Knee Injuries, Surgeries, and Vitamin D Status. The knee joint is one of the largest and complex joints. It connects the thigh bone to the shinbone, which has a very important role in:
Supporting the body’s weight
Facilitating movement
Allowing the ability to bend the knee
Because of the complexity of the knee joint, it is highly susceptible to injuries. The most common injuries include tears in the:
Ligaments
Tendons
Cartilage
The kneecap itself can be fractured and/or dislocated.
Tears
Meniscal Tears
The meniscus is the cartilage between the knee joint that absorbs the impact/shock when running, playing sports, yard work, hiking, bicycling, etc. It cushions the joint and maintains stability.
Meniscus tears are common in sports that have a lot of jumping, starting/stopping quickly, changing direction suddenly, like volleyball, basketball, tennis, soccer, football. This is when the meniscus tears. Surgery can be required, depending on the severity/extent of the injury and tear.
Tendon Tears
The patellar tendon works with the knee muscles in the front of the thigh to straighten the leg. Tears in the patellar tendon are common among middle-aged individuals and those that participate in running or jumping sports.
A complete tear is considered a disabling injury that requires surgery for full functional recovery.
Fortunately, most tears are partial and require rest and chiropractic/physical therapy to heal.
Dislocation
Knee dislocations happen when the knee bones shift out of position. This can happen after a fall, car crash, or high-speed impact. It can also be caused by twisting the knee while the foot stays planted. Dislocations require relocation. However, sometimes a dislocated kneecap corrects itself and returns to the proper position. Other cases can require a mild sedative to allow a doctor to relocate the knee. Dislocations generally take around six weeks to fully heal.
Anterior Cruciate Ligament – ACL Injury
The anterior cruciate ligament or ACL is knee tissue that joins the upper and lower leg bones and maintains the knees’ stability. The ACL can be torn if the lower leg over-extends forward or if the leg gets twisted. ACL injuries are common knee injuries and account for around 40% of sports-related injuries. These injuries can range from a small tear in the ligament to a severe injury where the ligament tears completely or gets separated from the bone. Treatment depends on the severity of the injury. Depending on various factors including the severity of the tear, surgery could be required.
Knee Surgery
For most cases, surgery is done using arthroscopytechnology. This procedure uses small incisions to insert a camera and surgical instruments into the joint. Usually, two or three incisions are needed with recovery time being quicker than large incision surgery where the whole knee is opened. Minimally invasive arthroscopic surgery is preferred by sports medicine experts. With this procedure:
There is no need to cut the tendons or muscles
Bleeding is reduced
Small incisions decrease scarring
Recovery time is shorter
However, sometimes a large incision is required for complex surgical techniques. Common knee surgery procedures include:
Arthroscopy Surgery
This method allows the ability to see inside the knee joint. The procedure is often recommended for:
Diagnosis
Minor repairs to ligaments and/or tendons
Cartilage or bone that needs to be removed
Total Knee Replacement
A full knee replacement is known as arthroplasty. When the joint is damaged beyond repair from injury or disease, an implant is placed in the knee joint restoring function. A small amount of cartilage and bone from the shinbone and thigh bone gets removed for perfect placement of the new knee joint.
Revision Knee Replacement
Most knee replacements last around 15 – 20 years. For individuals that have knee replacement early, then a new operation for new implants could be required. Here, the surgeon removes the original prosthesis and replaces it with a new one.
Partial Knee Replacement
Some knee injuries do not require complete replacement. Here, only the worn-out portion of the joint is replaced. As an example, the cartilage that has been lost in an area of the knee can be repaired with a partial replacement.
Vitamin D Status
A study on athletes that underwent ACL surgery looked at their vitamin d status and how it affected their recovery.
The research concluded that vitamin D status had no effect on surgery outcomes.
However, those with the lowest vitamin D status had three times the failure rate than those with higher vitamin D
The average age of the individuals was around twenty-four and were healthy athletes.
Each of the patients in this study had their vitamin levels measured before the operation and were grouped based on their vitamin D status:
Group 1 vitamin D below 20 ng/mL – considered deficient
Group 2 vitamin D between 20-30 ng/mL – considered low but in a technical range
Group 3 vitamin D above 30 ng/mL – considered sufficient, but not optimal
All were followed for two years with their surgery recovery being measured with two systems.
