Tag Archives: back pain

SURGEON ON A MISSION

At Sarasota Orthopedic Associates, we believe in supporting our community in many ways and we encourage our staff to do so as well. Our spine surgeon, Dr Andrew Moulton, goes a step further and shares his skills globally to help children in developing countries. Our local newspaper recently interviewed him to learn more about his mission as co-founder of the Butterfly Foundation.  Read about it here:

Moulton Surgical Team

Dr. Andrew Moulton is a nationally recognized expert in the diagnosis and treatment of spinal disorders and a surgeon at Sarasota Orthopedics Associates. He is also the founder of the Butterfly Foundation, a non-profit organization dedicated to improving the lives of children with complex spinal deformity in developing countries.

Since 2003, Dr. Moulton has performed dozens of living-saving surgeries, while promoting the advancement of spine deformity treatment technology by training local surgeons. We spoke to him recently about his philanthropic work. Visit www.SOA.md for more information.

What inspired you to start the Butterfly Foundation?

As an orthopedic resident, I visited Honduras on a pediatric mission in which many club foot surgeries were performed. The next trip, there were more patients than before. I looked at the demographics and realized that the procedures themselves were a drop in the bucket compared to the size of the problem, and then decided to focus on training local surgeons. “Teach a man to fish and he feeds his community for a lifetime” is our motto.

Where are some of the places the foundation serves?

We have ongoing efforts in the Dominican Republic, Malawi, Chile, Peru, Jamaica, Vietnam, China and Myanmar.

What kind of spinal injuries or illnesses have you treated?

We treat primarily pediatric deformities, including spinal injuries and severe, life-threatening cases of scoliosis.

Moulton pt    Moulton spine film

Where did the name “Butterfly Foundation” come from?

Because of society’s attitudes toward their deformity, we saw how these kids would come in, bundled up, socially withdrawn, embarrassed, even outcast. Once they have their surgeries and heal, they stand up straight, they run, and they jump and play. There’s such a profound joy to see them move so freely, without pain. Their transformation reminded us of how a butterfly is born and the name stuck.

What was your most memorable case?

The most memorable case may have been one of the first very extensive ones. After a 15-hour surgery, with my hands bleeding from blisters acquired over the week of surgeries, I sat in a corner waiting over an hour for the patient to wake up to ensure she was not paralyzed from the surgery. She woke up in great shape. I slept well that night!

What inspires you to continue doing this work?

Doing this work takes me back to the basics of being a doctor — to why I wanted to become one in the first place. These people don’t have many chances in life. For me to give a little means a lot to them. When the people thank you, they really mean it. You’re the only chance they have.

How can our readers become involved with your foundation?

People are welcome to email inquiries to info@SOA.md.

Moulton photo

SOURCE: Herald Tribune/Style Magazine/Sunday, August 6, 2017

Link to article: http://sarasotaheraldtribune.fl.app.newsmemory.com/publink.php?shareid=0b1b06237

Butterfly Foundation Facebook Page

What’s That Sound? SNAP, CRACKLE, POP

knuckle cracking

It’s a question most orthopedic surgeons get asked on a daily basis: “My joint pops…is that normal?” Like most things in life, if it’s not broke (or hurting), don’t fix it. An acute injury resulting in an audible “pop” is different from a situation such as a hip “popping” for years. Popping, cracking, or crunching of joints is quite common and often nothing to be too concerned with, especially if it is not causing discomfort or affecting one’s activities. Here are some need to know tidbits on joint popping and cracking.

What Causes This?

