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Orthopedics


Spine

Over 90% of the population experiences spine symptoms at some point in their lifetime. The spine consists of 33 individual bones (vertebrae), including 7 cervical (neck) vertebrae, 12 thoracic vertebrae with corresponding ribs on each side (mid-back), 5 lumbar vertebrae (low back), 5 fused sacral vertebrae, and 4 fused coccyx vertebrae (tailbone). The normal curvature of the spine, combined with the joints between each segment, the discs, as well as the surrounding muscles, tendons and ligaments serve to absorb shock, maintain balance and promote movement all while protecting one of our most vital anatomical structures...the spinal cord, the link between the brain and the entire body.


Low back

80% of adults experience low back pain at some point in their lifetime. Low back pain (LBP) usually involves muscle spasm of the supportive muscles along the spine. Also, pain, numbness and tingling in the buttocks or lower extremity can be related to the back. There are multiple causes of low back pain:

  • Muscle strain - when muscle is overworked
  • Ligament sprain - with a sudden or forceful movement
  • Poor posture - slouching creates muscular fatigue, joint compression and stresses the disc
  • Age - normal aging causes decreased bone density, strength, and elasticity of muscles and ligaments
  • Disc bulge or herniation - can cause pressure on the a nerve

Other causes of LBP - kidney or bladder infections, endometriosis, cancer, or ovarian problems


Neck

90% of the population experience spine symptoms at least once in their lifetime. The neck has a significant amount of motion and supports the weight of the head. However, because it is less protected than the rest of the spine, the neck can be vulnerable to injury and disorders that produce pain and restrict motion. Some contributing factors can include:

  • Trauma - sports injuries, car accidents, falls
  • Poor posture - creates muscular fatigue or joint compression
  • Emotional stress - tight muscles contribute to holding patterns in the neck
  • Wear and tear - with age the spine undergoes changes which can be exacerbated by lifelong poor posture

Thoracic and rib cage pain

Thoracic pain is an uncomfortable sensation that is found in the area surrounding the spine from the base of the neck to mid back, just above the lowest rib. Most people associate back pain with low back pain or neck pain. However, research is finding that thoracic pain is almost equally as common as those areas.

Rib cage pain can be as a result of injury, a fall, or even poor posture. This can lead to irritation of the joints where they attach in the mid-back, or the muscles running between each rib. This can lead to pain in the mid-back or pain that wraps around the side. Always check with your doctor if you have chest or rib cage pain as this can also be a sign of a more serious condition.

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Shoulder

The shoulder is one of the most mobile joints in the body, but mobility has its price. The complexity of the joint predisposes it to a number of different injuries. Here are some common problems we see:


Impingement

Shoulder impingement occurs when the top of the shoulder blade (acromion) puts pressure on the underlying soft tissues when the arm is lifted away from the body. As the arm is lifted, the acromion rubs, or "impinges" on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, causing pain and limiting movement. Over time, severe impingement can even lead to a rotator cuff tear.


Arthritis

At times, shoulder pain can result from arthritis. There are many types of arthritis. The most common type of arthritis in the shoulder is osteoarthritis, also known as "wear and tear" arthritis. Symptoms, such as swelling, pain, and stiffness typically begin during middle age. Osteoarthritis develops slowly and the pain it causes worsens over time. Often people will avoid shoulder movements in an attempt to lessen the pain but this can lead to additional stiffness and aching with movement.


Instability

Shoulder dislocation typically occurs with sudden injury. The injury can be partial, with the ball of the upper arm coming just partially out of the socket. This is called a subluxation. A complete dislocation means the ball comes all the way out of the socket. The ligaments and tendons around the shoulder can become loose or torn resulting in recurrent dislocations or instability with shoulder movement. This can increase wear and tear on the shoulder joint.


Frozen shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. It is thought to be an abnormal autoimmune response to an injury of the shoulder or after surgery. The capsule around the joint thickens and tightens restricting its movement. Frozen shoulder typically occurs in three stages. Each stage can last a number of months.

  • Freezing stage - Any movement of the shoulder causes pain, and the range of motion starts to become limited.
  • Frozen stage - Pain may begin to diminish during this stage. However, the shoulder becomes stiffer, and using it becomes more difficult.
  • Thawing stage - The range of motion in the shoulder begins to improve.

Frozen shoulder typically takes 1 - 1/12 years to run its course. People typically regain full use of their shoulder.


