arm bones, usually from overuse. They’re more common in the lower legs and feet, but athletes who throw a lot, such as baseball pitchers, can get them in the elbow, too. The pain is usually worse when throwing.

Diseases

Several diseases can also cause elbow pain, though it’s usually not the main symptom.

  • Arthritis: Many types of arthritis can affect your elbow, but the main ones are rheumatoid arthritis and osteoarthritis.
    • Rheumatoid arthritis is the most common type of arthritis in the elbow. When you have it, your immune system attacks your body’s healthy tissue and causes swelling in your joints. You get osteoarthritis when your elbow cartilage breaks down over time, which means the bones rub together and cause pain and stiffness.
  • Osteochondritis dissecans: Children and teenagers mostly get this condition, where a piece of bone near the elbow dies. The bone piece and some cartilage then break off, which causes pain during physical activity. It’s more common in the knees, but can happen in the elbow, as well.
  • Gout: This is actually a type of arthritis. Uric acid, normally a waste product to be sent out of your body, builds up as crystals in your tissues. If the buildup happens in your elbow, it can be very painful.
  • Lupus: This is another illness where your immune system attacks healthy parts of your body, including your joints and organs. It more commonly affects your hands and feet, but it can cause problems in your elbow.
  • Lyme disease: Carried by ticks, Lyme disease can cause serious problems if not treated early. You may have issues with your nervous system and pain in your joints, like your elbow.

When to Call Your Doctor

If you think you’ve fractured or dislocated your elbow — it hurts and doesn’t look right — go to the emergency room.

Call your doctor if you have:

  • Elbow pain that doesn’t go away with rest and ice, or pain that doesn’t go away even when you’re not using your arm
  • Intense pain, swelling, and bruising around your elbow
  • Pain, swelling, or redness that gets worse, especially if you have a fever, too
  • Problems using your elbow, such as difficulty bending your arm

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

How to Protect Your Spine When You Have Osteoporosis

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Article featured on Spine-Health

In some cases of osteoporosis, one or more vertebral bones can become so weak that they cannot fully support their load and develop tiny cracks. This type of fracture, called a vertebral compression fracture, can be painful and sometimes leads to worsening symptoms, such as tingling, numbness, weakness, or spinal deformity (kyphosis). Fortunately, you can take steps to lower your risk for vertebral compression fractures, as well as seek treatment if one occurs.

Visit your doctor regularly

If you’re dealing with a chronic condition, such as osteoporosis, it’s especially important to have regular checkups to monitor how you’re doing and whether the treatment plan needs to be adjusted. For example, your doctor might recommend certain medications for osteoporosis, such as bisphosphonates, which may reduce the risk for a vertebral compression fracture.

Eat healthy and quit bad habits

Everyone needs to get plenty of calcium for bone health. If you have osteoporosis or low bone mass, your doctor might also recommend calcium supplements. In addition, it is important to get plenty of vitamin D, which helps the body absorb calcium into the bones.

If you smoke, try to quit. Smoking is known to weaken bones and can worsen osteoporosis.

Regularly drinking lots of soda and/or alcohol may also contribute to weaker bones. If you are in the habit of drinking soda or alcohol every day, try to quit or cut back.

Consult with your doctor to find a balanced diet that works best for you. While it’s important to get enough calcium for bone health, too much calcium can also potentially cause problems, such as kidney stones.

Stay active but use good judgment

The phrase “use it or lose it” is especially true when it comes to your bones. Weight-bearing activities help to build and maintain bone mass. On the other hand, being inactive allows the bones to thin and weaken.

In general, it is good for people to stay active and exercise regularly. If you’ve been diagnosed with osteoporosis or low bone mass, check with your doctor regarding which activities may or may not be right for you. A supervised physical therapy program that focuses on safe resistance exercises may be recommended to help build muscle strength and bone density. Research continues to show that resistance training can strengthen both muscles and bones, even in older people, which may also lower the risk for osteoporotic fractures.

Most people with osteoporosis are encouraged to do some form of weight-bearing exercise as a way to better maintain bone mass, but some activities may be discouraged. For example, your doctor might advise against heavy lifting, doing sit-ups, or bending over to touch the toes, which could put undue stress on the spine.

Don’t ignore a compression fracture

Any time you have back pain that lasts more than a week or two, it is important to see the doctor. Ignoring back pain and potential vertebral compression fractures may lead to bigger problems down the road, such as increased pain, tingling, numbness, weakness, and severe spinal deformity.