  • Numerous theories and causes exist including ligament stretching, tendons snapping, nerves subluxing, or bubbles forming within the joint. A recent study investigated the bubble theory using MRI videos to propose the mechanism by which “cracking” your knuckles results in a negative-pressure event which draws synovial fluid into the joint, thus leading to the subsequent pop. Why does it feel good to crack a knuckle? Thoughts are that the pressure phenomenon within/around the joints stimulates certain receptors which allows for muscles to relax. Another theory suggests natural painkillers (endorphins) are released with such activity, which may explain why it can be a difficult habit to break.
  • Other things must also be taken into account when discussing the cause of noise around a joint, such as prior injuries, surgeries, hardware/implants around the joint, and other accompanying symptoms. It is quite common for someone who injures their ACL to feel or hear a “pop” from the ligament rupturing. This must be taken in a different context from the chronic, painless popping that someone may experience around their knee cap from soft-tissue issues.
  • Lastly, arthritis can commonly be accompanied with crunching or cracking sensations and as long as it is not resulting in increasing pain or swelling, it is something that can be observed. Some older style knee/hip implants may result in noises (e.g. squeaking), and if you were experiencing this, it would likely be best to visit with your orthopedic surgeon to check the status of things and make sure the components were not wearing out in an abnormal fashion.

Should I Be Concerned?

In general, if the popping/cracking around a joint is not causing pain or swelling to occur or interfering with your function or activities, there shouldn’t be much concern. Studies have looked at whether or not cracking your knuckles would lead to arthritis, and to date, no such correlation has been shown. That said, it is generally recommended that one not perform such activities too frequently or on purpose as there have been reports of joints/knuckles becoming loose from habitual cracking. In addition, habitual knuckle crackers have been shown to develop hand swelling (not from arthritis) and decreased grip strength which can lead to decreased manual function. Nodules can also form from such activity, and this may cause cosmetic concerns for certain patients.

Common Areas to Experience It

Any joint can develop it, but perhaps the most common areas to experience it are in the hands, knees, spine, and shoulders.

  • As already mentioned, knuckle cracking is a common occurrence.
  • With regards to the knee, the anterior aspect often experiences popping/crunching from the patellofemoral joint (knee cap). This can be from mild softening of the joint, but most of the time it is from soft-tissues in the area (e.g. plica, fat pad) that simply release themselves during motion.
  • Similar to the knuckles in the hand, the facet joints and other muscles/ligaments around the spine are prone to popping.
  • The spine is a complex unit with numerous muscles, joints, discs, and ligaments contributing to its stability. Chiropractors make a living out of therapeutically popping, cracking, and aligning patients’ backs, so why would you get too concerned with your back popping if you’re not having any discomfort with it?
  • Lastly, the AC joint of the shoulder almost always develops arthritis, but rarely causes too much pain or functional limitation. Popping over this portion of the shoulder with no other symptoms is quite common. On the contrary, patients with symptomatic instability or arthritis in the shoulder joint proper will almost always have pain or issues with their function accompanying this, and would thus be treated differently to the above mentioned scenarios.

Summary

Painless popping around joints is an issue that one should hardly ever get too concerned with. If popping occurred from an acute injury or there were other symptoms being experienced in addition to it, then a visit with your orthopedic surgeon would be recommended at that point. Otherwise, keep up what you are doing and don’t let some painless noise around a joint stress you out.

Born-077_R2

Trevor Born, MD is an orthopedic surgeon with a specialty in sports medicine. At Sarasota Orthopedic Associates our commitment is to get our patients back on their feet, back to work, back in the game, and back to life. We have four convenient locations and offer same day appointments when needed. Visit our website at www.SOA.md or call us at 941-951-2663 for an appointment. Appointments may also be made via our website.

 

TEXT NECK … Is that really a “thing”?

texting adults

Indeed it is. Think about it. We spend much of our day with our heads lowered to read our smartphones. It’s not unusual to see people “text-walking” or worse, driving while texting. With all the advantages of having a world of information at our fingertips, there is also an associated health risk.

There are over 4 billion mobile devices in the world and the average American usage is 2.7 hours per day communicating on these devices. It’s no wonder we have sore necks and shoulders. In fact, it’s becoming an epidemic affecting millions and it’s growing.

Constant lowering of the neck to look downward puts the spine in an unnatural curve that can cause reduction in the cervical spine, thus creating a “pain in the neck”. Worse, that pain can radiate through the shoulders, creating tension, and even debilitating headaches. As the situation intensifies, the arms may become weak, numb, or tingle. Over time, this pattern can become lingering and as a result, a challenge to treat.