Shoulder tendinitis

A tendon attaches muscle to bone. Tendinitis is usually a result of the wearing down of the tendon that occurs slowly over time, but can also occur with repetitive motion activities. The tendons of the rotator cuff and biceps are the most frequently affected in the shoulder. Tendinitis can become very painful, making it difficult to reach up or across the body.


Rotator cuff tear

Tearing of the rotator cuff tendon can result from an acute injury or degenerative changes. These tears can be partial or complete and can lead to weakness, pain or loss of motion in the shoulder.


Bursitis

An inflammation of the fluid filled sac (bursa) that cushions tendons and joints. Impingement or overuse of the shoulder may contribute to irritation of the bursa and the shoulder can become inflamed and painful. Daily activities such as reaching overhead, brushing hair or putting on a belt may become difficult.

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Elbow

The elbow is comprised of the joints between the three long bones of the arm. The bone of the upper arm (humerus) meets with the inner bone of the forearm (ulna) and the outer bone of the forearm (radius) to form a hinge joint. The radius and ulna also meet in the elbow to allow for rotation of the forearm. Here are some common problems that we treat in the elbow.


Lateral epicondylitis (tennis elbow)

The bony prominence on the outside of the elbow is called the lateral epicondyle. A large group of muscles that extend the wrist/hand attach to the epicondyle via a tendon, and inflammation in this attachment site is commonly referred to as lateral epicondylitis (tennis elbow).


Medial epicondylitis (golfer's elbow)

The bony prominence on the inside of the elbow is called the medial epicondyle. The muscles that flex the wrist and hand attach here and the inflammation of these tendons is called medial epicondylitis (golfer’s elbow).


Olecranon bursitis

A fluid filled sac (bursa) which serves to reduce friction pads the tip of the elbow. A hard impact at the tip of the elbow can irritate the bursa and this condition is known as olecranon bursitis. Fracture (broken bone)

Common causes of elbow fractures include:
  • Fall on the outstretched arm
  • High impact trauma or athletic injury

  • Arthritis

    Inflammation of the elbow joint (arthritis) can occur as the result of osteoarthritis (“wear and tear” arthritis) as well as many systemic forms including rheumatoid arthritis, gout, and psoriatic arthritis. Symptoms can include heat, swelling, pain, tenderness, redness and decreased range of motion due to swelling.


    Nerve entrapment

    The ulnar nerve is the “funny bone” nerve that travels in a groove between tip of the elbow (olecranon) and the boney prominence on the inside of the elbow (medial epicondyle). With an impact to this area, the nerve can become pinched by swollen structures after the injury. Symptoms can include numbness and tingling in the “pinky” and “ring” fingers, pain in the forearm and reduced strength in the hand. Nerve entrapments can also occur around the elbow in the two other major nerves (median and radial nerves) which pass through this region.

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    Wrist & Hand

    There are 27 bones in the human hand. The wrist is comprised of the numerous joints between the two long bones of the forearm (the radius and ulna) and the eight carpal bones. A complex design of tendons and ligaments allow the wrist and hand to perform intricate movements. Here are a few common injuries to the wrist or hand.


    Trigger finger

    Trigger finger occurs when a tendon of the finger or thumb become inflamed causing it to catch or lock when bent. Inflammation narrows the space within the sheath that surrounds the tendon making it “snap” or “pop”.


    Skier’s thumb

    Skier’s thumb is usually caused by trauma when the thumb is forced out, resulting in a tear or sprain of the ulnar collateral ligament at the bottom of the thumb. The classic example is a skier holding a ski pole and falling hard or planting the pole and pole pushes hard against the inside of the thumb. Sometimes a “pop” is felt during the injury, followed by pain, bruising or swelling on the inside of the thumb.


    Carpal tunnel

    Carpal tunnel syndrome is a compression of the median nerve at the wrist, causing numbness, tingling, and possibly weakness in the hand. It is typically associated with the repetitive motion of typing on a computer or using a mouse, and may also be associated with neck problems.


    Fracture (broken bone)

    Fractures of the wrist and hand are frequently sports related, particularly contact sports, or due to a fall on the outstretched hand. This injury may require casting or surgery. Physical Therapy can help restore range of motion and strength after the injury.

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    Hip

    The hip joint, a ball and socket joint similar to the shoulder, provides an amazing combination of both mobility and stability in weight bearing. This is due to the configuration of the hip joint and the strength of the muscles, ligaments and tendons which support it. Damage to one of these structures can negatively affect range of motion or the ability to bear weight through the hip.


