Posts Tagged ‘arthritis’

How Aging Affects Your Cervical Spine – Part II: Arthritis of the Neck

NeckArthritis_ 7-7Cervical spondylosis refers to the degenerative process of the vertebral disks in the neck (arthritis). Like the rest of the body, the bones in the neck slowly degenerate as we age, which frequently results in arthritis. Most of the time, this condition causes mild to moderate neck pain and stiffness.

Causes:

Neck pain is extremely common, with more than 85% of people over age 60 being affected. It’s typically caused by chronic wear on the cervical spine as a result of aging. Facet joints in the neck become enlarged, causing the ligaments around the spinal canal to thicken and bone spurs to form. Over time, these changes can press down on (compress) one or more of the nerve roots. In advanced cases, the spinal cord becomes involved.

Aside from aging, the other factors that can make a person more likely to develop spondylosis are:

  • Being overweight
  • Past neck or spine injury
  • Ruptured or slipped disk
  • Genetics – if your family has a history of neck pain

Symptoms:

Many people have spondylosis of the neck and do not know it. This is because most of the time, there are no symptoms, or the symptoms are mild. When symptoms do develop, they are typically neck pain, stiffness, headaches (especially in the back of the head), and sometimes shoulder pain. In rare cases, the pain may spread to the upper arm, forearm, or fingers.

Treatments:

Non-surgical

Treatment for cervical spondylosis depends on the severity of your signs and symptoms. Most patients who do not have neurological compression associated with spondylosis do not need surgery. Interventional treatments for cervical spondylosis may include:

  • Physical therapy – Strengthening and stretching weakened or strained muscles to relieve the pressure on the nerve root is usually the first treatment that is advised.
  • Medications – Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain and analgesics to relieve pain.
  • Steroid-based injectionsMany patients find short-term relief from steroid injections to help reduce swelling and treat acute pain that radiates to the hips or down the leg.

Surgical

For cervical spondylosis causing symptomatic compression of nerve roots or the spinal cord, surgery may be indicated to relieve pain and improve or preserve neurological function. For spondylosis without nerve root or spinal cord compression, surgery is typically avoided. In some unusual conditions, cervical spinal fusion can be performed.

Have you been told you need neck surgery? Over 90% of neck and back problems can be treated without surgery, but if surgery has been recommended, you may want to seek a second surgical opinion.

At the Emory Orthopaedic & Spine Center, our internationally-recognized spine surgeons research, pioneer and refine the most effective approaches to treating a variety of spine conditions.

To see if you may be a candidate for spine surgery, take our five minute spine quiz

About Dr. Rhee

John M. Rhee, MD, is a Spinal Surgeon and Associate Professor of Orthopaedic Surgery specializing in cervical spine surgery, lumbar spine surgery, complex spinal deformity surgery (scoliosis and kyphosis) and surgery for spinal tumors. Dr. Rhee is an active researcher and sought-after teacher/lecturer at the national and international level in multiple medical societies. He has served as faculty and been an invited lecturer at numerous meetings and courses on spine surgery. In addition, he has served as Program Chairman at numerous national and international spine surgery meetings. Dr. Rhee has also published extensively in a number of peer reviewed journals and books, and he has received numerous awards and honors. He is actively involved the training of international research scholars and other spinal surgeons and has been the author and editor of major textbooks on spine surgery techniques.

Understanding Osteoarthritis

OsteoarthritisWhile “arthritis” is a commonly known disease, it is generally misunderstood. In fact, arthritis is not a single disease, rather a way of referring to joint pain or joint disease. There are more than 100 types of arthritis and related conditions. Osteoarthritis (OA), which is also known as Degenerative Joint Disease (DJD), is one of the most common forms of arthritis, affecting nearly 27 million Americans according to the Arthritis Foundation.

Unlike other forms of inflammatory arthritis, OA is most common in older adults. It occurs when cartilage, the smooth, rubbery material that cushions each bone becomes thinned, damaged or worn away. The “wearing down” of cartilage leads to pain, swelling and joint stiffness, and as the disease continues to worsen over time, bone rubbing against bone can lead to joint damage and more intense pain.