The average head weighs about 10 pounds. When tilted downward 15 degrees, the force of your head on your cervical spine increases to about 25 pounds. The more tilt, the more weight; that can be up to as much as 60 pounds of force on your neck. Prolonged tilting downward creates excessive strain causing stress injury. Over a long period of time it may even lead to spinal misalignment, early onset of arthritis, disc compression, or nerve damage.

text neck

So how do we combat this growing concern? Resistance and strengthening are keys to reinforce the neck and shoulder muscles and offset damage. Taking frequent breaks, maintaining good posture, and doing neck stretches help circumvent damage. Most important, when using a mobile device, place it at eye level to avoid tilting of the neck. Remember … Hold Your Head Up!

If you believe you have “text neck” or any form of musculoskeletal pain, Sarasota Orthopedic Associates has four convenient locations to help you alleviate your discomfort. We offer same day appointments when needed. Give us a call at 941-951-2663 (BONE) or check our website here for more information.

 

Sources:   WFLA; LA Times; Today Health & Wellness

SUMMER IS A PERFECT TIME FOR POOL THERAPY

pool therapy

One of the advantages living in Florida is our sunny weather year round so it is not unusual to have daily access to a pool, whether at a private home, community development, or a local Y. Even if you’re in a climate with cold winter temperatures, there are gyms offering year round swimming. From an orthopedic perspective, swimming is one of the most beneficial exercises you can do, and better yet, it can be so much fun that you don’t think of it as exercise.

When prescribed as Aquatic Therapy, there are many techniques and forms of bodywork. Applications include those for spine pain, musculoskeletal discomfort, post-operative rehabilitation, and disabilities or disorders. It may be most beneficial when non-weight bearing exercises are needed or when normal range of motion is limited due to pain, inflammation, or rehabilitation.

Water has properties that provide resistance which are beneficial in exercising. Because of these properties, the muscles actually work harder when submerged in water compared to doing that same exercise on dry ground. Try to imagine running through water and how much more difficult it would be and how much more time it would take to cover the same distance as running a mile on land. Submersion into the water makes it harder to move because of the buoyancy. This resistance also helps tone muscle and improve balance.

Pool exercise can also burn calories. An average 30 minute pool exercise routine can burn off approximately 300 calories. The water also helps reduce body fatigue as it supports so much of the body weight. Pool exercises, done three or four times a week, could result in weight loss and be fun in the process!

Water is also known to have an added benefit on the body and brain. There is a theory called “blue mind” that suggests being close to, in, over, or under the water makes us happier and healthier. For this reason, yoga studios and massage spas incorporate waterfalls into their décor. The gentleness of being near or in the water sends a soothing feeling of relaxation and can lower blood pressure.

PT Pool

Pool therapy has become a widely accepted form of exercise and is now offered in many gym facilities, parks, and community developments. The Arthritis Foundation has even partnered with many YMCA’s across the country in a program called PACE, or People with Arthritis Can Exercise. In fact, they have an excellent website with great tips for a water walking routine. Always check with your physician before beginning any exercise regimen. http://www.arthritis.org/living-with-arthritis/exercise/workouts/simple-routines/water-walking.php

At Sarasota Orthopedic Associates we have an on-site therapy pool at our Bahia Vista location as well as a team of expert physical therapists at our offices. To learn more about us, click here or call us at 941-951-2663 for an appointment.

 

Sources: brainline.org; SOA.md website; Wikipedia; Arthritis Foundation

Driving … A Pain In The Neck? AND IN MY BACK!

driving neck pain

We’ve heard many times about how important it is to maintain good posture at our workplace desks to protect our neck and spine, however most of us don’t give it a second thought when driving. Unlike sitting in a chair, the spine experiences variations of force when in a car. Vibrations from car movement may push on the discs, our internal “shock absorbers”, acting as cushions.

Proper driving posture and seat positioning may avoid a myriad of chronic problems. Here are some helpful tips to avoid discomfort:

Position your car seat to the proper height and distance across from the wheel so that your hands can comfortably reach the recommended “10 and 2” or “9 and 3″ location.