The Lysholm score, which is a 100 point scoring system that looks at an individual’s knee functions that include:
Mechanical locking
Instability
Pain
Swelling
Stair climbing
Squatting
The WOMAC score is a scoring system that measures:
After 2 years, the Lysholm score and the WOMAC scores were similar.
However, there was a difference in the graft failure rate which was about 6% in group 1 with the lowest vitamin D and around 2% in groups 2 and 3. This shows that the lowest vitamin D status has three times the failure rate compared with those that had increased vitamin D levels. Vitamin D is a known anti-inflammatory with metabolic functions that are documented. Therefore, vitamin D does improve surgical success and recovery in healthy athletes.
Body Composition
Disclaimer
The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico
References
Brambilla, Lorenzo, et al. “Outcome of total hip and total knee arthroplasty and vitamin D homeostasis.” British medical bulletin vol. 135,1 (2020): 50-61. doi:10.1093/bmb/ldaa018
European Journal of Orthopedic Surgery and Traumatology, January 2021
Zhang, Hao et al. “Vitamin D Status and Patient Outcomes after Knee or Hip Surgery: A Meta-Analysis.” Annals of nutrition & metabolism vol. 73,2 (2018): 121-130. doi:10.1159/000490670
Spinal vertebral compression fractures are a common injury in older individuals brought on from a lowered bone density. Hip and wrist fractures get most of the attention when it comes to osteoporosis. However, spinal fractures happen almost twice as often and affect around 700,000 individuals yearly. This is according to the American Academy of Orthopaedic Surgeons or the AAOS. These types of fractures are also known as:
Fragility fractures
Vertebral compression fractures
Osteoporotic compression fractures. These usually happen as a result of thinning and weakening bones caused by osteoporosis.
The Academy of Orthopedic Surgeons notes that changes in the body’s musculoskeletal bone structure can go unnoticed for years. This leads to the vertebrae narrowing and flattening, rounding the spine as a result, creating compression. Because of the weakened bone, the pressure, even from everyday low-impact movements like reaching, bending or twisting. There are strategies that can help prevent osteoporosis and osteoporotic compression fractures.
More Movement and Physical Activity
One prevention strategy that is highly recommended is more movement and physical activity. This does not include occasional gentle movements like taking a break from sitting. Improving the spine’s health means using the full range of motion and loading the bones so they can get build strength. This could be walking more, which creates spinal resistance. Also using light weights with high repetitions with five to ten pounds of a load is enough to challenge the spine without generating muscle stress.
Individuals think they need to rest more as they get older, but to build and maintain bone density to prevent osteoporotic compression fractures more physical activity is needed. Moving around for 10 to 15 minutes every hour is a good way to start. Incorporating more activity, and focusing on healthy diet changes will help shed excess weight. This will decrease pressure on the spine, reducing the risk of fractures. For individuals with osteoporosis of the spine, it is important to review any exercise plans with a physician or doctor of chiropractic to ensure that they are safe. The wrong types of movement or too much stress on a fragile spine can definitely cause a fracture.
Medications and Other Conditions
There are medications that can help build bone density, but there are also medications for conditions that can actually cause faster bone density loss. Individuals could be taking a medication that’s good for one issue/condition, but not realize it may be associated with a reduction in bone density. This is why it is important to review prescriptions with a doctor with bone density loss side effects in mind. Medications that can cause bone loss include:
Anti-seizure drugs like carbamazepine and phenytoin
Diuretics like furosemide
Also, review any underlying conditions that could affect osteoporosis. As an example, the National Institutes of Health or NIH note that individuals with diabetes, specifically type 1, can have poor bone quality increasing their risk of fractures.
Adding Calcium To The Diet
An adequate intake of calcium is essential for osteoporosis prevention and helps lower the risk of fragility fractures. A low calcium intake contributes significantly to lower bone density and faster bone loss with age. Vitamin D also helps in bone injury prevention.
Treatment
Compression fracture/s diagnosis are confirmed through imaging tests like:
X-rays
Magnetic resonance imaging MRI scan
Bone scan
Computed tomography CT scan
Bone density testing with dual-energy x-ray absorptiometry DEXA will determine bone mineral density. If a scan reveals there is a vertebral compression fracture, the most common approach is no treatment. According to the Academy of Orthopedic Surgeons, most individuals with this type of injury improve within three months with a combined rest period and limited pain medication use.