Osteoarthritis can affect any joint, but mostly affects the knees, hips, hands and spine joints. While the cause of osteoarthritis is unknown and there is no cure, there are ways to relieve symptoms and improve joint function for those suffering from the disease:

  • Exercise! Just 30 minutes of physical activity five times a week (150 minutes in total) can help significantly reduce joint pain and improve joint mobility in as little as four to six weeks. If you cannot fit in a whole 30 minutes, try breaking your exercise into three, 10-minute increments throughout the day. Any physical activity is better than none!
  • Be SMART when it comes to physical activity:
    • Start low and go slow. Begin with three to five minutes of physical activity twice a day and add activity in small amounts to allow your body to adjust.
    • Modify activity if arthritis symptoms increase, but try to stay active.
    • Activities should be low impact, such as walking, bicycling, water aerobics or dancing.
    • Recognize safe and effective ways to be active. Consider exercise classes designed for people with arthritis. When planning your own activity, make sure to choose safe locations with sidewalks/pathways that are level (e.g., a neighborhood or park).
    • Talk with your healthcare provider to help monitor chronic osteoarthritis symptoms.
  • Watch your weight. If you are overweight, losing one pound can take four pounds of pressure off your knee joints! A weight loss of five percent helps reduce joint pain. Maintaining a healthy weight and physical activity are also beneficial with other chronic illnesses such as high blood pressure, diabetes and heart disease, which often affect those with OA.
  • Eat right. While there is no specific diet for people with arthritis, studies have identified certain foods that can help control inflammation, strengthen bones and boost the immune system. Incorporating foods often found in the Mediterranean diet, which emphasizes fish, vegetables, fruit and olive oil, have been found to promote good joint health.

Can osteoarthritis be prevented? Learn more about risk factors for osteoarthritis >>

Find the right physician

If you are experiencing severe pain, swelling or stiffness in your joints, it may be time to see one of the physicians at the Emory Orthopaedics & Spine Center for further evaluation and treatment.

Related Resources

About Dr. Mason

Amadeus Mason, MDAmadeus Mason, MD, is an assistant professor in the Orthopaedics and Family Medicine departments at Emory University.

He is board certified in Sports Medicine with a special interest in track and field, running injuries and exercise testing. He has been trained in diagnostic musculoskeletal ultrasound, orthopedic stem cell therapy and Platelet Rich Plasma (PRP) therapy. Dr. Mason is Team Physician for USA Track & Field, Tucker High School, and Georgia Tech Track and Field.

Dr. Mason is a member of the American College of Sports Medicine, the American Medical Society for Sports Medicine, the America Road Racing Medical Society, and the USA Track and Field Sports Medicine and Science Committee. He has been invited to be a resident physician at the US Olympic Training Center, a Sports Medicine consultant in his homeland of Jamaica and the Chief Medical Officer at multiple USA Track and Field international competitions. He is an annual speaker at the pre-race expo for PTRR, Publix marathon and Atlanta marathon commenting on a wide variety of topics related to athletics and running injuries.

Dr. Mason is an active member of the Atlanta running community. He attended Princeton University and was captain of the track team. His other sports interests include soccer, college basketball and football, and the National Hot Rod Association (NHRA). A Decatur resident, he is married with three children.

Did you know that July is Juvenile Arthritis Awareness Month?

We are all painfully aware that arthritis affects many older adults, but did you know that kids can develop juvenile arthritis?

Approximately 294,000 children age 16 or younger are affected by pediatric arthritis and rheumatologic conditions.
In adults, arthritis typically affects the joints. While juvenile arthritis can cause bone and joint growth problems, it also can affect the eyes, skin, and gastrointestinal tract.