Most vertebral compression fractures are treated nonsurgically, such as with rest, pain medications, or applying ice and/or heat while the fracture eventually heals on its own. If the pain cannot be successfully managed with nonsurgical treatments, surgery may be considered. A couple of surgical options for vertebral compression fractures include:

  • Vertebroplasty. This minimally-invasive procedure involves carefully placing a needle through the back and into the compression fracture, delivering bone cement to fill the cracks and re-stabilize the vertebra.

  • Kyphoplasty. This procedure is similar to vertebroplasty, except that a small balloon is inserted and expanded into the compression fracture to help restore the collapsed vertebra closer to its original height before injecting the bone cement.

Some studies have found that both vertebroplasty and kyphoplasty have been effective at reducing pain from vertebral compression fractures, especially when done within 2 months of sustaining the fracture.

By following these tips, you’re well on your way to protecting your spine and successfully managing osteoporosis.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours

Rheumatoid Arthritis of the Foot and Ankle

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Article featured on OrthoInfo

Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. It most often starts in the small joints of the hands and feet, and usually affects the same joints on both sides of the body. More than 90% of people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease.

Description

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.

How It Happens

The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes an overactivity of this lining. It swells and becomes inflamed, destroying the joint, as well as the ligaments and other tissues that support it. Weakened ligaments can cause joint deformities — such as claw toe or hammer toe. Softening of the bone (osteopenia) can result in stress fractures and collapse of bone.

In RA, the lining of the joint swells and becomes inflamed. This slowly destroys the joint.

Rheumatoid arthritis is not an isolated disease of the bones and joints. It affects tissues throughout the body, causing damage to the blood vessels, nerves, and tendons. Deformities of the hands and feet are the more obvious signs of RA. In about 20% of patients, foot and ankle symptoms are the first signs of the disease.

Statistics

Rheumatoid arthritis affects approximately 1% of the population. Women are affected more often than men, with a ratio of up to 3 to 1. Symptoms most commonly develop between the ages of 40 and 60.

Cause

The exact cause of RA is not known. There may be a genetic reason — some people may be more likely to develop the disease because of family heredity. However, doctors suspect that it takes a chemical or environmental “trigger” to activate the disease in people who inherit RA.

Symptoms

The most common symptoms are pain, swelling, and stiffness. Unlike osteoarthritis, which typically affects one specific joint, symptoms of RA usually appear in both feet, affecting the same joints on each foot.

Anatomy of the foot and ankle

Anatomy of the foot and ankle.

Ankle

Difficulty with inclines (ramps) and stairs are the early signs of ankle involvement. As the disease progresses, simple walking and standing can become painful.

Hindfoot (Heel Region of the Foot)

The main function of the hindfoot is to perform the side-to-side motion of the foot. Difficulty walking on uneven ground, grass, or gravel are the initial signs. Pain is common just beneath the fibula (the smaller lower leg bone) on the outside of the foot.

As the disease progresses, the alignment of the foot may shift as the bones move out of their normal positions. This can result in a flatfoot deformity. Pain and discomfort may be felt along the posterior tibial tendon (main tendon that supports the arch) on the inside of the ankle, or on the outside of the ankle beneath the fibula.

Midfoot (Top of the Foot)

With RA, the ligaments that support the midfoot become weakened and the arch collapses. With loss of the arch, the foot commonly collapses and the front of the foot points outward. RA also damages the cartilage, causing arthritic pain that is present with or without shoes. Over time, the shape of the foot can change because the structures that support it degenerate. This can create a large bony prominence (bump) on the arch. All of these changes in the shape of the foot can make it very difficult to wear shoes.

Rheumatoid arthritis of the midfoot

This x-ray shows signs of RA of the midfoot. Note that the front of the foot points outward and there is a large bump on the inside and bottom of the foot.

Forefoot (Toes and Ball of the Foot)

The changes that occur to the front of the foot are unique to patients with RA. These problems include bunions, claw toes, and pain under the ball of the foot (metatarsalgia). Although, each individual deformity is common, it is the combination of deformities that compounds the problem.

The bunion is typically severe and the big toe commonly crosses over the second toe.

Illustration of bunion and claw toe

People with RA can experience a combination of common foot problems, such as bunions and clawtoe.

There can also be very painful bumps on the ball of the foot, creating calluses. The bumps develop when bones in the middle of the foot (midfoot) are pushed down from joint dislocations in the toes. The dislocations of the lesser toes (toes two through five) cause them to become very prominent on the top of the foot. This creates clawtoes and makes it very difficult to wear shoes. In severe situations, ulcers can form from the abnormal pressure.

Severe claw toes can become fixed and rigid. They do not move when in a shoe. The extra pressure from the top of the shoe can cause severe pain and can damage the skin.

Doctor Examination

Medical History and Physical Examination

After listening to your symptoms and discussing your general health and medical history, your doctor will examine your foot and ankle.

