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Common Shoulder Injuries and Conditions

Shoulder injuries are common, but that doesn’t make them any less painful or inconvenient. Your hands are like puppets, and your shoulders the puppet masters. Whatever you want your hands to do — whether brushing your hair, throwing a ball or scratching your back — your shoulders need to support and facilitate the motion.

Your shoulder is made up of several bones, muscles, and tendons. Its main function is to give your arm a wide-range of motion. Unfortunately, the near constant movement in the joint can lead to injuries.

Most shoulder problems fall into four major categories:

  • Tendon inflammation and tears
  • Instability
  • Arthritis
  • Fracture (broken bone)

Tendon Inflammation and Tears

Tendon inflammation and tears can be caused by a sudden injury, but are usually caused by repetitive motions. Certain sports like golf and tennis or activities like painting can lead to the following shoulder injuries.

  • Tendonitis happens when the tendon, or tissue that attaches muscle to bone, is inflamed, irritated and/or swollen.
  • Bursitis is the inflammation of a bursa. Bursa are small fluid-filled sacs located in your joints. They act as cushions between bones and overlying soft tissues and help to reduce friction between gliding muscles and bone.
  • Impingement occurs when bone rubs directly on the tendon, causing the tendon to weaken or tear. This is often brought on by inflammation that gives less space for the tendons and muscles to move within the joint.
  • Rotator cuff tears are commonly caused by overuse and happen when the group of muscles and tendons that surround your shoulder joint and keep the head of your upper arm bone in your shoulder socket, split or tear. The size and length of tears vary.

Treatments

Treatment options may include:

  • Resting your shoulder and avoiding activities or positions that cause pain
  • Taking anti-inflammatory (non-steroid) medicine
  • Receiving a cortisone injection to reduce inflammation and control pain
  • Participating in physical therapy to stretch and strengthen the injured area
  • Surgery may be needed if nonsurgical treatments are not enough

Instability

When the head of your upper arm bone is forced partially out of your shoulder socket by overuse or injury, you are experiencing shoulder instability. It may feel like a “slipping” or “catching” sensation in your shoulder. If the bone comes completely out of the socket, it’s called dislocation, which is very painful. Unfortunately, once the ligaments, tendons, and muscles around your shoulder become loose or torn, you’re prone to repeated dislocations.

Treatments

Your arm bone needs to be put back into your shoulder socket by a doctor. Once repaired, you’ll likely wear a sling for a few weeks. For recurring dislocations, shoulder surgery may be required.

Arthritis

Arthritis is inflammation in your joint(s) that causes pain and stiffness. You have two shoulder joints that can be affected by arthritis. One joint is where your collarbone meets the tip of your shoulder blade. The other is where your upper arm bone fits into your shoulder blade. Arthritis can be caused by “wear-and-tear,” (osteoarthritis), an autoimmune disease (rheumatoid arthritis) or by a prior injury — including a broken bone, rotator cuff tear or shoulder dislocation.

Treatments

Treatment options may include:

  • Resting your shoulder
  • Doing range of motion exercises and/or physical therapy
  • Taking anti-inflammatory (non-steroid) medicine
  • Having joint replacement surgery

Fracture

Shoulder fractures (broken bones) commonly involve the clavicle (collarbone), humerus (upper arm bone), and scapula (shoulder blade). They lead to severe pain, swelling and bruising around the shoulder and are caused by a sudden injury, such as a fall or car accident.

Treatments

Often, you’ll need to wear a sling or “figure 8” strap for three to eight weeks. If it’s not a “clean break,” surgery may be necessary. Plates, screws or wires may need to be incorporated with surgery.

Emory Healthcare

Emory Orthopaedics & Spine Center‘s nationally recognized specialists treat all types of shoulder conditions and injuries. Schedule an appointment to see an Emory shoulder specialist today. Call 404-778-3350 or complete our online appointment request form.

Signs of a Torn Meniscus

As one of the largest joints in the body, the knee is highly susceptible to injury. One of the most common knee injuries is a torn meniscus. The meniscus is a rubbery, C-shaped disk that cushions the knee joint and absorbs shock between the shinbone and thighbone. Each knee has two menisci to keep the weight balanced across the joint.

Athletes, particularly those who play contact sports, are most prone to meniscal tears, but the injury can happen to anyone at any age.

A meniscal tear is most often caused when a person twists or turns quickly with one foot planted on the ground and the knee bent. For example, if a tennis player squats and twists his or her knee at the same time, a tear can happen. A torn meniscus is more likely to occur with age, as the meniscus and cartilage in the knee wear thin over time. Just twisting awkwardly while standing up from a chair could be enough to cause a tear in someone whose meniscus has age-related wear and tear.