The most common symptoms of juvenile arthritis are joint swelling, pain, and stiffness that won’t go away, particularly in the knees, hands, and feet. Symptoms are generally worse in the morning and after naps. Other signs of juvenile arthritis include:

•    Limping due to a stiff knee

•    Excessive clumsiness

•    High fever and skin rash

•    Swelling in the lymph nodes

The most common type of juvenile arthritis is juvenile idiopathic arthritis. (Idiopathic means “from unknown causes.”) You may have heard this referred to as juvenile rheumatoid arthritis. This type of arthritis is diagnosed when a child has swelling in one or more joints for at least six weeks.

There are several different types of juvenile idiopathic arthritis. The type is usually determined by the number of joints affected as well as by the results of a rheumatoid factor blood test. While children may have a genetic predisposition that makes them more likely to develop the disease, at this point, researchers have not determined a direct cause, and there’s no evidence that toxins, foods, or allergies can cause it. Most children with juvenile arthritis experience remission, when the symptoms get better or go away, and times when symptoms flare, or get worse.

If your child has juvenile arthritis symptoms, the first thing to do is get an accurate diagnosis. Your child’s pediatrician can run tests that will rule out other potential causes, but if the signs point to juvenile arthritis, he or she may suggest you make an appointment with a pediatric rheumatologist.

There is no cure for juvenile arthritis; however, a number of treatments can improve your child’s quality of life, including:

•    Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and analgesics to help relieve inflammation and control pain

•    Disease-modifying anti-rheumatic drugs (DMARDs) and a biologic response modifiers (biologics), which can alter the course of the disease, put it into remission, and prevent joint damage

•    Splints to help keep joints in the correct position and to relieve pain and orthopedics or shoe inserts to compensate for any difference in leg length or to improve balance

•    Physical therapy to help restore motion and flexibility in joints that have become stiff and occupational therapy to help children learn how to do basic activities without aggravating their arthritis

And, of course, it’s super important for kids with juvenile arthritis to eat healthy foods and get regular moderate exercise, to keep joints strong and flexible.

Does your child have juvenile arthritis? How does your family cope? We welcome your questions and feedback in the comments section below.

At-Home Workouts Ease Osteoarthritis Pain

Osteoarthritis at home workoutsIf you have osteoarthritis, you already know that exercise can help reduce pain and improve mobility. But did you know that working out at home with a DVD may bring even more relief?

According to a study presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), 107 people with osteoarthritis in the knee were randomized to either a DVD-based exercise group or a control group. The DVD group received a DVD-based exercise program along with verbal and hands-on exercise instructions for the first four to eight weeks. Participants in the DVD group reportedly exercised 5.3, 5.0, and 3.8 times per week at three-, six-, and 12-month intervals and had significantly greater improvement in pain and physical function than those in the control group.

While exercise did not make a significant difference in the progression of osteoarthritis, the reduction of pain and mobility among the DVD group speaks to the benefits of adding a video-based home exercise program to an existing exercise regimen.

When you exercise regularly, you strengthen the muscles around the arthritic joint, which helps decrease the pain of osteoarthritis and improve function. We suggest you do whatever keeps you on track to exercise regularly, whether it’s a video-based exercise program or exercising with a friend. But first, we recommend that you have an exercise program designed specifically for you by a physical therapist who understands osteoarthritis, to avoid injuries from overdoing it or doing the wrong exercises. The physical therapists here at the Emory Orthopaedics & Spine Center have the experience and the expertise to develop an exercise plan that meets your unique needs and helps bring relief from osteoarthritis pain.

Do you have osteoarthritis? Has a regular home-based exercise program helped ease your pain? We welcome your questions and feedback in the comments section below.

Related Resources:

Can Soda Consumption Affect Your Bone Health?

Cola bone healthOur team gets lots of questions about bone health, ranging from questions like “does  soda decrease my bone strength?”  To “how much calcium and Vitamin D are needed to maintain bone health?” In honor of National Nutrition Month, last week, we shared with you details on the roles of Calcium and Vitamin D in your bone health, and foods you can consume to make sure you get enough of each. This week, we want to share some interesting findings from new research being conducted around soda, and its effect on your bone strength.