Some individuals are recommended to wear braces to restrict movement so the fracture can heal without any added compression or stress. For those that do not respond to non-surgical treatment, minimally invasive surgery could become an option. In both cases, a doctor will suggest similar aforementioned strategies to help strengthen the bones and prevent worsening or creating new issues.
More flab on the middle that gets harder to burn off
Performance at work, the gym, or on the road slows down or begins to reverse
Workouts, sporting events, physical activity that the body was able to bounce back from quite easily now take twice as long to recover from
Things start to change when the body enters its 30’s. Whether light exercise, playing weekend games, local sports, etc, the key is to just stay active. By paying close attention to nutrition and making minor adjustments, individuals can maintain and improve body composition, stay strong and healthy in their 30s and be ready for the future.
Disclaimer
The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Dr. Alex Jimenez DC, MSACP, CCST, IFMCP, CIFM, CTG* email: coach@elpasofunctionalmedicine.com phone: 915-850-0900 Licensed in Texas & New Mexico
Medications can be lifesavers when it comes to the treatment of various conditions. But they can also open the door to other serious conditions. Medications fall into pharmacological drug classes. Certain medications can interfere with bone health, and induce bone density loss. Users of these medications could put them at risk for osteoporosis and possible spinal fracture/s. Medications that can potentially weaken bones and how to protect yourself is the focus. Not all of the medications listed are for treating spinal disorders or neck and back pain.
Steroids
Steroids taken by mouth are commonly prescribed for spinal conditions. This includes:
Low back pain
Neck pain
Spinal inflammatory arthritis
These medications carry anti-inflammatory compounds that are pretty powerful. These help the pain but can cause bone loss with long-term use. These types of steroids put the bones at risk because of how they slow down the osteoblasts, which are bone-building cells. As the osteoblasts are slowed, the work of the osteoclasts, which are bone-absorbing cells gets increased straining the system and ultimately leading to bone loss.
Examples of steroids:
Dexamethasone
Methylprednisolone
Prednisone
Daily doses of more than 5 mg pose the biggest threat to the skeletal system. Ask a doctor about a short-term low-dose regimen, especially, if there is a heightened risk for osteoporosis or spinal fracture.
Selective Serotonin Receptor Uptake Inhibitor
Selective serotonin receptor uptake inhibitors help those with neck and low back pain in a variety of ways. These include reducing the mental and emotional effects of chronic pain. But, selective serotonin receptor uptake inhibitors can boost the fracture risk. This type of medication can cause bone loss in older women and reduced bone density in men and children.
Examples of selective serotonin receptor uptake inhibitors:
Ask a doctor for another type of selective serotonin receptor uptake inhibitor. Possibilities include serotonin and norepinephrine reuptake inhibitors, that can achieve the same results without bone loss and fracture risks.
Certain Anticonvulsants
Anticonvulsants are used to control seizures. However, they have been found to help individuals with spinal nerve pain. But there are some types of anticonvulsants that can increase the liver�s vitamin D metabolism. This lowers the blood�s vitamin D levels. Vitamin D is essential to the body�s ability to absorb calcium. That means that lower vitamin D levels can cause bone loss.
Talk to a doctor, chiropractor, or health coach about taking a vitamin D supplement/s to boost vitamin D levels.
Certain Diabetic Medications
There are two types of diabetic medications that can increase the risk of fracture. Thiazolidinediones known as TZD’s and sodium-glucose cotransporter 2 inhibitors. The TZD’s increase the fat cells in the bone marrow, and lower the bone-building cells. The sodium-glucose cotransporter 2 inhibitors can reduce bone density.
If there is a high risk of fracture, ask a doctor if an alternative medication to a TZD can be taken.
Examples of sodium-glucose cotransporter 2 inhibitors:
Canagliflozin
Dapagliflozin
Empagliflozin
If there is a greater risk of falls, ask a doctor if an alternative to taking a sodium-glucose cotransporter 2 inhibitor can be taken.
Hormone Medications
Medications that reduce estrogen or androgen levels in the body also increase the bone’s absorbing cell activity. And this can lead to bone density loss.
If there is an increased risk for osteoporosis or fracture, talk to a doctor about ways to protect the bones while taking these medications.