  • Your thighs should rest as much as possible on the seat in order to align your knees on the same level plane as your hips.
  • Elbows should be slightly bent.
  • Consider using a neck support, one similar to that used on a plane. This keeps your neck straight. Even a 20 degree downward curve in the neck will cause stress over time.
  • If you have lumbar support in your car, use it. If not, use a portable back support or a rolled up sweater to place at the small of your back.
  • A seat cushion used for extra padding will help protect your spine from a bumpy ride.
  • For long rides, take regular breaks; get out and s-t-r-e-t-c-h.
  • If you have cruise control, use it to give your back a rest. Place both feet firmly on the car floor. Bend your ankles a few times to stimulate blood flow.

seat-position

Whatever the cause of your neck or back pain, don’t delay having it checked. Chronic pain needs assessment, particularly if it’s worse at night and wakes you up from your sleep.

The physicians at Sarasota Orthopedic Associates are experts in diagnosing, evaluating, and treating neck and back pain. Call us at 941-951-2663 for an appointment at one of our four locations in Sarasota, Lakewood Ranch, Venice, or Bradenton. For more information about us, visit our Facebook page at www.facebook.com/srqsoa or our web page at www.SOA.md

GOING BEYOND MEDICATION TO TREAT CHRONIC PAIN

The following is a repost from: St. Jude Medical PULSE Blog: Neuro Regional MD – NanostimTM Leadless Pacemaker/SCS

For many people, traditional treatments don’t address chronic pain – a condition that impacts as many as 100 million Americans. Nomen Azeem, MD, Interventional Pain Management physician at Sarasota Orthopedic Associates, provides insights on how he helps patients find relief through technological advances in spinal cord stimulation.

chronic pain

Despite the large number of people who battle chronic pain, many remain unaware of the treatment options available to patients once physical therapy, chiropractic care, over-the-counter (OTC) and prescription medications have reached their limit. This results in many patients simply suffering in silence, unsure where to turn for meaningful relief from their pain.

National Pain Awareness Month is designed to help shed light on the problem, and raise awareness of potential therapies available to patients battling chronic pain.

The numbers may surprise you, but chronic pain affects an estimated 100 million Americans, more than heart disease, cancer and diabetes combined. The condition can negatively impact personal relationships, daily routine and work productivity. Often, someone is determined to be suffering from chronic pain if their pain lasts for three to six months.

For many patients, the road to effective management of their chronic pain can be complex and can include prescription medications, over-the-counter products, lifestyle modifications and physical therapy. But when those options have been exhausted and the pain continues, many people aren’t sure where to turn.

Nomen Azeem, M.D., is a pain specialist with Sarasota Orthopedic Associates in Sarasota, FL. Every day, he treats people with chronic pain and helps them find relief based on their individual clinical needs. According to Dr. Azeem, spinal cord stimulation (SCS) and therapies such as radiofrequency ablation (RFA) can offer some patients meaningful pain relief, but some patients arrive to his clinic unaware that these options exist.

A renowned SCS expert, Dr. Azeem was the first doctor in Florida to implant the St. Jude Medical Protégé MRITM chronic pain system, and has a great deal of experience with SCS therapy and the technology behind the treatment. Dr. Azeem recently shared his insights on the use of neurostimulation to treat chronic pain.

ProtegeMRI_Hero_Image_Angle_White

What is neurostimulation?

Azeem: Neurostimulation, also known as spinal cord stimulation (SCS), is an advanced therapy option used to manage intractable chronic pain in the arms, legs and trunk, and pain caused by failed back surgery.

What is a spinal cord stimulator and how does it work?

Azeem: An SCS system involves a small device (approximately the size of a silver dollar) along the spinal cord that emits low intensity electrical pulses that intercept the body’s pain signals before they reach the brain, replacing feelings of pain with a more pleasant tingling sensation.

What new technology is available for patients considering an SCS implant?

Azeem: Earlier this year, the FDA approved the St. Jude Medical Protégé MRI™ chronic pain system, which is an important advancement for physicians because it allows people with chronic pain to remain eligible for MRIs of their head and extremities if required by their physician. The technology is also upgradeable, which means that as new therapies or software upgrades are approved, patients can access those upgrades through software updates and not repeat surgical procedures.