There are many activities and behaviors that can serve to either improve or worsen bone health, but many recent studies have been conducted to determine if there is a link between soda consumption and decreased bone health. Check out some interesting take- aways from just a few of those studies below:

  • According to findings from a study at Harvard, 9th and 10th grade girls who consume sodas are at three times the risk for bone fractures compared to those who don’t.
  • Research out of Tufts University shows that “women–but not men–who drank more than three 12-ounce servings of cola per day had 2.3 percent to 5.1 percent lower bone-mineral density in the hip than women who consumed less than one serving of cola per day.”1
  • In a 2010 study from the Journal of American Dietetic Association, 170 girls were  followed from age 5 to 15. Of those, the participants who drank soda at age 5 were less likely to drink milk throughout childhood than those who didn’t consume soda at age 5. Those who drank soda from the age of 5 were also  more likely to consume diets lacking in calcium, fiber, vitamin D, protein, magnesium, phosphorus and potassium.
  • In a 2001 study out of Creighton University Osteoporosis Research Center , researchers followed 32 people for a month and had them drink various  formulations of soda with differing levels of caffeine, phosphorus or citric acid so the research team could take urine samples and determine how much calcium the subjects were excreting. Those who drank caffeine-rich sodas excreted calcium; the others did not.

While all of the research conducted so far indicates that there is more to be done to directly tie cola consumption to decreased bone health, it is clearly a hot topic  for future medical investigation. We will follow up on our blog as more details emerge.


1http://articles.chicagotribune.com/2003-10-26/features/0310260520_1_acid-in-cola-drinks-bone-mineral-density-carbonated

Why Are Women Over 50 More Likely to Suffer From Knee Pain?

Knee Pain in womenIf you have knee pain, you know how debilitating it can be. And if you’re a woman, you have an even greater chance of developing knee pain after you reach 50. In a recent “Health Minute” spot, CNN’s Elizabeth Cohen spoke with Emory orthopedic physician Dr. Ken Mautner about knee pain in women over 50.

According to Dr. Mautner, knee pain in younger women tends to come from tendonitis or irritation issues around the knee. However, as women age, earlier knee injuries may lead to arthritis. The American College of Rheumatology reports that nearly two-thirds of women ages 50 and older have some degree of knee pain, and that pain is often due to osteoarthritis. And, Dr. Mautner says, women are more at risk for arthritis than men.

“We think that estrogen may have some protective effect on the cartilage of the knee,” Dr. Mautner says. That translates to a greater chance of experiencing knee pain after menopause.

Overuse injuries can cause knee pain, as can weight. If you have knee pain, your first step is to see your primary doctor to start determining the cause. He or she may then send you to a specialist. Treatment options may be as simple as taking acetaminophen or anti-inflammatory medications or using exercise as medicine, to strengthen the stabilizing muscles around the knee. Physical therapy may also be an option. When working out, avoid high-impact exercises that can further injure the knee. Low-impact exercises, like swimming, are a good alternative.

To watch Cohen’s “Health Minute,” visit: http://www.cnn.com/video/#/video/health/2012/01/26/hm-womens-knees.cnn

Are you over 50 and suffering from knee pain? Would you like to learn more about knee pain treatment at Emory? We welcome your questions and feedback in the comments section below.

Can Osteoarthritis Be Prevented?

preventing osteoarthritisIf you’re starting to feel the twinges of pain or stiffness in your joints or spine, you may be wondering what’s causing it and whether you can prevent it from getting worse. One common contributor to joint and spine pain is osteoarthritis. Osteoarthritis is a common joint disease that is caused by degeneration of the cartilage, the cushiony substance between the bones, and if severe, it can then affect the bone itself. Osteoarthritis most commonly affects the weight-bearing joints (hips, knees, and spine).