Torn Meniscus Symptoms

Symptoms vary depending on the severity of the injury. Meniscal tears are categorized into three groups: minor, moderate and major tears. Most people find they can walk on the injured leg after the tear but may feel a “popping” sensation. Athletes often continue playing with a torn meniscus, but the affected joint will likely become swollen and stiff within two to three days.

The most common symptoms are:

  • Catching or locking of the knee
  • Feeling a “pop” in the knee
  • Inability to move the knee through a full range of motion (such as not being able to straighten the knee)
  • Pain
  • Stiffness and swelling
  • The sensation of the knee feeling “wobbly” or unstable, giving way without warning

If a torn meniscus is severe enough or you do not seek treatment, it’s possible for a piece of the meniscus to come loose and drift into the knee joint. This can cause your knee to catch, pop or slip.

Torn Meniscus Diagnosis

To diagnose a torn meniscus, your doctor may perform a McMurray test. During this exam, your doctor will bend your knee, then straighten it while rotating it. This move puts tension on a torn meniscus and if your meniscus is indeed torn, you will hear a clicking sound.

Your doctor may also order an imaging test, such as an X-ray or MRI to confirm a tear.

Torn Meniscus Treatment

Your doctor will determine your best treatment options based on the type, location, and severity of the tear. He or she will also consider your age and activity level.

Common treatments include:

  • Ice
  • Non-steroidal anti-inflammatory medicines (such as aspirin or ibuprofen)
  • Physical therapy
  • Rest
  • Surgery

Surgical Treatment for a Meniscal Tear

If your doctor determines you need surgery to repair a torn meniscus, you will likely have a minimally invasive form of surgery using arthroscopy as opposed to having a large incision in the knee.

Knee arthroscopy is a surgical procedure in which a miniature camera is inserted into your knee through a small incision. This allows your surgeon to better view your knee joint. Miniature surgical instruments will then be inserted into your knee to trim or repair the tear.

Depending on the tear, one of the following procedures can be done:

  • Meniscectomy – In this procedure, the damaged meniscal tissue is trimmed away (partial meniscectomy) or, in serious cases, the entire meniscus is removed (total meniscectomy). Total meniscectomy procedures are rare because of the likelihood of causing osteoarthritis in the knee.
  • Meniscus repair – Some meniscal tears can be repaired by stitching the torn pieces together.

Ideally, much of the meniscus can be preserved. This reduces your future risk of knee joint degeneration.

Torn Meniscus Rehabilitation

Your healing and recovery time depends on the severity of your meniscal tear. You may need a cast or brace around your knee after surgery to keep the joint from moving. You may also need crutches to walk for a period of time to keep weight off your knee.

Your doctor will help you develop a rehabilitation program that allows you to regain as much flexibility and strength as possible.

Kids & Sports: Injuries, Benefits & More

Rotationplasty Child Limb Sparing Surgery AlternativeSporting activities are highly beneficial for kids, both mentally and physically, but these activities are not without risk. It’s best to find an approach to address the potential danger that rests somewhere between bubble-wrapping your kid and prescribing the old “Walk it off and rub some dirt on it.”

Dr. Lee Kneer, a sports medicine physician at Emory Sports Medicine Center and a team physician for the Atlanta Falcons and the Atlanta Braves, details some of the most common sports injuries and what parents can do to help prevent them from happening.

The Most Common Injuries among Kids

Contusions, sprains, and traumatic events are most common among kids, whereas their adult counterparts often face debilitating overuse injuries. Think bruises, twisted ankles, and falls.

How to Best Prevent Injury

Identify the risk factors in each sport and make sure kids wear protective equipment. Prevention can also come in the form of limiting time on the field or court. Dr. Kneer points to what has been especially prevalent in youth soccer to help mitigate the risk of concussions by minimizing the amount of exposures to those events.

Finally, kids should be encouraged to train without over-training.

Stretching: Not the Be-All and End-All

“Most kids are fairly flexible to begin with, and in all honesty, stretching in most sports has never been shown to be protective of injury,” explains Dr. Kneer. He suggests focusing on postural control, which can be as simple as standing on one foot and moving the body around or closing one’s eyes while trying to maintain balance.

Variety Is the Spice of Life… And Key to Injury Prevention

Playing different sports puts stresses on different parts of the body rather than overstressing one part with repetition. Picking up an additional sport helps improve your overall athletic development.

“I have two young children myself, and I’ve trained my five-year-old to repeat the mantra of ‘playing basketball will make me better at baseball, playing baseball will make me better at soccer,’ and so on and so forth,” says Dr. Kneer.

Kids also won’t know which sport is “their sport” until they try it. Dr. Kneer, a life-long runner would never have run marathons and ultra-marathons were he not late for tennis tryouts in high school and stumbled across the cross country tryouts.