What do you want people to know about SCS and how it can help them?

Azeem: Spinal cord stimulation is an important option for patients who have not been able to alleviate their chronic pain through traditional methods, such as back surgery or prescription medications. Studies have shown SCS can reduce pain by 50 percent or more for many patients, and patients have the option to try a temporary implant to see if they’re comfortable with the therapy.1

 Note: Patients interested in learning more about SCS therapy and the Protégé MRI chronic pain system should visit www.poweroveryourpain.com for more information or to find a chronic pain physician in their area.

 The implantation of a neurostimulation system can involve risk, such as painful stimulation, loss of pain relief and surgical risks (e.g., paralysis). Patients are encouraged to talk to a physician to determine if SCS therapy is right for them.

For an appointment with Dr Azeem at any of our three locations, (Sarasota/Lakewood Ranch/Venice) please call 941.951.2663.  We offer same day appointments when necessary. The commitment of Sarasota Orthopedic Associates is to get our patients back on their feet, back to work, back in the game, and back to life.

 

CUTTING EDGE TREATMENT FOR VERTEBRAL COMPRESSION FRACTURES

1360705775_compression-fracture

Vertebral compression fractures affect approximately 25 percent of all postmenopausal women in the United States and are recognized as the hallmark of osteoporosis.  The prevalence of this condition steadily increases with advancing age, reaching 40 percent in women 80 years of age. Although less common in older men, compression fractures also are a major health concern in this group. Acute and chronic pain in the elderly is commonly attributed to severe pain from vertebral compression  and often leads to further disability. In addition to physical limitations, vertebral compression fractures may produce a psychosocial and emotional burden on the aging person who already faces losses of independent function. This may cause the person to worry about what the future may bring. These worries are not unfounded, because there is a substantial risk of subsequent fractures of all types and further morbidity in persons who have had a vertebral compression fracture.

About one third of vertebral fractures are actually diagnosed, because many patients and families regard back pain symptoms as “arthritis” or a normal part of aging.  Dr. Nomen Azeem, Interventional Pain/Sports Medicine Physician at Sarasota Orthopedic Associates states, “It is vital to conduct a thorough physical examination as close to the onset of pain symptoms as possible. This is combined with imaging such as X-ray and/or MRI of the spine to confirm the diagnosis.  When it comes to vertebral compression fractures, the sooner you can treat the patient, the better!”

Percutaneous-vertebroplasty(800x550)

Conservative treatment includes analgesic, muscle relaxers, a back brace and physical therapy. Patients who do not respond to conservative treatment or who continue to have severe pain may be candidates for percutaneous kyphoplasty. Percutaneous kyphoplasty involves using a high-pressure balloon which is placed into the center of the collapsed vertebral bone to restore the shape and height meanwhile creating a cavity.  After the cavity is created, acrylic cement is injected into the collapsed vertebra to stabilize and strengthen the fracture and vertebral body.   According to Dr. Azeem, “Kyphoplasty is a great option in the appropriately selected patient. It is amazing the magnitude of pain relief that is reported by the patient immediately following the procedure.”

The physicians at Sarasota Orthopedic Associates are committed to getting our patients back on their feet, back to work, back in the game, and back to life. Same day appointments are available in our three offices located in Sarasota, Lakewood Ranch, and Venice. You may call 941-951-BONE (2663) for an appointment.

 

CHRONIC PAIN: A new innovative, minimally invasive treatment

back-pain-manture-woman-white-e1313440331753

Chronic pain is a largely under-treated and misunderstood disease that affects more than 1.5 billion people worldwide according to the American Academy of Pain Medicine. Sarasota Orthopedic Associates offer an alternative solution that has proven to be quite successful for many of its patients:  spinal cord stimulation (SCS) which was approved by the FDA in 1998. In a 2009 study published in the Journal of Clinical Monitoring and Computing, researchers noted that SCS is “effective in reducing intensity, duration and frequency of pain experienced by the patient.”

SCS is for those who have endured chronic pain in the neck, back, arms or legs, neuropathic pain (burning, tingling or numbing sensations), or inadequate surgeries.  Think of it as analgesia “on demand,” though the patient must go through a broad prescreen before the trial can be done.