Skin. The location of callouses indicate areas of abnormal pressure on the foot. The most common location is on the ball of the foot (the underside of the forefoot). If the middle of the foot is involved, there may be a large prominence on the inside and bottom of the foot. This can cause callouses.

Foot shape. Your doctor will look for specific deformities, such as bunions, claw toes, and flat feet.

Flexibility. In the early stages of RA, the joints will typically still have movement. As arthritis progresses and there is a total loss of cartilage, the joints become very stiff. Whether there is motion within the joints will influence treatment options.

Tenderness to pressure. Although applying pressure to an already sensitive foot can be very uncomfortable, it is critical that your doctor identify the areas of the foot and ankle that are causing the pain. By applying gentle pressure at specific joints your doctor can determine which joints have symptoms and need treatment. The areas on the x-ray that look abnormal are not always the same ones that are causing the pain.

Imaging Tests

Other tests that your doctor may order to help confirm your diagnosis include:

X-rays. This test creates images of dense structures, like bone. It will show your doctor the position of the bones. The x-rays can be used by your doctor to make measurements of the alignment of the bones and joint spaces, which will help your doctor determine what surgery would best.

Computerized tomography (CT) scan. When the deformity is severe, the shape of the foot can be abnormal enough to make it difficult to determine which joints have been affected and the extent of the disease. CT scans allow your doctor to more closely examine each joint for the presence of arthritis.

Magnetic resonance imaging (MRI) scan. An MRI scan will show the soft tissues, including the ligaments and tendons. Your doctor can assess whether the tendon is inflamed (tendonitis) or torn (ruptured).

Rheumatology Referral

Your doctor may refer you to a rheumatologist if he or she suspects RA. Although your symptoms and the results from a physical examination and tests may be consistent with RA, a rheumatologist will be able to determine the specific diagnosis. There are other less common types of inflammatory arthritis that will be considered.

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Nonsurgical Treatment

Although there is no cure for RA, there are many treatment options available to help people manage pain, stay active, and live fulfilling lives.

Rheumatoid arthritis is often treated by a team of healthcare professionals. These professionals may include rheumatologists, physical and occupational therapists, social workers, rehabilitation specialists, and orthopaedic surgeons.

Although orthopaedic treatment may relieve symptoms, it will not stop the progression of the disease. Specific medicines called disease-modifying anti-rheumatic drugs are designed to stop the immune system from destroying the joints. The appropriate use of these medications is directed by a rheumatologist.

Orthopaedic treatment of RA depends on the location of the pain and the extent of cartilage damage. Many patients will have some symptom relief with appropriate nonsurgical treatment.

Rest

Limiting or stopping activities that make the pain worse is the first step in minimizing the pain. Biking, elliptical training machines, or swimming are exercise activities that allow patients to maintain their health without placing a large impact load on the foot.

Ice

Placing ice on the most painful area of the foot for 20 minutes is effective. This can be done 3 or 4 times a day. Ice application is best done right after you are done with a physical activity. Do not apply ice directly to your skin.

Nonsteroidal Anti-inflammatory Medication

Drugs, such as ibuprofen or naproxen, reduce pain and inflammation. In patients with RA, the use of these types of medications should be reviewed with your rheumatologist or medical doctor.

Orthotics

An orthotic (shoe insert) is a very effective tool to minimize the pressure from prominent bones in the foot. The orthotic will not be able to correct the shape of your foot. The primary goal is to minimize the pressure and decrease the pain and callous formation. This is more effective for deformity in the front and middle of the foot/

For people with RA, hard or rigid orthotics generally cause too much pressure on the bone prominences, creating more pain. A custom orthotic is generally made of softer material and relieves pressure on the foot.

Braces

A lace-up ankle brace can be an effective treatment for mild to moderate pain in the back of the foot and the ankle. The brace supports the joints of the back of the foot and ankle. In patients with a severe flatfoot or a very stiff arthritic ankle, a custom-molded plastic or leather brace is needed. The brace can be a very effective device for some patients, allowing them to avoid surgery.

Ankle brace

A custom-molded leather brace can be effective in minimizing the pain and discomfort from ankle and hindfoot arthritis.

Steroid Injection

An injection of cortisone into the affected joint can help in the early stages of the disease. In many cases, a rheumatologist or medical doctor may also perform these injections. The steroid helps to reduce inflammation within the joint. The steroid injection is normally a temporary measure and will not stop the progression of the disease.

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Surgical Treatment

Your doctor may recommend surgery depending upon the extent of cartilage damage and your response to nonsurgical options.

Fusion. Fusion of the affected joints is the most common type of surgery performed for RA. Fusion takes the two bones that form a joint and fuses them together to make one bone.