RICE: More Than a Carb

RICE, which stands for rest, ice, compression, and elevation, is a traditional remedy for minor injuries. Ice is especially important. “I would never use heat in the acute setting,” advises Dr. Kneer. “Think of heat as a pro-inflammatory. When the spot of injury gets warm, your blood vessels will expand to allow more blood flow to the area. When you first injure something, you want to restrict blood flow to that area.”

In later stages of recovery, heat can be helpful for the muscles. Dr. Kneer suggests a warm-up/cool-down method at that point. Heat in the morning to get the body moving and ice in the evening to deal with the day’s inflammation.

Get a Physical

Physicals are important to help identify potential medical concerns that might not be apparent in an otherwise healthy kid. Hernias or cardiac abnormalities are concerns you want to discover before they cause problems. It’s better to identify potential conditions than not know they exist.

Youth Football

Limiting the accumulation of exposures is key. “In my personal and professional opinion, I would rather a kid avoid the number of times he has head-to-head contact until his body is a bit more mature to deal with the impact,” states Dr. Kneer. “That may mean restricting football to middle school ages rather than earlier on with Pee-Wee football.”

Dr. Kneer would never tell kids they couldn’t play football. That said, if a kid loves football, he or she is going to love it just as much in middle and high school as at six or seven.

Benefits of Sports

Sports help with whole-body development, whether it’s a second identity, the ability to deal with wins and losses, body confidence, or discipline. Just as academics or playing a musical instrument contribute to the ability to work toward a longer-term goal, so do sports.

Watching Your Kid Is Great; Participating with Them Is Even Better

“As parents, I think we more often get pushed to the side as spectators, but the more you’re involved with your kids, the more opportunities exist to connect with them,” shares Dr. Kneer. “I find that with my kids, they start talking about topics I would never have heard about aside from the setting of being ‘comfortable’ while we’re playing sports.”

To learn more, visit emoryhealthcare.org/sports or listen to the full interview with Lee Kneer, MD.

 

 

A Runner Gets Back on Track

Brad Frink is not a man who gives up easily. That’s surely what gives him the stamina to compete in ultramarathons, races that make a traditional 26.2-mile marathon seem like a jog in the park. So when recurring knee pain sidelined him a few years ago, he wasn’t about to back down.

Brad’s issue, iliotibial band friction syndrome (ITBFS), is a common overuse injury among recreational and competitive runners. Also known as “runner’s knee”, this condition happens when the iliotibial band, a bundle of thick fibers that runs from your hip to your shinbone and crosses your knee joint, becomes inflamed and tight after repeated use. The pain associated with ITBFS usually subsides with rest, anti-inflammatories, stretching and icing.

Brad had tried all of those things and more, including seeing multiple chiropractors, therapists, and doctors before meeting Kyle Hammond, MD at Emory Sports Medicine Center. Nothing had solved the problem or relieved his pain enough to allow him to return to training. “I visited several specialists who all gave me poor prognoses,” says Brad. “But I finally found Dr. Hammond. He and his team recognized that giving up running wasn’t an acceptable outcome for me.”

A Surgical Option

The surgical option for ITBFS is a procedure called iliotibial band release, which involves cutting out a section of the iliotibial band. This relieves tension and reduces the friction that causes pain. However, the need to correct ITBFS surgically is uncommon, and Dr. Hammond estimates he only needs to perform the procedure about once per year. “But Brad, he says, “is an outlier. He’s not most people.”

Together, the surgeon and the runner discussed the pros and cons. The argument for surgery was clear—without it, Brad might never be able to run without pain again. However, the cons gave both men pause: “Aside from the typical complications of surgery such as scarring and infection, there was the potential of it not working at all, leaving Brad completely out of options,” says Dr. Hammond. “While I wasn’t concerned from a surgical or technical perspective—I was confident I could perform the surgery well for Brad—I did have very little data to rely on since it’s not as common of a surgery.”

Procedure Yields Incredible Results

Despite any reservations, Brad and Dr. Hammond decided to go for it. And the results speak volumes:

  • Two days post-surgery Brad began rehabilitation to regain range of motion and build his muscle strength. He began a 3 day per week rehab routine.
  • Four weeks post-surgery Brad was running again and even completed a 26.7-mile bike ride. Four weeks later he was ready to race again!
  • Eight months post-surgery Brad raced an ultra marathon, running 66 miles. Not only did he win, his finish time tied for the course record.
  • Ten months post-surgery Brad completed a sprint triathlon with a personal best time and qualified for USAT-age-group nationals.
  • One year post-surgery Brad set his lifetime personal bests in the squat as well as 400 meter, 1 mile, and 5K distances.

“Miraculous might be an overly strong word, but my recovery was unbelievably quick,” Brad said.

While those are all important accomplishments, Brad notes that above all, getting to experience the joy of being active again—and the physical, mental and emotional wellbeing that happens as a result—is most important.

“The only regret I have was not having the procedure done earlier after suffering so long,” he said.