Antacids
Antacids both over-the-counter and prescription that contain aluminum help to neutralize stomach acid. There are other medications called H2-blockers also known as proton-pump inhibitors. These reduce how much acid the stomach produces. While these aid in reducing heartburn, stomach pain, etc, long-term use can reduce the body�s ability to absorb calcium and thus increase the risk for fracture.
These medications help reduce the risk of stroke, can interfere with the body�s ability to absorb calcium. They reduce the activity of the bone-building cells. This causes bone loss and increases the risk of fracture.
Examples of anticoagulants or blood thinners:
Enoxaparin sodium
Warfarin
Talk to a doctor about a possible alternative anticoagulant. A change in medication has been shown to put the bones at less risk.
Diuretics
Loop diuretics work by reducing inflammation/swelling along with water retention by increasing the kidneys urine production. These medications can cause the kidneys to remove key nutrients like calcium, potassium, and magnesium to help increase bone production. Reduction in all of these increases the risk of bone loss and a spinal fracture.
Examples of loop diuretics:
Furosemide
Ethacrynic acid
Bumetanide
Talk to a doctor about an alternative known as a thiazide diuretic. These encourage the kidneys to retain calcium, thus increasing bone density.
Reduce The Risk
Protecting bone health is the objective. A bone mineral density test could help along with taking bone-boosting supplements. Learning about the risks of taking these medications can help prevent osteoporosis and spinal fractures. Keep track of all medications over-the-counter, prescription, holistic, all-natural, etc, and make sure all doctors, specialists understand what is being taken. A spine specialist or endocrinologist might not what the other doctor has prescribed, so keep everyone informed.
Rehabilitation for Cerebral Palsy
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Increase in sports-related fractures among young and active people
Any type of bone fracture, especially when the spine is involved, comes with the most common and debilitating symptom is severe pain.
Managing pain correctly is vital to the proper healing of a fractured bone.
Unfortunately, the common treatments prescribed to manage fracture pain can cause significant side effects, especially when used beyond the short-term or acute phase of pain.
Bone fractures cannot be always be avoided, but when it comes to osteoporosis, everyone can take steps to help minimize the risk of developing the condition.
How to Prevent Osteoporosis and Bone Fracture
First, understand that osteoporosis is not a normal part of the aging process.
It is an irreversible and degenerative disease that causes bones to become porous over time.
Prevention should begin as early as possible, as this will benefit an individual later in life.
It’s never too late to begin taking steps!
Protecting the bones begins with the most important thing and that is diet.
Most individuals’ diet does not fill the recommended daily values of calcium and Vitamin D.
Both are essential for strong bone health and density.
Diet must be well-balanced with an abundance of:
Green leafy vegetables
Fruit
Dairy sources high in calcium:
Milk
Yogurt
Cheese
However, vitamin D is typically highest in sources of wild-caught fatty fish like salmon and tuna.
Regular exercise is the next important step to help reduce the risk and keep bones strong.
Do exercises that are both:
Weight-bearing (high/low-impact aerobics or walking/jogging)
Muscle-strengthening (weightlifting and exercise bands)
Yoga and Pilates can also help to improve:
Strength
Balance
Flexibility
These are essential in the prevention of bone fractures from falls.
Engage in exercise that you enjoy, this way you will stick with it on a regular basis.
Try for two to three sessions a week if you�re beginning and try to work up to five.
While diet and exercise are extremely important to prevent osteoporosis, there are some areas that should be removed from the lifestyle or limited.
Smoking
Alcohol
These chemicals in bothcigarettes and heavy alcohol consumption are known to be significant contributors to bone loss.
Injury Medical & Chiropractic Clinic offers not only chiropractic treatment, but exercise, and diet programs set up by professional life/health coaches that are customized to each patient. Set up an appointment today, we can help!
Chronic Body Pain Treatment El Paso, TX Chiropractor
Aracely Norte suffered a slip-and-fall accident which tremendously limited her ability to work, affecting her quality of life. Due to the chronic pain she experienced, Aracely had difficulty engaging in her regular, everyday responsibilities. After her lawyer recommended Dr. Alex Jimenez, chiropractor, Aracely found the relief she was looking for.
Chronic pain is a common issue that can occur due to a variety of reasons, including injuries and underlying conditions, however, chiropractic care can help eliminate chronic pain symptoms from the source.
NCBI Resources
As with most conditions, prevention is the most�effective treatment. If you have a family history or fall under any of the risk factors, there are things you can do to minimize the effects or prevent the conditions completely.