During the surgery, the joints are exposed and the remaining cartilage is removed. The two bones are then held together with screws or a combination of screws and plates. This prevents the bones from moving.

Because the joint is no longer intact, this surgery does limit joint motion. Limited joint motion may not be felt by the patient, depending on the joints fused. The midfoot joints often do not have much motion to begin with, and fusing them does not create increased stiffness. The ankle joint normally does have a lot of motion, and fusing it will be noticeable to the patient. By limiting motion, fusion reduces the pain.

Fusion can be a successful technique. However, because patients with RA also show damaged cartilage and loose ligaments, the success rate of this type of surgery is lower in patients with RA than in patients without RA. The use of newer generation medication can slow the progression of the disease and impact the type of surgeries that can be performed successfully.

Other surgeries. The front of the foot is where there are more surgical options for some patients. Surgeons can now perform joint sparing operations to correct the bunion and hammertoes in some patients. Your surgeon will review the most appropriate options for your case.

Ankle

Ankle fusion and total ankle replacement are the two primary surgical options for treating RA of the ankle. Both treatment options can be successful in minimizing the pain and discomfort in the ankle. The appropriate surgery is based upon multiple factors and is individualized for every patient.

Ankle fusion and ankle replacement

This patient had arthritis of the hindfoot. It was treated by fusing all three joints of the hindfoot (triple fusion). An ankle replacement was also done in order to improve mobility and avoid the severe stiffness that would result from another ankle fusion. The ankle replacement implants can be seen here from the front and the side.

Patients with severe involvement of other joints around the heel or patients who have previously undergone a fusion on the other leg, may be more suited for ankle replacement. In addition, patients who have fusions within the same foot may be more suited for an ankle replacement.

Newer generation ankle replacement implants have shown promising early results. Ankle replacement implants have not yet been shown to be as long-lasting as those for the hip or knee, due to the fact that the newer generation of implants have not been available long enough to determine how long they will last.

Ankle fusion

These x-rays show an ankle fusion from the front and the side. The number and placement of screws and the use of a plate are dependent upon the surgeon’s technique.

Following ankle fusion, there is a loss of the up and down motion of the ankle. The up and down motion is transferred to the joints near the ankle. This creates a potential for pain in those joints, and possibly arthritis.

Patients are able to walk in shoes on flat, level ground without much difficulty after an ankle fusion, despite the loss of ankle motion. The joints in the foot next to the ankle joint allow for motion similar to the ankle joint, and help patients with fused ankle joints walk more normally.

Arthritis in subtalar joint

Over time, the increased stress that is placed on the rest of the foot after an ankle fusion can lead to arthritis of the joints surrounding the ankle. This patient had pain in the subtalar joint (arrow) and required an additional fusion of that joint to minimize the pain. Increased stress on other joints is the most concerning problem following ankle fusion.

Hindfoot (Heel Region of the Foot)

A fusion of the affected joints of the hindfoot is the most common surgery used to treat patients with flatfoot or arthritis of the hindfoot. A triple arthrodesis is a fusion that involves all three joints in the back of the foot. Occasionally, the joint on the outside of the foot is not fused if there is minimal to no involvement of that joint (this is at the surgeon’s discretion). This type of fusion eliminates the side-to-side motion of the foot, while preserving most of the up and down movement.

If RA is only in one joint, then a fusion of just that affected joint may be all that is needed.

Ankle fusion

(Left) In this x-ray, two of the three joints in the hindfoot have been fused. (Right) Just the subtalar joint is fused in this x-ray.

Any fusion of the hindfoot will limit side-to-side motion of the foot. This will affect walking on uneven ground, grass, or gravel. There is no method to replace the joints of the hindfoot.

Midfoot (Middle of the Foot)

Fusion is the most reliable surgical method to treat RA of the midfoot joints. If the shape of the foot is not normal, surgery is designed to help restore the arch and minimize the prominences on the foot.

There are joint replacement implants available for joints on the outside of the midfoot. This may preserve some midfoot motion. However, the use of these implants is at the surgeon’s discretion. These implants are not available for the joints on the inside of the midfoot.

Although the foot cannot be returned to a normal shape, the goals are to reduce pain in the foot and improve the potential for the patient to wear more normal shoes.

Reconstruction of collapsed arch

(Top) This x-ray shows RA of the midfoot that has collapsed the arch. (Bottom) The surgical reconstruction involved a fusion of the middle of the foot with plates and screws.

Forefoot (Toes and Ball of the Foot)

The choice of treatment for patients with a bunion or lesser toe deformities (hammer or claw toes) depends on a number of factors.