The 38-year-old is also quick to point out his gratitude not just for Dr. Hammond’s surgical expertise, but for the entire team at Emory Sports Medicine, including athletic trainer Megan East, who he says played a significant role in his recovery, continued motivation and overall positive experience. “They helped me every step—literally every step—of the way. I can’t recommend them highly enough,” he says.

Because when you’re someone who won’t back down, you want a medical team that won’t give up, either.

For more information about Emory Sports Medicine Center, visit emoryhealthcare.org/sports or call 404-778-3350.

Learn more about total ankle replacement

Emory Healthcare and Atlanta Falcons Announce New Healthcare Partnership

Emory Healthcare and the Atlanta Falcons have entered into a new medical partnership that designates Emory Healthcare as the Official Team Healthcare Provider of the Atlanta Falcons.

Emory Healthcare physicians in sports medicine, cardiology and ophthalmology have been providing medical support for the players and coaches for years, including during the Falcons’ trip to the Super Bowl in 2017. The new partnership promotes a broader relationship between Emory Healthcare and the entire Atlanta Falcons organization that builds on the medical support and care currently provided to the team. The partnership also gives Emory Healthcare new opportunities to engage in community outreach and educate Falcons fans on the importance of maintaining or achieving a healthy lifestyle through preventative care, good nutrition, exercise, regular checkups, and screenings.

Along with the Atlanta Falcons, physicians at Emory Healthcare also serve as the official team health care providers for the Atlanta Hawks, the Atlanta Braves, and the Atlanta Dream, as well as Georgia Tech and several other college and high school athletic associations.

“We are excited to have Emory Healthcare as our Official Team Healthcare provider for the Atlanta Falcons,” says Tim Zulawski, chief revenue officer, AMB Sports, and Entertainment. “Over the past few years, we have enjoyed a great partnership between our players and coaching staff and their team of physicians; we are proud to bring them on in this official capacity.”

“We are very excited about this new partnership and honored that another Atlanta-area team has chosen us to care for their athletes to help them perform at the highest level,” says Jonathan S. Lewin, MD, President, CEO, and Chairman of the Board of Emory Healthcare.

Find the care you need, when and where you need it, with the region’s most comprehensive academic health system, Emory Healthcare. To learn more, visit www.emoryhealthcare.org/about.

Learn more about total ankle replacement

Your Running Questions Answered by Dr. Amadeus Mason

Thank you for submitting your questions for our Facebook Q&A: Preparing for a Race. A big thank you to Dr. Amadeus Mason from Emory Sports Medicine for answering the submitted questions. We hope you find these answers helpful as much as we did!

What is the best way to approach chronic patellar tendinitis, possibly tendinosis? 
The best way to approach it is to get a correct diagnosis.  There are a lot of things that can act like tendonitis but aren’t.  Once you have gotten the diagnosis you should get started with some physical therapy where they will give you specific exercises to strengthen the muscles around the knee to take the additional, abnormal stress off the tendon.  In some instances, you do not have to shut down completely depending on how symptomatic you are you may be able to continue running during the rehab process – this should be done only with the blessing of your physician and therapist.

Do you have any tips for preparing for a race after having chemo? I am currently trying build up my stamina again now. Unfortunately, I am not coming back as quickly as I hoped. 
The biggest thing is probably to be patient.  Chemo takes a toll on the body, (running does as well) you want to give your body adequate time to adjust. Have a plan – what time/distance do you want to get up to running.  Start off with a fraction of that (eg 1/5, 1/8, 1/10) then running every other day you increase your distance or speed (NOT both) every 2-3 weeks.

If you have a skin allergy, what are some good tips to prepare for outdoor activities?
I can comment on how to prepare for running specifically but would defer to your allergist or dermatologist for general outdoor activity recommendations.  My recommendations would be – know your route, understand what potential allergens you might encounter, wear appropriate clothing and take your medications as directed.

I am not a runner but would like to start running. How many miles are suggested for a beginner?  
It depends on what type of running you ultimately would like to do, 5K, 10K, ½ marathon, marathon, ultra-marathon all require a different amount of training mileage.  What’s also going to be important is how you go about doing that mileage – you need to have a plan to you progress appropriately and hopefully avoid injury.

I recently did a 5K race. I am 52 and finished in 38 minutes. How can I up my speed and handle the hills?
Train for them. Build speed work into your preparation, cross train with some free weights (not for bulk but for endurance – low weight high repetition), cross train on hills (do your work out on hills e.g. if you’re supposed to run 1.5 miles find a ¼ mile hill and run up it 6 times).