    Hip bursitis

    A bursa is a fluid filled sac which functions as a gliding surface to reduce friction. There are two primary bursae in the hip which can become inflamed (bursitis) and cause pain with movement, the trochanteric and iliopsoas bursae. Bursitis can occur for many reasons including repetitive motion, tendinitis, arthritis, or muscular imbalances.

    Osteoarthritis

    Osteoarthritis can occur in any joint in the body, but most often develops in weight-bearing joints, such as the hip. Symptoms can include pain and stiffness which can be felt in the groin, thigh, lower back or buttock. These symptoms can make everyday activities such as walking, bending over to put on socks and shoes, rising from a chair or going to the bathroom very difficult.


    Hip replacement

    At times, injuries or degeneration in the hip is severe enough that it requires surgical replacement of the hip socket in the pelvic bone and the ball at the top of the thigh bone (femur). While rehabilitation can be an extensive process, many times it allows the patient to return to many former activities they had to give up due to hip pain.


    Labral tear (acetabulum)

    The acetabular labrum is the ring of cartilage along the rim of the socket of the hip joint. The labrum acts like a rubber seal or gasket to help both pad and hold and the ball at the top of the thighbone securely within the socket. A tear of the labrum can result in a locking, clicking or catching sensation in the hip, pain in the hip or groin, and stiffness or limited range of motion. Tears can occur for many reasons including trauma to hip, a sudden planting of foot with twisting at hip, or in athletes that participate in such sports as soccer, golf, ballet, football and hockey.


    Piriformis syndrome

    The piriformis is one of the deep hip rotator muscles located in the buttock region, and the sciatic nerve exits out of the pelvis right next to this muscle. Piriformis syndrome occurs when the sciatic nerve is irritated by the piriformis causing pain, tingling or numbness in the buttocks and down into the back of the thigh.


    Referred pain, SI pain or sciatica

    The lower back and sacroiliac (SI) joints are some of the most common areas of the body that, when injured, may cause pain that is referred to the hip, buttock or groin. Some of the more common conditions which may cause these symptoms include lumbar disc bulge, sciatica, lumbar facet joint sprain, spinal stenosis, or SI joint inflammation.


    Hamstring strain

    Hamstring injuries, often referred to as “pulled hamstring”, occur frequently in running sports, particularly those requiring sprinting. The strain is felt as a sudden, often sharp pain or pulling in back of the thigh. Risk factors include muscle imbalance, muscle tightness, low back pain, fatigue, or a recent growth spurt in adolescent athletes.


    Snapping hip

    Snapping hip syndrome, also known as dancer's hip, is a condition in which a snapping sound or sensation is felt in the hip when walking, running, getting up from a chair, or swinging the leg around. In most cases, snapping is caused by the movement of an inflamed muscle or tendon over a bony structure in the hip. For many people, the condition is little more than an annoyance but for dancers or athletes, snapping hip symptoms may also include pain and weakness that interfere with performance.

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    Knee

    The knee is a hinge joint and one of the strongest in the human body, allowing the lower leg to move relative to the thigh while supporting the body’s weight. The knee joint is comprised of three bones, the femur (thigh), tibia (lower leg) and patella (kneecap) and movement at this joint are essential to many everyday activities, including walking, running, sitting and standing. Muscle imbalances or tightness in musculature around the knee, weakness in the hip, or problems in the foot can all increase one’s likelihood for an injury or pain in the knee.


    Patellofemoral syndrome (runner’s knee)

    Patellofemoral pain syndrome (PFPS) is a term used to describe discomfort in the front of knee or around kneecap which is aggravated by activity or by sitting for extended time with knees bent. PFPS may be caused by overuse, injury, or a kneecap that is not properly aligned and occurs frequently in runners. The patella (kneecap) is supposed to track smoothly in a groove at the end of the femur (thighbone). Tightness in the lateral thigh muscles and tendons or weakness in the inner thigh can result in abnormal tracking of the patella, causing the patella to grate against the femur. Catching, popping, or grinding when walking, running or with knee movement is common.


    Iliotibial band syndrome

    Iliotibial band (IT band) syndrome is a common injury in runners characterized by inflammation of the thick tendon that connects the gluteus maximus and the tensor fascia latae (TFL) muscles, extends down the outside of the thigh and attaches just below the knee joint. An excessively tight IT band, with repeated bending and straightening of the knee, can cause friction between the IT band and the surrounding structures. The IT band can also become irritated by improper form, un-level running surfaces, and overuse. The most common symptom is pain on the outer side of the knee but occasionally may radiate the entire length of the band.