If the disease is very mild, joint-sparing procedures that preserve motion can be considered. The decision is dependent on the medication that the patient is taking and the amount of damaged cartilage that is present. A fusion of the great toe may be recommended despite that fact the bunion is very mild. If there is damage to the cartilage of the great toe joint, correcting the bunion will not minimize the arthritic pain.

If the RA has progressed and the lesser toes (two through five) have dislocated, a complex operation to minimize the pain and restore the shape of the foot may be recommended. The operation involves fusion of the big toe and removing a portion of bone of each of the metatarsals. This surgery removes the prominent bone on the bottom of the foot that is a source of the pain and allows the toes to re-align into a better position.

Occasionally, the lesser toe metatarsals can be preserved by shortening them to allow the toes to resume their position within the joints. This is not always possible, however, and the joint may have to be removed.

RA of the forefoot before and after fusion

(Left) RA of the forefoot. The big toe is deviated and crosses over the second toe, a typical appearance of a bunion. The lesser toes (two through five) are dislocated, resulting in painful and severe claw toes. (Right) This x-ray taken immediately after fusion of the big toe shows that the prominent bones on the ball of the foot were removed and the claw toes were corrected. The pins hold the toes in place while the soft tissues heal. The pins are removed in the office after 4 to 6 weeks with minimal discomfort.

To fix the bend in the toes themselves, the surgeon may suggest cutting a tendon or removing a small portion of bone of the toes to allow them to straighten. Pins that stick out of the foot are temporarily required and will be removed in the office after healing takes place.

There are some newer implants available that can be buried within the toes, which avoid the need for pins sticking out of the foot. These implants may not work if the bone is soft, or if significant destruction of the joints has occurred.

This operation puts a lot of stress on the blood vessels and skin of the foot. In severe cases, the toes may not survive the operation and may require amputation of a portion or the entire toe. This operation can provide the patient with a high level of function and the ability to enjoy a wider variety of shoewear.

Footwear

Reconstruction of the foot does not mean that a patient will be required to wear bulky and unappealing shoes every day. The patient shown here had both feet reconstructed. She is able to wear sandals and mild heels without difficulty. Although these types of shoes are not recommended all the time, they can be worn from time to time. Not all patients will achieve such an excellent result.

Preparing for Surgery

Many of the medications that help with RA also affect the ability of the body to heal wounds and fight infection. Your surgeon will work with your rheumatologist or medical doctor to review which of your medications will need to be stopped prior to surgery. Once the wounds are healed, the medication is typically resumed.

This period of time can be very difficult for patients with other areas of the body that are affected by RA. Many fusions require at least 6 weeks of time where no pressure can be placed on the foot. Making appropriate preparations to ensure you have help at home is crucial for success after surgery.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Six Common Winter Injuries and How to Avoid Them

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Article featured on Froedtert & Medial College of Wisconsin. 

Winter is approaching! Find out how to avoid common injuries. Cold, snow and ice are part of living in Wisconsin in the winter, so it can be challenging to stay healthy at this time of year. Emergency departments often see people suffering from winter-related injuries, some of which are preventable.

1. Slips and Falls

Icy outdoor surfaces make people vulnerable to slips and falls. Common injuries include broken bones, hurt backs or sprained joints. Head injuries are also common.

Being mindful of how you walk in the winter can decrease your chances of slipping on ice. Take short, slow steps with slightly bent knees — as if you’re waddling like a penguin — and extend your arms to your sides. Leaving your hands in your pockets will make it harder to keep your balance. Use handrails whenever possible, and treat every walkway as though it has black ice.

Appropriate care after a fall is always important, and this is especially true for older adults. Older people, especially those over 65, can be severely injured as a result of what in younger people might constitute a minor fall, such as slipping while stepping off a curb. Broken hips, head injuries and other serious injuries can significantly impact overall health, well-being and longevity and should not be underestimated. An urgent care clinic may be appropriate if you think you have a sprain or strain. Many minor injuries can be treated by rest, ice, compression and elevation (RICE). Call your primary care doctor for advice, or try an online virtual clinic.

If you fall and are unable to get up, think you may have a broken bone or are in severe pain, you probably need emergency care. This is especially important if you have or think you may have a head injury, as it may be serious. Seek emergency care if you have a loss of consciousness, a severe headache after the fall, nausea and vomiting, confusion or disorientation after the injury, increased sleepiness, seizures or are on blood-thinning medications.

2. Back and Neck Injuries

Shoveling can lead to neck and back injuries, which is why proper form is important. Instead of lifting the snow onto the shovel, push the snow away. Protect your back by keeping a slight bend in your knees. You may also want to warm up your muscles first by stretching.