Your chiropractor can talk to you about lifestyle changes, exercise, and�diet�as well as supplements that you can take. Chiropractic adjustments can also be effective for many patients with osteopenia and osteoporosis as long as the chosen technique is a low force technique like Activator.
With the increase of osteoporosis in older adults, the diagnosis and treatment�of abnormal hip fractures, such as�bisphosphonate-related proximal femoral fractures,�has become more important. According to Dr. Edward J. Fox, MD, obesity is often managed through the long-term�use of bisphosphonate treatment, which can inhibit�osteoclast-mediated bone regeneration. Over the prolonged utilization of bisphosphonate, patients� may develop atypical proximal femoral fractures.
Understanding Atypical Femur Fractures
Atypical femur fractures are characterized as stress fractures which commonly occur in the proximal one-third of the diaphyseal bone, although they might also occur more distally, developing in the lateral cortex and slowly progressing medially. “With irregular fractures, a small ‘beak’ of bone can form on the lateral surface of the femur and that is where the fracture generally begins,” explains Dr. Fox. This contrasts with stress fractures which occur laterally in the medial portion of the bone.
As a result, when a patient with osteoporosis reports feeling hip and knee pain without previous damage or injury, healthcare professionals will ask about bisphosphonate treatment. It is essential for the�doctor to request x-rays of the hip and femur shaft for proper diagnosis.�It is also important to request x-rays of the opposite femur, as atypical bisphosphonate-related proximal femoral fractures frequently occur bilaterally. Dr. Edward J. Fox urges patients to discontinue bisphosphonate use in the case of hip fractures,�followed by the subsequent use of crutches or a walker. Patients will eventually be able to resume regular physical activities.
Approximately more than 250,000 hip fractures occur in the United States, causing significant patient disability. The variety of hip fractures in older adults, including bisphosphonate-related proximal femoral fractures, often need several treatment approaches which depend on different considerations, such as the mechanism of injury, location and degree of the fracture, as well as the patient’s age and overall health and wellness.
Dr. Alex Jimenez D.C., C.C.S.T.
The precise mechanism of injury by which bisphosphonates cause atypical femur fractures is unknown. Research studies have demonstrated that the suppression of osteoclast activity prevents the clearance of bone fragments which build up on the bone surface during regular daily tasks; decreasing the strength of the bones which lead to fracture. “We all know that the threat of those fractures increases with the extended duration of bisphosphonate exposure, particularly after five decades. Bisphosphonates are stored with a half-life of at least eight decades in bone matrix. To reduce over-exposure and risk of atypical fracture, passing medication discontinuance has been speculated to be beneficial,” explained Dr. Fox
Dr. Edward J. Fox, MD, stated that until research studies find the exact mechanism of injury and treatment for bisphosphonate-related proximal femoral fractures, healthcare professionals should continue to determine the best treatment option for each patient, carefully weighing the benefits and risks of individual patients. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Acute Back Pain
Back pain�is one of the most prevalent causes of disability and missed days at work worldwide. Back pain is the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as�herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
Fractures of the process of the lower spine or upper thoracic spine are often referred to as clay-shoveler’s fractures.
Initially reported in 1940, these fractures were described among employees in Australia who dug drains in clay soil and also threw the clay overhead with shovels. The mud wouldn’t discharge from the spade, causing excess power to be transmitted into the supraspinous ligaments and leading to an avulsion fracture of one or more spinous processes.
The following frequently describes the mechanism of injury for clay shoveler’s fractures. The contraction of the paraspinal and trapezius muscles on the ligaments along with the attachment to the spinous processes make this a common injury during athletics with a flexed position of the shoulders and neck. The consequent fracture or apophyseal avulsion is painful and frequently requires a visit to the doctor, together with plain films, computed tomography (CT) scans, or magnetic resonance imaging (MRI) confirming the identification.
Often a period of rest will allow a return to activity, although treatment of these fractures hasn’t been clarified. We present a collection of adolescent athletes who underwent surgical interventions to treat the fracture of the spinous process, after rest and physical therapy with persistent symptoms.
Surgical Intervention Study
Dr. Hedequist operated on 3 patients using a spinous process nonunion within the study time period. The patients’ average age was 14 years; the location of the spinous process fracture was the T1 vertebra in all patients. Two patients sustained the injury while playing hockey and one while wrestling. The average duration of symptoms before surgery was 10 months; all patients had seen physicians without a diagnosis before test in institution. All patients had a trial of physical therapy and all had been unable to return after trauma to pain.