Emory Healthcare welcomes and encourages open discussions on all of Emory Healthcare’s social media sites. We look forward to any comments, stories, interactions, and experiences you want to share online. Before posting, please be mindful that Emory Healthcare’s social media sites are open to the public. DO NOT disclose any personal information that you do not want to be shared. By sending any content over the internet, you acknowledge that you assume full responsibility related to security, privacy, and confidentiality risks. The information presented here is NOT intended to replace a consultation with a qualified medical professional or take place of professional medical care. Due to a large number of questions we received, we are unable to answer all questions. The questions selected above are (in our opinion) of value to all readers.  

Joint Replacement for an Active Life: Q&A with Dr. Maughon

Joints play an essential role in your body’s movements, and joint pain can negatively impact almost every facet of life. The goal of joint replacement surgery is to return patients back to their original level of activity.

From organized sports athletes to weekend warriors, Scott Maughon, MD, an Emory orthopaedic surgeon, enjoys helping athletes of all levels get back to doing what they love.

Below, he answers a few common questions about joint replacement surgery.

What is joint replacement surgery?

Dr. Maughon: Joint replacement surgery replaces the joint, or damaged or diseased parts of the joint, with man-made parts in order to relieve pain and improve mobility. Emory offers the highest in quality joint replacement surgery from our expert team of specialty fellowship-trained physicians.

What joints can be replaced with surgery?

Dr. Maughon: Almost any joint in the human body can be replaced. Some replacements are more common than others – hips, knees, and shoulders, for example. However, advances in technology and medicine have made ankle, finger, wrist and many other joint replacements more common as well.

Who is a candidate for joint replacement?

Dr. Maughon: My goal is to get my patients back to the same level of activity they enjoyed before injury or pain. Anyone who seeks to relieve pain in their joints could be a candidate for joint surgical intervention and/or replacement.

What is the recovery like after joint replacement surgery?

Dr. Maughon: Joint replacement surgery recovery time can range from several weeks to several months, depending on the patient and the joint being replaced. Emory Healthcare physicians work with each patient to develop a recovery plan based on their unique circumstances and needs.

For all joint surgery patients, there are a few general recommendations around activities. As the primary reason patients have joint replacement surgery is pain relief, the recommended post-op activities focus on those that do not put undue pressure or wear on the joint, including:

  • Swimming
  • Cycling
  • Using the Elliptical
  • Playing Doubles Tennis
  • Golf
  • Ice Skating

What inspired you to choose the sports/orthopaedic medicine specialty?

Dr. Maughon: Joint replacement helps athletes – from professional and organized sports players to weekend warriors – relieve pain and lead an active life. An athlete myself, it’s rewarding and exciting to be able to help kids and adults, and athletes of myriad abilities and levels, get back to what they enjoy doing. Moreover, being in sports medicine helps me connect to the community, making sure local youth sports have access to the appropriate medical care for any sports-related injuries.

Have there been any recent advances in joint replacement surgery?

Dr. Maughon: Arthroscopic surgery has made a significant difference in joint replacement and sports medicine. Being able to make a small incision instead of opening up major muscle groups during surgery dramatically improves recovery time for patients.

Watch Dr. Maughon discuss joint replacement in the video below.

Dr. Maughon practices at Emory University Orthopaedics & Spine Hospital in Johns Creek, Ga. To learn more about Emory Orthopaedics & Spine surgeons and treatment options available to you, visit www.emoryhealthcare.org/ortho or call 404-778-3350.

 

About Dr. Scott Maughon


T. Scott Maughon, MD, is an orthopaedic surgeon specializing in joint surgery and sports medicine, including ACL/MCL/PCL reconstruction, knee arthroscopy, rotator cuff tears, shoulder instability and dislocations, injuries in the aging athlete, meniscal/cartilage repair, ligament injuries, tendon injuries, joint preservation, and joint replacement surgery of the knee and shoulder. His research interests include the prevention of youth injuries in baseball for the throwing athlete, as well as proactive training and conditioning of youth and high school athletes to avoid the risk of injury.

Dr. Maughon is a member of the American Academy of Orthopaedic Surgeons and a member of the American Orthopaedic Society for Sports Medicine. He is also Board Certified in Orthopaedic Surgery and Sports Medicine. He received his medical degree from the Medical College of Georgia, completed an internship and residency in orthopaedic surgery at Georgia Baptist Medical Center in Atlanta, Ga., and a sports medicine fellowship with Dr. James R. Andrews at the American Sports Medicine Institute in Birmingham, Alabama.


About Emory Orthopaedics & Spine Hospital

Emory’s Orthopaedics & Spine Hospital has locations across the Atlanta metro area and offers a full range of services to diagnose, treat and repair bones, joints and connective tissue, like muscles and tendons. Emory Healthcare has the only hospital in Georgia that is dedicated to spine and joint surgery as well as non-operative spine and joint surgical interventions for physical therapy. For more information, or to schedule an appointment or an opinion, visit www.emoryhealthcare.org/ortho.