3. Heart Attacks

Shoveling snow or using a snow blower can be strenuous work, especially for someone whose heart may not be used to that amount or type of exercise. If you have one or more risk factors for heart disease, avoid overexerting yourself in cold weather. That means taking frequent breaks from shoveling or having someone else do it for you, and going inside if you start to overheat.

If you experience shortness of breath, chest pain or any other heart attack symptoms, you should call 911 immediately. If you haven’t seen your primary care doctor in a while, it may be time for a yearly checkup to ensure you are in tip-top shape!

4. Hypothermia

The body does an excellent job of maintaining a constant temperature, but extended exposure to cold can overwhelm its auto-regulation. Hypothermia occurs when a person’s body temperature drops below 95°F. If you must be outside during frigid weather, wear plenty of layers and stay as dry as possible. Elderly individuals and young children are often at more risk, but hypothermia can affect anyone. Alcohol use can also make you more susceptible to hypothermia.

Warnings signs of hypothermia include shivering, loss of dexterity, impaired thinking, high pulse and increased breathing. Shivering is one way the body maintains its temperature. As hypothermia progresses, the body’s shivering mechanism may stop working, people may get more confused and the heart can stop working normally. If you think someone is suffering from hypothermia, call 911, gently bring them out of the cold and remove any wet clothing. If you think someone does not have a pulse, call 911 and start CPR.

5. Frostbite

Frostbite can cause permanent damage to the body as skin, nerves and tissue freeze at the site of injury. Your extremities — hands, feet, ears or tip of your nose — are most vulnerable. Avoid prolonged time outdoors in frigid weather. If you must go outside, wearing gloves, warm socks and hats can help prevent frostbite.

The first signs of frostbite can be numbness, clumsiness and cold skin. The skin can also appear discolored or turn black. Treatment often includes rewarming (as long as there is no risk of re-freezing), wound care, and pain control. If you believe you may be experiencing frostbite, seek emergency care.

6. Carbon Monoxide Poisoning

Carbon monoxide is often called “the silent-killer” because it is an odorless, colorless gas found in exhaust fumes of carbon containing fuels (gas, wood, coal, etc). Inhaling the fumes causes the carbon monoxide to build up in your blood stream. Carbon monoxide decreases delivery of oxygen to your body. This can lead to brain and heart problems. Symptoms of carbon monoxide poisoning include headache, nausea, dizziness and tiredness.

The risk for carbon monoxide poisoning increases in the winter due to an increased use of fume-producing products like fireplaces, furnaces and kerosene heaters. To prevent carbon monoxide poisoning, have your home heating system inspected every winter and make sure any fuel-burning devices, like heaters or gasoline generators, are properly ventilated. If you have a fireplace, clean your chimney and flue annually. Do not “warm up” your car in a garage, as this can lead to a build-up of carbon monoxide. Install a carbon monoxide alarm or test your existing alarm.

If you suspect someone may be suffering from carbon monoxide poisoning, get them outdoors and call 911. Fire departments have devices to test for carbon monoxide and can initiate medical care if you need it.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Patellar Tendinitis: Causes and Symptoms

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Article featured on Mayo Clinic

Overview

Patellar tendinitis is an injury to the tendon connecting your kneecap (patella) to your shinbone. The patellar tendon works with the muscles at the front of your thigh to extend your knee so that you can kick, run and jump.

Patellar tendinitis, also known as jumper’s knee, is most common in athletes whose sports involve frequent jumping — such as basketball and volleyball. However, even people who don’t participate in jumping sports can get patellar tendinitis.

For most people, treatment of patellar tendinitis begins with physical therapy to stretch and strengthen the muscles around the knee.

Symptoms

Pain is the first symptom of patellar tendinitis, usually between your kneecap and where the tendon attaches to your shinbone (tibia).

Initially, you may only feel pain in your knee as you begin physical activity or just after an intense workout. Over time, the pain worsens and starts to interfere with playing your sport. Eventually, the pain interferes with daily movements such as climbing stairs or rising from a chair.

When to see a doctor

For knee pain, try self-care measures first, such as icing the area and temporarily reducing or avoiding activities that trigger your symptoms.

Call your doctor if your pain:

  • Continues or worsens
  • Interferes with your ability to perform routine daily activities
  • Is associated with swelling or redness about the joint

Causes

Patellar tendinitis is a common overuse injury, caused by repeated stress on your patellar tendon. The stress results in tiny tears in the tendon, which your body attempts to repair.

But as the tears in the tendon multiply, they cause pain from inflammation and weakening of the tendon. When this tendon damage persists for more than a few weeks, it’s called tendinopathy.