    Patellar tendinitis

    The patellar tendon attaches the patella (kneecap) to the tibia (shinbone). Patellar tendinitis, commonly referred to as “jumper’s knee”, is an inflammation or irritation of this tendon due to overuse, repetitive movements particularly squatting and jumping, or sports such as basketball and volleyball, which involve constant jumping, landing, and changing direction. Pain is usually felt directly over the patellar tendon, and the tendon can be tender, swollen, and at times is “crunchy” to the touch or with movement.


    Chondromalacia

    Articular cartilage, normally smooth and hard, protects bony surfaces where they come in contact with one another. This cartilage may become damaged due to injury or wear and tear. Chondromalacia is a softening, irritation or fragmentation of the articular cartilage under the patella (kneecap). It causes pain under the kneecap especially when walking up and down stairs and squatting. Other symptoms can include swelling, locking or catching under kneecap, noise during motion, pain with prolonged walking or stair climbing, buckling or giving way when full weight is placed on leg.


    Meniscal tear

    A meniscal tear is a tear of one of the two crescent-shaped cartilages (medial and lateral meniscus) that serve as a shock absorber in the knee joint. Meniscal tears most often occur in athletes or older adults who have degeneration in the knee. The tear most commonly occurs with a forceful twisting injury to the knee, possibly accompanied by a “pop” that is heard or felt in the knee. The most common symptoms of meniscal tear are pain, stiffness and swelling, catching or locking of the the knee, sensation of knee “giving way”, and inability to move knee through full range of motion


    Ligament sprain

    Ligament injuries are tears or sprains of the ligaments that help to support the knee joint. The most frequently injured knee ligaments are the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL), but can also occur in the posterior cruciate ligament (PCL) or lateral collateral ligament (LCL). Ligament injuries are most often a sports-related injury, but can also occur during rough play, vehicle collisions, falls and work-related injuries. However, despite the well-known association of these injuries with contact sports such as football, over 80% of the sports-related ligament injuries are “noncontact” injuries, commonly occurring when simply pivoting or landing from a jump. Symptoms of a ligament injury include the knee “giving way”, and if torn, may have felt a “pop” at the time of injury followed by swelling and pain.


    Osteoarthritis

    Osteoarthritis, the most common form of arthritis in the knee, is an inflammation or a wearing out of the cartilage in the knee joint which serves to protect the bones where they contact one another. When this protective layer is inflamed or worn out, the bones rub hard against each other. This can result in pain and stiffness, difficulty navigating steps, walking and squatting. If the arthritis becomes severe enough, a knee replacement may be required.


    Bursitis

    Bursitis is an inflammation of the bursa, a fluid-filled sack which protects tendons and joints. The most common bursa affected in the knee is the prepatellar bursa, which lies just in front of the knee cap. Bursitis can develop from extended periods of kneeling such as gardening or a fall on the knee. Symptoms may include pain with activity, especially with kneeling, swelling and tenderness on the front of kneecap, limited or painful range of motion of the knee.


    Knee replacement

    Knee replacement surgery, also known as knee arthroplasty, can help relieve pain and restore function in severely damaged knee joints. During a knee replacement, the surgeon cuts away damaged bone from the femur (thighbone), tibia (shinbone), and patella (kneecap) and replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers. While rehabilitation can be an extensive process, many times a knee replacement provides pain relief, improved mobility and a better quality of life.

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    Foot & Ankle

    The foot gets you from point A to point B without ever having to think about it...until something goes wrong and the foot starts to hurt. The primary function of the foot and ankle, besides locomotion, is shock absorption. The foot is an amazing configuration of 26 bones, 2 distinct arches (front to back and side to side), and meets the two long bones of the lower leg, tibia and fibula, to form the ankle. Because of its critical role in shock absorption, when there is pain or dysfunction in the foot, excess mechanical stress may be distributed up the chain and affect the knee, hip and even low back.


    Plantar fasciitis

    The plantar fascia is a strong band of the connective tissue that runs from the heel to the toes and provides shock-absorption and support for the arch of the foot. Plantar fasciitis is an inflammation of this tissue, often a result of walking, standing or running, particularly on hard surfaces for long periods of time. Additional factors include improper footwear, structural issues in the foot including high arches or flat feet, tight Achilles tendons or calf muscles. Plantar fasciitis may cause sharp pain in the heel and arch, especially with the first steps in the morning or after sitting for extended period of time. Pain and stiffness may lessen as the tissue “warms up” but can increase again as activity continues. If plantar fasciitis becomes severe and is left untreated, heel spurs can develop.