Your Spine Surgery Questions Answered by Dr. Scott Boden

Having spine surgery is a big decision, and it’s in your best interest to ask questions so you know how to prepare, and what to expect both immediately after the surgery and long-term. A week ago, we asked you to send us your spine surgery questions through Facebook Messenger. Below are Dr. Scott Boden’s responses to the questions we received.

Your Spine Surgery Questions Answered

Question: I had spine surgery in March 2015. There’s something wrong in my L4 & L5 disks that cause me severe unbearable pain. The spine doctors don’t see anything wrong other than desiccation on the MRIs. I have nerve and muscle spasms constantly, can barely walk, and severe pain in my lower back and legs. I’m on Medicaid and can’t get the help I need because spine institutes don’t accept Medicaid. What can I do?

Dr. Boden:  It’s unfortunate that your type of insurance might limit your access to care.  There are physicians and centers that will accept your insurance.  With that said, if you have radiating leg pain but don’t have severe pressure on the nerve roots on your MRI, then it is much less likely that surgery will help and you may be better served visiting a pain management specialist rather than a spine surgeon.

Question: How do you alleviate severe spine pain? How do you restore broken cartilage of the spine?

Dr. Boden:  Unfortunately, there is currently no way to restore, repair, or replace damaged cartilage in the disc structures which are located between each of the spinal vertebrae bones.  Back pain can often be lessened through a variety of medications, exercises, and special pain treatment modalities.  Also, as the spine ages and naturally becomes less mobile, some of the painful causes of back pain in middle-aged patients will remedy themselves over time.  If the situation is associated with significant pain radiating down one or both legs, then surgery may be an option.  If the pain is due to a fracture, tumor, infection, or excessive mobility of the spine, then surgery may be an option.

Question: Are there any new advancements in scoliosis surgery? Is it still metal bars and being in a body cast for months?

Dr. Boden:  There are many new advancements in scoliosis surgery including less invasive surgical approaches, better ways to minimize blood loss, and use of biologics to improve the healing of bone necessary for scoliosis surgery to be a success.  With that said, metal rods, screws, hooks, and cages are still part of the process.  Use of body casts is much less common, but removable custom molded plastic braces are sometimes still utilized.

Question: I have disc degeneration at all lumbar levels, can surgery be performed, if not, what else can be done to relieve pain?

Dr. Boden: When there is disc degeneration at all levels and the primary symptom is back pain (and not radiating leg pain), we would typically not suggest surgery. You would have to come in to see a spine specialist to fully address your pain and specific situation, though.

Question: If less than 10% of patients who experience back or neck problems are candidates for surgery, why is that?

Dr. Boden: The majority of back or neck problems will resolve with time or non-operative treatments such as physical therapy or medications. Only a very small percentage will require or benefit from surgery.

Question: Could you walk us through a general sequence of determining whether or not a patient should consider surgery following a disc herniation, PT and epidural steroid injections? Having a hard time sorting out the difference between patience to allow healing and delaying and inevitable surgery now 2 years post injury

Dr. Boden: In general, a disc herniation might need surgery if the primary symptom is radiating leg pain rather than just low back pain. The majority of disc herniations – over 90% – resolve on their own within three months. During that time steroid injections, physical therapy and medications can be tried to help relieve pain while the body heals the disc. If the leg pain persists longer than 3 months than the ideal surgical window is between 3 and 6 months after the leg pain started. You can still get acceptable results after 2 years, but the likelihood of success is slightly smaller.

Question: When is it time to be evaluated by a spine surgeon?

Dr. Boden: Over 90% of spine related problems usually resolve on their own or with some simple non-operative treatment. Relatively few people need to get into the hands of a surgeon. If you have radiating pain or weakness down your arms or legs that has not been getting better within a short amount of time, is an indicator to be evaluated by a spine surgeon.

Question: Who is a good candidate for spine surgery?

Dr. Boden: Based on age, looking at the under 50 age group – one of the most common problems that could lead to spine surgery is a herniated disc. If that does not resolve with non-operative treatment, then that patient with that problem is usually an excellent surgical candidate assuming their main symptoms is persistent radiating arm or leg pain.

Question: What type of tools or techniques are generally involved with spine surgery?

Dr. Boden: It depends on what the patient’s specific spine problem is. For a herniated disc, it will be an outpatient surgery with a small incision that removes the herniated piece of disc cartilage and unpinch the nerve. For older adults (50+), our spinal canal eventually gets more narrow that causes pinching. In these situations, it involves surgery that will unpinch or decompress the nerve roots.


About Dr. Scott Boden


Scott D. Boden, MD, is Professor of Orthopedic Surgery and Director of the Emory Orthopaedics & Spine Center. Dr. Boden started practicing at Emory in 1992. During his fellowship at Case Western Reserve Hospital in Cleveland, Dr. Boden trained with one of the founding fathers of modern spine surgery, Dr. Henry Bohlman. A primary original researcher on bone growth factor development and spine fusion technology, Dr. Boden is also an internationally renowned lecturer and teacher and the driving force behind the Emory University Orthopedics and Spine Hospital (EUOSH).