The chance of developing arthritis increases with age. Although some people may have it as early as their 20s and 30s, it is more likely to develop osteoarthritis in your 50 and 60s and older. There is no cure for osteoarthritis, so prevention is the key. There are some risk factors that you can’t change, such as your genes (heredity) and your age. The goal is to decrease risk factors that you do have control over to help prevent osteoarthritis. These include:

  • Weight – obesity increases risk of arthritis
  • Trauma
  • Performing repetitive-motion tasks over a long period of time
  • Weaksurrounding muscles

The same factors that will help you prevent osteoarthritis can also help treat the pain and discomfort from osteoarthritis. Extra weight puts a strain on your joints, so try to keep your weight in a healthy range or lose weight if you’re not in that range. If you’re not sure what a healthy range is for you, check with your doctor. Also, keeping your muscles strong can help decrease the weight on your joints. If pain occurs while you’re doing an activity, listen to your body and decrease your intensity. Bear in mind that repetitive activities can cause joint pain and stiffness. Repetitive activities might include working on the computer or repeated bending or lifting. Try to find other ways of performing daily activities and be sure to take frequent breaks.

If you’re experiencing ongoing or increasing pain and stiffness, it may be time to see one of the physicians at the Emory Orthopaedics & Spine Center for further evaluation and treatment.

Emory physiatrists are physicians specially trained in rehabilitation and pain management. Our physiatrists can work with you to develop a plan that includes daily strengthening and stretching exercises to reduce pain and stiffness. Because osteoarthritis can occur in different areas of your body, you want a plan designed to target the affected joint or joints. Your physician may suggest formal therapy or bracing the joint to help ease pain. Finally, your doctor can suggest an over-the-counter anti-inflammatory medication or prescribe medication to help with the pain if needed.

Do you have osteoarthritis? What do you do to ease the pain and stiffness? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

Dr. Diana SodiqAbout Diana Sodiq, DO:
Diana Sodiq, DO, is an Assistant Professor of Orthopedics and Rehabilitation Medicine. She is Board Certified in Physical Medicine and Rehabilitation (Physiatry). As an osteopathic physician, Dr. Sodiq is trained in both traditional medicine as well as osteopathic manipulative treatments (OMT). She started practicing at Emory in 2010.

How Do You Know if You Have a Hip Problem?

Thomas Bradbury, MDThink you’ve pulled a groin muscle? You may have a hip problem instead. Because hip pain often presents in the groin area, a lot of patients come to me thinking they’ve pulled a muscle, when in fact they have arthritis of the hip or a hip impingement.

Causes of hip pain may include arthritis, hip impingement, and labral tear.

Arthritis is the most common cause of hip pain, usually affecting older adults. Hip impingement, which generally affects younger folks, is caused by abnormalities in the shape of the ball in the socket, and it’s usually congenital, or a condition you’re born with. Impingement can lead to arthritis.

When you have hip impingement, you feel pain when the hip is at the extreme of its range of motion, such as when you’re sitting or walking up stairs. Because impingement pain is positional, it shouldn’t occur when you’re walking on level ground or at night, while you’re sleeping. Hip impingement also may cause a labral tear.  The labrum can be thought of as a cartilage “O-ring” that attaches to the rim of the hip socket. Rarely, trauma can result in a labral tear.

If you have pain in the buttock area, you may have a spine problem rather than a hip problem.

How do you know when to see a physiatrist or an orthopedist?

Pain that doesn’t resolve with several weeks of rest and avoidance of painful activities or with the use of Tylenol or anti-inflammatory drugs needs to be evaluated.  At the Emory Orthpaedics & Spine Center, we use x-rays and MRIs to help diagnose hip problems. Steroid injections into the joint also may help with both diagnosis and to ease the pain.

When hip problems are caused by arthritis, we start treatment with conservative methods, such as use of a cane, modification of activities, and taking Tylenol or anti-inflammatories. If these don’t sufficiently ease hip pain, hip replacement surgery offers the potential for dramatic improvement in pain, function, and quality of life.

When impingement causes hip pain, hip arthroscopy may be beneficial. During hip arthroscopy, your orthopedic surgeon uses a small camera to look inside the joint. If there’s an abnormal shape to the ball or socket, it can be corrected with special instruments. This treatment will often offer improvement in pain. Labral tears can be trimmed or repaired at the time of arthroscopy.

Have you experienced groin pain or hip pain? Have you tried conservative measures and not found relief? Or have you had a hip replacement or arthroscopy? We’d like to hear about your experience. Please take a moment to give us feedback in the comment section below.

About Thomas Bradbury, MD:

Dr. Bradbury is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He began practicing at Emory in 2007.

Getting In Shape For Surgery

In this post, I’ll discuss the importance of “getting in shape” for surgery. When conservative nonsurgical measures fail, and we’re considering joint replacement surgery for the treatment of end stage arthritis of the hip or knee, it’s important to take measures to increase your chance of success and reduce the risk of complications. Ideally, these steps should take place well before the actual procedure, and can be compared to “training for a marathon”. Generally, we look at three things in particular: Are you close to your ideal body weight? Are you aerobically conditioned? Are you a nonsmoker? If the answer to each of these questions is yes, you’re probably an excellent candidate for surgery. If not, we suggest that you take the following steps prior to scheduling surgery:

Lose weight

Being at or close to your ideal weight enhances your chances of surgical success. (You can calculate your BMI here.) If your BMI is 30–39, you have a higher risk of complication from surgery. If your BMI is 40 or above, you may not be a candidate for surgery right now, but we have resources at Emory to support you in your weight-loss efforts. Emory Family Medicine offers weight-loss counseling services, and the Emory Bariatric Center provides both surgical and nonsurgical weight-loss options. Weight loss is among the most important steps toward improving overall health and quality of life. In most cases, weight loss will improve the pain and loss of function associated with arthritis of the hip and knee. This improvement can be significant enough to obviate the need for surgery.  If surgery is necessary, appropriate weight loss prior to surgery will dramatically reduce the risk of complications including infection and dangerous blood clots. In addition, it will speed the recovery process and help prevent future orthopedic problems.

Get active

Patients who exercise regularly tend to recover from surgery more quickly than patients who don’t. If you’re preparing for orthopedic surgery such as knee or hip replacement, weight training and cardiovascular exercise can smooth the recovery process. When your muscles and soft tissues are strong and well conditioned, they help stabilize the knee and protect the joints, helping you get moving again more quickly.

Further, if you‘ve been diagnosed with hip or knee arthritis, don’t discontinue exercise and aerobic conditioning. Exercise has been scientifically proven to improve the pain and loss of function associated with arthritis of the knee. If you aren’t currently active, you can start now by slowly introducing exercise into your schedule—even just three times a week is helpful. Choose an exercise that does not cause pain. In general, lower impact exercises such as swimming, cycling, and the elliptical machine will allow elevation of heart rate while minimizing pain associated with hip or knee arthritis. There’s no evidence that increasing activity level will cause worsening of knee arthritis.

If you need help creating an exercise plan, the physical therapists at the Emory Orthopedics & Spine Center can work with you. Having professional support and/or a partner to exercise with can make it easier to begin and stick with an exercise program.

Stop smoking

Smoking cigarettes increases the risk of complication after orthopedic surgery. If you’re a smoker, cessation from smoking for at least one month before and one month after surgery can significantly reduce the risk of complications after surgery. Smoking can inhibit bone’s ability to heal itself, slow surgical wound healing, and increase the risk of infection following surgery. Smokers also have an increased chance of having lung problems, such as pneumonia, after surgery. One study demonstrated that smoking cessation prior to and after surgery could reduce the risk of complication by more than 50%.

If you need help quitting, Emory Family Medicine offers smoking cessation counseling services.

Are you getting in shape for orthopedic surgery? We welcome your questions and feedback in the comments section below.

Thomas Bradbury, MD, is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He started practicing at Emory in 2007.