    Achilles tendinitis

    Achilles tendinitis is an inflammation of the Achilles tendon at the back of the heel. Achilles tendinitis can result from overuse or repetitive motion during sports which involve repeated push-offs or a stop-and-go motions such as running, basketball, tennis or ballet dancing. In addition, it can occur with lack of conditioning or warm-up, improper footwear, or work related activities. Symptoms may range from mild to severe pain in the back of the heel, particularly in morning, stiffness that subsides as the tendon “warms up”, swelling and tenderness, decreased strength with push-off or a feeling of sluggishness in the leg. If not resolved, the condition may progress to degeneration or microscopic tearing within the tendon.


    Shin splints

    Shin splints, or medial tibial stress syndrome (MTSS), is an overload injury occurring when too much force is being placed on the tibia (shinbone) and connective tissues attaching the muscles to this bone. Shin splints are very common in runners. Risk factors include lower leg muscle weakness, use of improper shoes, biomechanical issues and improper progression of training program. Shin splints cause pain or swelling along the tibia or just to the inside of the bone. In the early stages, pain is only felt with activity, but eventually, pain may become continuous.


    Fracture (broken bone)

    Broken (fractured) bones in the foot or ankle typically occur with tripping or falling, landing awkwardly after a jump, twisting, rotating or severely rolling the ankle, or from a sudden impact such as a car crash. The symptoms of a sprain and of a fracture are very similar, and fractures are sometimes mistaken for sprains. The signs include sudden, severe pain, swelling, bruising and an inability to walk or bear weight on the injured ankle.


    Stress fracture

    A stress fracture is a tiny break in a bone. A stress fracture in the foot or leg is usually caused by repetitive stress from running or jumping. Stress fractures frequently occur with dance, running and track and field sports. They are also much more likely to develop in people who have just started a new sport or have suddenly increased workout intensity. When muscles aren’t well-conditioned, they tire easily and can’t help with support and shock absorption. The increased pressure is exerted directly on the bones, which can lead to a fracture. Pain is the most common complaint, although often not in the exact area of the fracture. Gradual swelling and bruising can occur around the site.


    Bunion

    A bunion is typically caused by arthritis in the joint at the base of the toe. Hallux valgus, a bunion in the big toe, causes the big toe to turn inward toward the second toe. Bunions develop for a variety of reasons including over-pronation, flat feet, wearing high heels or shoes that are too tight, or can sometimes run in families. Dancers are very susceptible to developing bunions. Symptoms develop gradually and may include swelling at the base of the toe, redness, pain or stiffness, and skin irritation. At times, a bunion may not cause any pain if the stress on the joint is relieved.


    Metatarsalgia

    Metatarsalgia is a common overuse injury. The term describes pain and inflammation in the ball of the foot. It is often thought of as a symptom of other conditions, rather than as a specific disease.


    Morton’s Neuroma

    Morton’s Neuroma describes a condition in which a nerve is inflamed or pinched in the forefoot (balls of feet). This can occur for a variety of reasons including having high arches, over-pronation of foot, wearing high heels or being involved in activities that require excess weight bearing through the forefoot, particularly dance. Symptoms include pain and numbness in the foot that radiates into the toes.

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    Post Surgical

    At times, the conditions listed above may require surgery and manual physical therapy is very beneficial for post-surgical recovery. Manual physical therapy, the advanced clinical skill which is Nesin’s speciality, helps relieve pain and restore the normal movement to the soft tissue (i.e. muscles, tendons, ligaments) and joints. In addition, manual treatment helps improve the mobility of post-surgical scar tissue. Physical therapy helps the patient recover strength in the muscles affected by the surgery and restore normal range of motion.

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    Madison Clinic

    Madison Clinic

    540 Hughes Road, Suite 8
    Madison, AL 35758
    256-461-9654

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    Huntsville Clinic

    Huntsville Clinic

    165 Whitesport Drive, Suite 2
    Huntsville, AL 35801
    256-425-0300

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    Research Park Clinic

    Research Park Clinic

    1267 Enterprise Way NW, Suite B
    Huntsville, AL 35806
    256-713-1872

    Read more

    Madison Clinic

    Madison Clinic

    540 Hughes Road, Suite 8
    Madison, AL 35758
    256-461-9654
    Huntsville Clinic

    Huntsville Clinic

    165 Whitesport Drive, Suite 2
    Huntsville, AL 35801
    256-425-0300
    Research Park Clinic

    Research Park Clinic

    1267 Enterprise Way NW, Suite B
    Huntsville, AL 35806
    256-713-1872

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