Dr. Boden’s Clinical Interests
Dr. Boden’s areas of clinical interest include surgical and nonsurgical management of adult degenerative spinal disorders including herniated discs, spinal stenosis, and spondylolisthesis in the cervical and lumbar spine. He was recently named in another Becker’s list of Top 50 Spine Surgeons in the U.S. and is a skilled surgeon with techniques of microdiscectomy, laminectomy, spinal fusion, and laminoplasty.

Education
Medical School: University of Pennsylvania School of Medicine, Philadelphia, PA 1986
Internship: George Washington University Medical Center, Washington, D.C. 1987
Residency: George Washington University Medical Center, Washington, D.C. 1991
Fellowship: Case Western Reserve University Hospital, Cleveland, OH 1992

Personal
Dr. Boden is the proud father of triplets who graduated first and tied for second in their high school class. He is also a baseball aficionado and coaches high school and travel softball teams.

Emory Healthcare welcomes and encourages open discussions on all of Emory Healthcare’s social media sites. We look forward to any comments, stories, interactions, and experiences you want to share online. Before posting, please be mindful that Emory Healthcare’s social media sites are open to the public. DO NOT disclose any personal information that you do not want to be shared. By sending any content over the internet, you acknowledge that you assume full responsibility related to security, privacy, and confidentiality risks. 

Meet your Spine Surgeon: A Conversation with Dr. John Heller 

Spine Surgeon

The spine supports the body’s weight and protects the nerves in the spinal cord that run through it. It helps maintain the body’s muscle control and nerve coordination, and without it, we wouldn’t be able to function. Spine surgery, a subspecialty of orthopedic surgery, includes the treatment and management of a wide variety of conditions affecting the neck and back, including herniated discs and fractures.

For Emory Healthcare spine surgeon John G. Heller, MD, the care and treatment of patients with spine issues is personally rewarding. His practice works to improve the lives of patients while training the next generation of spine surgeons.

Patients, understandably, often have many questions regarding spine conditions and their treatment. Recently, Dr. Heller spoke with Dr. Bruce Feinberg for The Weekly Check-up on WSB Radio about a wide range of issues related to the spine surgery. The following are summarized excerpts.

Question: Tell us about your team.

Dr. Heller: Over the last 28 years I’ve been at Emory, our team of spine specialists has grown a lot and so has our field. Right now, we have a team comprised of 11 orthopedic and neuro-spine specialists who are surgeons. We also have more than a dozen non-operative specialists, whose job it is to keep people from meeting the surgeons. It’s the minority of folks who actually need to or end up seeing a surgeon.

Question: How have you seen your practice grow?

Dr. Heller: We’ve been really fortunate in recent years to have the Emory Orthopaedic & Spine Hospital, in addition to Emory Midtown, to work in. It’s been a game changer for us and our patients. We have an entire hospital with a mission focused on joint replacement and spine. It’s a smoother experience for patients and we’ve seen that in our patient satisfaction rates, which are some of the highest in the country. We’re very proud of what we have built as a team, and in doing that alongside our educational and research activities. We now have points of access across the region to serve patients closer to home.

Question: How do you spend your days?

Dr. Heller: I alternate days either in the office all day or in the operating room all day. If I’m in the office, I see about 15 to 20 patients a day, which means I get to spend a good bit of time with each patient.

What we do really takes some time to get to know the patient, what’s going on and their options, and to go over all the information. On the days I’m operating, it can vary between a few operations that are several hours long each, to one operation that lasts anywhere from 10 to 14 hours.

Question: What is myelopathy?

Dr. Heller: We see and treat many cervical spine conditions, and this is one of our most common. Myelopathy is compression of the spinal cord caused by wear and tear which creates multiple points of pressure. We see this most commonly in those aged 55 and over. Myelopathy commonly presents with little to no pain, wobbly legs, and clumsy hands. There are a variety of different operations that we can do to help people with this condition.

Question: What is spinal stenosis?

Dr. Heller: Spinal stenosis is the narrowing of the spinal canal. As patients get older, their discs wear out and the place for the nerves in the low back and neck get crowded out. This condition can be associated leg pain, arm pain, back or neck pain, and sciatica.

Question: What is disc herniation?

Dr. Heller: Disc herniation commonly occurs in young healthy people who have a piece of a disc break off and compress a nerve. More than half the time, they never need to see a spine surgeon.

Question: What are your thoughts on using opioids to manage pain, given the concerns from patients and the medical industry?