HOW IT WORKS

The SCS system consists of a pulse generator with remote controls, implanted to stimulate electrodes and conducting wires, known as “leads”, connecting the electrodes to the generator, similar to a pacemaker. To qualify for permanent implantation, a patient must undergo a trial period of about a week. During this time, a temporary stimulator device is implanted by the physician after a local anesthetic or sedative is administered. The physician places the leads under the skin, guided by an X-Ray machine and a radiology technician. The leads are then attached to a small, hand-held generator that the patient controls. The generator sends electrical pulses to the spinal cord, thus interfering with the nerve impulses that cause the pain sensation.

scs - Azeem

The system replaces pain with a feeling of massaging – or merely just the absence of pain. It may allow for reduced pain medication and help the patient improve mobility. Often times patients experience relief immediately, though the leads may occasionally need to be adjusted for optimum performance.

The spinal cord stimulation devices at Sarasota Orthopedic Associates are supplied by St. Jude Medical, whose motto is “Power over pain.” The company has a longstanding relationship with physicians and are able to directly answer patients’ questions or help them out with maintenance of the device. Says Dave Moss of St. Jude Medical, “We provide the stimulation device and become the first line when dealing with it. We have an excellent relationship with Sarasota Orthopedic Associates and Dr. Nomen Azeem and, we are very ingrained in the practice while working efficiently with their staff.”

“As an interventional pain physician, I witness the debilitating effects of chronic pain physically, mentally, and psycho-socially which impact individuals’ quality of life” said Dr Nomen Azeem. “All pain physicians worry of the long term systemic effects of pain medications. Fortunately, the technological advances being made in the field of neuro-modulation are astounding and have revolutionized how we think about treating neuropathic pain.” Dr. Azeem, Interventional Pain and Sports Medicine Specialist at Sarasota Orthopedic Associates, has seen a vast increase in quality of life for many of his patients, without having to resort to invasive surgery or increased medication.

Dr. Azeem is double board-certified  in Interventional Pain Management and Physical Medicine and Rehabilitation, and an expert in minimally invasive procedures for treating chronic back pain (with or without leg pain), chronic neck pain (with or without arm pain), pain that persists after back or neck surgery, peripheral neuropathy, Reflex Sympathetic Dystrophy (RSD), Occipital Neuralgia, and Post-Herpetic Neuralgia.  Click HERE to learn more about Dr Azeem or HERE to learn more about Sarasota Orthopedic Associates.

 

Treating Arthritic Back Pain: A SOLUTION

backpain

Arthritis or Osteoarthritis that causes back pain can be a debilitating condition for the people who suffer from it, and a challenging condition for physicians to treat. Arthritis of the back affects the facet joints in the spine and although these joints can be injected, studies have shown that this may only provide temporary pain relief.  With the recent technological advances in the field of interventional pain medicine, physicians now have the ability to block the pain from these joints for a much longer period of time.

Radiofrequency ablation is an outpatient procedure in which a specialized needle is used to apply heat directly to the nerves causing pain. After the nerves are heated, they are unable to continue sending pain signals. In addition to back pain, radiofrequency ablation is often used to treat buttock pain, posterior thigh pain, neck pain, shoulder pain, and headaches. Studies have shown that radiofrequency ablation can reduce pain severity and frequency in the majority of patients with facet arthritis for up to one to two years.

Radiofrequency ablation is carried out in two steps. In the first procedure, which is diagnostic, a medication is injected into the back over the sensory nerves of the facet joints, also known as the medial branch nerves. This medication serves to temporarily block the pain signals.

If a patient gets pain relief from the diagnostic procedure, the doctor will move forward with the second step, which is the actual radiofrequency ablation.

Nomen Azeem, MD has seen a vast increase in quality of life for hundreds of his patients, without having to resort to invasive surgery or increased medication. He is a double board-certified Interventional Pain Management and Physical Medicine and Rehabilitation, and an expert in minimally invasive procedures for treating arthritic back pain, including spondylosis, degenerative changes, and osteoarthritis. Click HERE for more information about Dr Azeem.