Risk factors

A combination of factors may contribute to the development of patellar tendinitis, including:

  • Physical activity. Running and jumping are most commonly associated with patellar tendinitis. Sudden increases in how hard or how often you engage in the activity also add stress to the tendon, as can changing your running shoes.
  • Tight leg muscles. Tight thigh muscles (quadriceps) and hamstrings, which run up the back of your thighs, can increase strain on your patellar tendon.
  • Muscular imbalance. If some muscles in your legs are much stronger than others, the stronger muscles could pull harder on your patellar tendon. This uneven pull could cause tendinitis.
  • Chronic illness. Some illnesses disrupt blood flow to the knee, which weakens the tendon. Examples include kidney failure, autoimmune diseases such as lupus or rheumatoid arthritis and metabolic diseases such as diabetes.

Complications

If you try to work through your pain, ignoring your body’s warning signs, you could cause increasingly larger tears in the patellar tendon. Knee pain and reduced function can persist if you don’t tend to the problem, and you may progress to the more serious patellar tendinopathy.

Prevention

To reduce your risk of developing patellar tendinitis, take these steps:

  • Don’t play through pain. As soon as you notice exercise-related knee pain, ice the area and rest. Until your knee is pain-free, avoid activities that put stress on your patellar tendon.
  • Strengthen your muscles. Strong thigh muscles are better able to handle the stresses that can cause patellar tendinitis. Eccentric exercises, which involve lowering your leg very slowly after extending your knee, are particularly helpful.
  • Improve your technique. To be sure you’re using your body correctly, consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Spine Structure and Function

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Article featured on the Cleveland Clinic
Key parts of your spine include vertebrae (bones), disks, nerves and the spinal cord. The spine supports your body and helps you walk, twist and move. The disks that cushion vertebrae may compress with age or injury, leading to a herniated disk. Exercises can strengthen the core muscles that support the spine and prevent back injuries and back pain.
spine, illustration, cervical, lumbar, thoracic
The spine has three normal curves: cervical, thoracic and lumbar. There are seven cervical vertebrae in the neck, 12 thoracic vertebrae in the torso and five lumbar vertebrae in the lower back.

What is the spine?

Your spine, or backbone, is your body’s central support structure. It connects different parts of your musculoskeletal system. Your spine helps you sit, stand, walk, twist and bend. Back injuries, spinal cord conditions and other problems can damage the spine and cause back pain.

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What are the parts of the spine?

A healthy spine has three natural curves that make an S-shape. These curves absorb shocks to your body and protect your spine from injury. Many different parts make up your spine:

  • Vertebrae: The spine has 33 stacked vertebrae (small bones) that form the spinal canal. The spinal canal is a tunnel that houses the spinal cord and nerves, protecting them from injury. Most vertebrae move to allow for a range of motion. The lowest vertebrae (sacrum and coccyx) are fused together and don’t move.
  • Facet joints: These spinal joints have cartilage (a slippery connective tissue) that allows vertebrae to slide against each other. Facet joints let you twist and turn, and they provide flexibility and stability. These joints can develop arthritis and cause back pain or neck pain.
  • Intervertebral disks: These flat, round cushions sit between the vertebrae and act as the spine’s shock absorbers. Each disk has a soft, gel-like center (the nucleus pulposus) surrounded by a flexible outer ring (the annulus). Intervertebral disks are under constant pressure. A herniated disk can tear, allowing some of the nucleus’ gel substance to leak out. Herniated disks (also called bulging, slipped or ruptured disks) can be painful.
  • Spinal cord and nerves: The spinal cord is a column of nerves that travels through the spinal canal. The cord extends from the skull to the lower back. Thirty-one pairs of nerves branch out through vertebral openings (the neural foramen). These nerves carry messages between the brain and muscles.
  • Soft tissues: Ligaments connect the vertebrae to hold the spine in position. Muscles support the back and help you move. Tendons connect muscles to bone and aid movement.

What are the spine segments?

The 33 vertebrae make up five distinct spine segments. Starting at the neck and going down toward your buttocks (rear end), these segments include:

  • Cervical (neck): The top part of the spine has seven vertebrae (C1 to C7). These neck vertebrae allow you to turn, tilt and nod your head. The cervical spine makes an inward C-shape called a lordotic curve.
  • Thoracic (middle back): The chest or thoracic part of the spine has 12 vertebrae (T1 to T12). Your ribs attach to the thoracic spine. This section of the spine bends out slightly to make a backward C-shape called the kyphotic curve.
  • Lumbar (lower back): Five vertebrae (L1 to L5) make up the lower part of the spine. Your lumbar spine supports the upper parts of the spine. It connects to the pelvis and bears most of your body’s weight, as well as the stress of lifting and carrying items. Many back problems occur in the lumbar spine. The lumbar spine bends inward to create a C-shaped lordotic curve.
  • Sacrum: This triangle-shaped bone connects to the hips. The five sacral vertebrae (S1 to S5) fuse as a baby develops in the womb, which means they don’t move. The sacrum and hip bones form a ring called the pelvic girdle.
  • Coccyx (tailbone): Four fused vertebrae make up this small piece of bone found at the bottom of the spine. Pelvic floor muscles and ligaments attach to the coccyx.