Dr. Heller: Opioid abuse is dangerous, and we take prescribing opioids very seriously. Daily, on average, 142 people in the U.S. die because of prescription opioid accidents. We also know that taking opioids for a long enough period of time can make the pain worse, not better since they change the body’s central nervous system. I tell patients to use common sense, use what you need to when you need to, and don’t use it when you don’t need to.

Listen to the full conversation >>

Dr. Heller practices at Emory University Orthopaedics & Spine Hospital. To learn more about Emory Orthopaedics & Spine surgeons and treatment options available to you, visit www.emoryhealthcare.org/ortho or call 404-778-3350.


About Emory Orthopaedics & Spine Hospital

Emory’s Orthopaedics & Spine Hospital has locations across the Atlanta metro area. Emory’s physicians diagnose and treat conditions ranging from simple herniated disc and lower back and neck pain to more complex problems such as spinal tumor scoliosis and spine fractures. Emory Healthcare has the only hospital in Georgia that is dedicated to spine and joint surgery as well as non-operative spine and joint surgical interventions for physical therapy. For more information, or to schedule an appointment or an opinion, visit www.emoryhealthcare.org/ortho.

About Dr. John Heller

John G. Heller, MD, is an orthopedic surgeon specializing in the research and development of instrumentation in cervical spine surgery, including cervical disc replacement and laminoplasty. His clinical interests include herniated disc sciatica, spinal stenosis, and spinal tumors. An internationally renowned lecturer and teacher, Dr. Heller is the past president of the Cervical Spine Research Society and was one of the first surgeons in the country to perform laminoplasty.

Learn more about Dr. Heller >>

Real Patients. Real Stories – Kathleen Karr’s Total Ankle Replacement

total ankle replacement karrKathleen Karr thought her dancing days were over — until she underwent total ankle replacement surgery. 

Kathleen suffered an ankle injury during a car accident when she was 39 years-old. Unfortunately, the injury worsened over time. She began to lose more and more mobility in her ankle until, finally, she found herself barely able to walk.

Frustrated with her lack of mobility, Kathleen scheduled an appointment with an orthopaedist. After performing an initial exam and reviewing her X-rays, the doctor found that she had end-stage ankle arthritis and recommended an ankle fusion. While the procedure would give her back some mobility, the doctor warned that she would still not even be able to walk uphill or downhill following her surgery.

Kathleen had always been an active, vibrant woman. The thought of living out the rest of her life with such limited mobility just felt wrong to her. She had dreams of roaming the streets of Paris and dancing the night away. For her, barely being able to walk on flat ground was just not going to cut it.

Unsatisfied with what she was told, Kathleen decided to seek a second opinion. That’s when she found Dr. Jason Bariteau of Emory Orthopaedics & Spine Center in Atlanta, Georgia. “Kathleen was severely limited from her ankle injury,” recalls Dr. Bariteau. “She had already tried several conservative treatment options, but still couldn’t do the things she wanted to do.” Kathleen and Dr. Bariteau discussed possible treatment options and weighed the risks and benefits of each. They decided that a total ankle replacement would be the best fit for her.

Total Ankle Replacement Procedure

Traditionally, patients with end-stage ankle arthritis have been treated with an ankle fusion, which can lead to significant limitations after surgery and could cause further arthritis in the foot. Fortunately, total ankle replacement has evolved over the last few years. Not everyone is a candidate for total ankle replacement, but those who are, often find it offers them consistent pain relief and improved mobility.

Kathleen had a great experience with the procedure and is now pain-free and loving life. “I went dancing last night. I’ve always been a very active person, and it feels good to get back to the things I enjoy. Going from not being able to do anything, to getting onstage to dance and sing, feels amazing. I’m back to my crazy old self!”

With her trip to Europe booked, Kathleen feels grateful to Dr. Bariteau. “He’s such a great doctor—so thorough and personable. That’s what gave me the confidence to have the surgery. And that’s why I have my life back! Thank you, Dr. Bariteau!”

Emory Orthopaedics & Spine Center

Emory Orthopaedics & Spine Center offers the full-spectrum of orthopaedic care. If you have a foot or ankle injury, we can help. We want to get you back to living the life you love.

Learn more about total ankle replacement

About Dr. Bariteau

Dr. Bariteau grew up in a small town just outside of Albany, New York. After completing his undergraduate degree in Biology at College of Saint Rose, he then pursued his medical degree at Upstate Medical University in Syracuse, NY where he graduated Magna Cum Laude. Following completion of his medical training, he developed his surgical skills during his orthopedic surgery residency at Brown University. He then subsequently completed two advanced orthopedics fellowships; the first at Brown University in orthopedic trauma and the second at Baylor Medical Center in Dallas Texas under the tutelage internationally known Foot and Ankle Surgeon James W Brodsky MD. He currently resides in Atlanta, GA with his wife and three children. Learn more about Dr. Bariteau.