Examination of patients showed pain directly over the fracture site and accentuated by forward flexion of the neck and neck. Evaluation of harm plain films revealed a fracture fragment in two patients (Figure 1). All 3 patients underwent CT and MRI scans confirming the identification. MRI confirmed areas of increased signal at the tip of the T1 spinous process, with inflammation in the supraspinous ligament directly at that area (Figure 2). The CT scans confirmed the presence of a bony fragment correlating with the suggestion of the T1 spinous process (Figure 3).
Figure 1
Figure 2
Figure 3
Surgery was performed under general endotracheal anesthesia using a midline incision over the affected region down to the spinous procedure. The supraspinous ligament was opened showing an identified and ununited ossicle, which has been removed without taking down the ligament. All 3 nonunions have been noted to be atrophic with no evidence of surrounding inflammatory tissue or bursa. The residual end of the spinous process was smoothed down with a rongeur. Standard closure was performed. There were no surgical complications.
All patients had complete relief of pain at followup; 1 individual returned to full sports activity at 6 months and the other 2 returned to full sports activity at 3 months. There was no loss of peripheral movement or trapezial strength at follow-up. All patients expressed satisfaction together with the decision.
Discussion
Clinical practice suggests that most patients with spinous process fractures will become pain-free; however, that is not universal. This series demonstrates that a tiny subset of patients with this trauma will continue to have significant symptoms despite a period of rest. In those patients who want a yield to sports, we recommend consideration of surgical excision after confirmation of nonunion with studies. The inherent risks of surgical treatment are minimal with this procedure, and the advantages include return for athletes, with the physical and psychosocial benefits to pain-free sports activity.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Automobile Accident Injuries
Whiplash, among other automobile accident injuries, are frequently reported by victims of an auto collision, regardless of the severity and grade of the accident. The sheer force of an impact can cause damage or injury to the cervical spine, as well as to the rest of the spine. Whiplash is generally the result of an abrupt, back-and-forth jolt of the head and neck in any direction. Fortunately, a variety of treatments are available to treat automobile accident injuries.
Stress fractures to the ribs occur in rowers, golfer, canoeists, lacrosse players and baseball pitchers. They are more common in sports involving an element of trunk rotation with scapula movement across the rib cage.
A stress fracture is described as an overload to the bone caused by repetitive loading due to a particular movement. Any load on the bone will create a stress in the bone. However, given enough recovery time the bone heals and ends up stronger. This is known as Wolfe�s law. But, if the bone load is too high or too frequent, then the bone does not repair quickly enough, a stress response occurs and a fracture follows.
In rowing, the repetitive loading is created by a number of factors. Muscles such as the serratus anterior and abdominals that directly attach to the ribs can lead to loading on the ribcage due to contraction. Bad rowing technique, perhaps caused by poor hip flexibility, which then requires an excessive compensatory thoracic rotation, may then lead to rib breakdown.
Other causes include equipment issues such as the oar type (lighter carbon oars increase rib loading), bigger boats with more drag and position in the boat (bow rowers have less incidence due to lower stroke rate and force). Rib cross section and density also influence the chance of stress fractures, and women have a higher chance due to greater likelihood of bone density issues. Finally, training variables such as volume, intensity, type of loading and off water training can also be factors in stress fracture development.
The signs and symptoms are usually straight forward. These include generalised rib pain with a focused spot of tenderness, pain rolling onto the ribs whilst sleeping and pain with deep breathing. They can be confirmed with bone scan (black spot) and/or MRI (white spot).
Unfortunately for the rower, the immediate management of the injury involves rest. Usually 4-6 weeks away from rowing will be enough to allow some bone healing and this is followed by a progressive increase in rowing load over another 4 weeks before the athlete is back to full training.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: Chiropractic and Athletic Performance
Chiropractic care is a popular, alternative treatment option which focuses on the diagnosis, treatment and prevention of injuries and/or conditions associated to the musculoskeletal and nervous system, primarily the spine. Many athletes, and civilians alike, seek chiropractic care to restore their natural health and wellness, however, chiropractic has been demonstrated to benefit athletes by increasing their athletic performance.
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