What conditions and disorders affect the spine?

Up to 80% of Americans experience back pain at some point. Vertebrae and disks can wear down with age, causing pain. Other conditions that affect spine health include:

  • Arthritic conditions, such as ankylosing spondylitis (AS).
  • Back strains and sprains.
  • Birth defects such as spina bifida.
  • Bone spurs (jagged edges on vertebrae that put pressure on the spinal cord and nerves).
  • Curvatures of the spine (scoliosis and kyphosis).
  • Neuromuscular diseases, such as amyotrophic lateral sclerosis (ALS).
  • Nerve injuries, including spinal stenosis, sciatica and pinched nerves.
  • Osteoporosis (weak bones).
  • Spinal cord injuries, including spinal fractures, herniated disks and paralysis.
  • Spine tumors and cancer.
  • Spine infections like meningitis and osteomyelitis.

How can I keep my spine healthy?

Strong back muscles can protect your spine and prevent back problems. Try to do back-strengthening and stretching exercises at least twice a week. Exercises like planks strengthen the core (abdominal, side and back muscles) to give your spine more support. Other protective measures include:

  • Bend your knees and keep your back straight when lifting items.
  • Lose weight, if needed (excess weight strains your back).
  • Maintain good posture.

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Back pain with fever.
  • Bowel or bladder control issues.
  • Leg weakness or pain that moves from your back down your legs.
  • Pain that worsens, causes nausea or sleeplessness or interferes with daily activities.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Nighttime Back Pain

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Article featured on WebMD
Nighttime back pain is a special type of lower back pain that could indicate a serious problem with your spine.In the U.S., up to 80% of the population experiences some form of low back pain at some time in their lives. It’s the second most common reason people see their doctor. But as debilitating as back pain can be, most instances of it are manageable, and people who get adequate rest and proper exercise often see improvement within a matter of weeks.With nighttime back pain, however, people can’t get the rest they need because they can’t get relief from their pain.

What Is Nighttime Back Pain?

The majority of people with back pain are able to adjust how they sleep to get relief from the pain they experience during the day. But with nighttime back pain — also called nocturnal back pain — the hurting doesn’t stop when a person lies down, no matter what adjustments they make. For some, the pain actually gets worse. And for others, the pain doesn’t even start until they lie down.

A person can actually go through a day virtually pain-free. But then at night, they might find it nearly impossible to get a full night’s sleep.

What Causes Nocturnal Pain?

Just as with normal back pain, the cause of nighttime back pain isn’t always clear. Among other things, back pain can be caused by any of the following:

  • Problems with the way the spine moves or other mechanical problems, the most common of which is disc degeneration. Discs are tissue between the vertebrae that function as a type of shock absorber; the discs can break down with age.
  • Injuries such as sprains or fractures or more severe injuries such as a fall or an auto accident.
  • Diseases and conditions, such as scoliosis, a curvature of the spine, or spinal stenosis, a narrowing of the spinal column. Kidney stones, pregnancy, endometriosis, certain cancers, and various forms of arthritis can all lead to back pain.

A large number of the participants in the British study suffered disc degeneration. Sometimes the cause of back pain might not be determined.

Can Nocturnal Back Pain Be a Sign of Something Serious?

Guidelines for discovering serious spinal health problems list a number of “red flags,” among them nocturnal back pain.

Nocturnal back pain can be a symptom of spinal tumors. It could be a primary tumor, one that originates in the spine, or it could be a metastatic tumor, one that results from cancer that started elsewhere in the body and then spread to the spine.Nocturnal back pain is also a symptom of spinal bone infection (osteomyelitis) and ankylosing spondylitis (AS), a condition that can cause the spine to fuse in a fixed, immobile position.Other “red flags” include:

  • Back pain that spreads down one or both legs
  • Weakness, numbness, or tingling in legs
  • New problems with bowel or bladder control
  • Pain or throbbing in your abdomen
  • Fever
  • Spots warm to the touch
  • Unexplained weight loss
  • History of cancer
  • History of a suppressed immune system
  • History of trauma

If one or more of these symptoms accompanies back pain — especially if you have a history of cancer — see your doctor right away. It’s also important to call the doctor if your back pain is the result of a recent injury.

It’s important to note that it’s rare that nighttime back pain is caused by a tumor, infection, or AS.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday