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The neck (cervical spine) is composed of vertebrae that begin in the upper torso and end at the base of the skull. The bony vertebrae along with the ligaments (which are comparable to thick rubber bands) provide stability to the spine. The muscles allow for support and motion. 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. For many people, neck pain is a temporary condition that disappears with time. Others need medical diagnosis and treatment to relieve their symptoms.
Neck pain Causes Neck pain may result from abnormalities in the soft tissues - the muscles, ligaments, and nerves - as well as in bones and joints of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms.
- Inflammatory Diseases - Rheumatoid arthritis can destroy joints in the neck and cause severe stiffness and pain. Rheumatoid arthritis typically occurs in the upper neck area.
- Cervical Disk Degeneration (Spondylosis) - The disk acts as a shock absorber between the bones in the neck. In cervical disk degeneration (which typically occurs in people age 40 years and older), the normal gelatin-like center of the disk degenerates and the space between the vertebrae narrows. As the disk space narrows, added stress is applied to the joints of the spine causing further wear and degenerative disease. The cervical disk may also protrude and put pressure on the spinal cord or nerve roots when the rim of the disk weakens. This is known as a herniated cervical disk.
- Injury - Because the neck is so flexible and because it supports the head, it is extremely vulnerable to injury. Motor vehicle or diving accidents, contact sports, and falls may result in neck injury. The regular use of safety belts in motor vehicles can help to prevent or minimize neck injury. A "rear end" automobile collision may result in hyperextension, a backward motion of the neck beyond normal limits, or hyperflexion, a forward motion of the neck beyond normal limits. The most common neck injuries involve the soft tissues: the muscles and ligaments. Severe neck injuries with a fracture or dislocation of the neck may damage the spinal cord and cause paralysis.
Hand & Wrist
The wrist is a more complicated joint than the hip or the knee. On the hand side of the wrist, there are
two rows of bones at the base of the hand. There are four bones in each row. The bones in these rows are
called the carpals. The long thin bones of the hand radiate out from one row of carpals and form the basis
of the fingers and thumb.
The radius and the ulna are the two bones of the forearm that form a joint with the first row of carpals.
The ends of the bones are covered with an elastic tissue, called cartilage. Cartilage creates a slick surface that enables the bones to move smoothly when they move against each other.
Scaphoid Fracture of the Wrist
The scaphoid is one of the small bones in the wrist. It is the wrist bone that is most likely to break. The scaphoid is located on the thumb side of the wrist, in the area where the wrist bends.
It can most easily be identified when the thumb is held in a "hitch-hiking" position. The scaphoid is at the base of the hollow made by the thumb tendons. Pain or tenderness in this area can be a sign that the scaphoid is injured.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common source of hand numbness and pain. It is more common in women than men.
The carpal tunnel is a narrow, tunnel-like structure in the wrist. The bottom and sides of this tunnel are formed by wrist (carpal) bones. The top of the tunnel is covered by a strong band of connective tissue called the transverse carpal ligament.
The median nerve travels from the forearm into the hand through this tunnel in the wrist. The median nerve controls feeling in the palm side of the thumb, index finger, and long fingers. The nerve also controls the muscles around the base of the thumb. The tendons that bend the fingers and thumb also travel through the carpal tunnel. These tendons are called flexor tendons.
Spine Related Injuries
When people say they have a "slipped" or "ruptured" disk in their neck or lower back, what they are actually describing is a herniated disk - a common source of pain in the neck, lower back, arms, or legs.
Disks are soft, rubbery pads found between the hard bones (vertebrae) that make up the spinal column. The spinal canal is a hollow space in the middle of the spinal column that contains the spinal cord and other nerve roots. The disks between the vertebrae allow the back to flex or bend. Disks also act as shock absorbers.
Disks in the lumbar spine (low back) are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine (neck), the disks are similar but smaller in size.
Herniated Disk in the Lower Back
A herniated disk most often occurs in your lower back. It is one of the most common causes of low back pain, as well as leg pain (sciatica).
Between 60% and 80% of people will experience low back pain at some point in their lives. A high percentage of people will have low back and leg pain caused by a herniated disk.
Although a herniated disk can sometimes be very painful, most people feel much better with just a few weeks or months of nonsurgical treatment.
Osteoporosis and Spinal Fractures
As we get older, our bones thin and our bone strength decreases. Osteoporosis is a disease in which bones become very weak and more likely to break. It often develops unnoticed over many years, with no symptoms or discomfort until a bone breaks.
Fractures caused by osteoporosis most often occur in the spine. These spinal fractures, called vertebral compression fractures, occur in nearly 700,000 patients each year. They are almost twice as common as other fractures typically linked to osteoporosis, such as broken hips and wrists. Not all vertebral compression fractures are due to osteoporosis. But when the disease is involved, a vertebral compression fracture is often a patient's first sign of a weakened skeleton from osteoporosis.
When the small bones of the spine (vertebrae) weaken from osteoporosis, they can narrow or shrink. This can lead to a rounded back, a hump or a "bent forward" look to the spine. Many people with osteoporosis also note that they are getting shorter over time.
The weakened vertebrae are at a high risk for fracture. A vertebral compression fracture occurs when too much pressure is placed on a weakened vertebra and the front of it cracks and loses height. Vertebral compression fractures are sometimes the result of a fall, although people with osteoporosis can suffer a fracture even when doing everyday things, such as reaching, twisting, coughing, and sneezing.
Elbow Related Injuries / Pain
Three bones come together to make up the elbow joint. The humerus is the bone in the upper arm. Two bones from the
forearm (the radius and the ulna) form the lower part of the elbow. Each of these bones has a very distinct shape.
Ligaments connected to the bones keep all of these bones in proper alignment.
The elbow is both a hinge joint and a ball and socket joint. As muscles contract and relax, two unique motions occur at the elbow.
- Bending occurs through a hinge joint that allows the elbow to bend and straighten. This is called flexion and extension, respectively.
- Rotation occurs though a ball and socket joint that allows the hand to be rotated palm up and palm down. This is called pronation and supination, respectively.
Tennis Elbow (Lateral Epicondylitis)
Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. But several other sports and activities can also put you at risk.
Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse - repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.
There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists, and, in some cases, surgeons work together to provide the most effective care.
Hip Related Pain / Injuries
The hip is a ball-and-socket joint. It allows the upper leg to bend and rotate at the pelvis. Common problems associated with the hip are strains, fractures and dislocations.
The large bones that make up the hip joint also serve as anchors for several muscles. Some of these muscles move down the thigh to the knee. Other muscles move across the abdomen or the buttocks. When overuse or injury stretches or tears the muscle fibers, the resulting injury is called a strain.
A hip fracture is a break in the upper quarter of the femur (thigh) bone. The extent of the break depends on the forces that are involved. The type of surgery used to treat a hip fracture is primarily based on the bones and soft tissues affected or on the level of the fracture.
Hip fractures most commonly occur from a fall or from a direct blow to the side of the hip. Some medical conditions such as osteoporosis, cancer, or stress injuries can weaken the bone and make the hip more susceptible to breaking. In severe cases, it is possible for the hip to break with the patient merely standing on the leg and twisting.
A hip dislocation occurs when the head of the thighbone (femur) slips out of its socket in the hip bone (pelvis). In approximately 90% of patients, the thighbone is pushed out of its socket in a backwards direction (posterior dislocation). This leaves the hip in a fixed position, bent and twisted in toward the middle of the body. The thighbone can also slip out of its socket in a forward direction (anterior dislocation). If this occurs, the hip will be bent only slightly, and the leg will twist out and away from the middle of the body.
A hip dislocation is very painful. Patients are unable to move the leg and, if there is nerve damage, may not have any feeling in the foot or ankle area.
Common causes of hip dislocations are Motor vehicle accidents, falls from a height or industrial accidents.
Knee Related Injuries
In 2003, patients made approximately 19.4 million visits to physicians' offices because of knee problems. It was the most common reason for visiting an orthopaedic surgeon.
The knee is a complex joint with many components, making it vulnerable to a variety of injuries. Many knee injuries can be successfully treated without surgery, while others require surgery to correct. Here are some facts about the knee from the American Academy of Orthopaedic Surgeons
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thighbone (femur), which rotates on the upper end of the shinbone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. The knee also contains large ligaments, which help control motion by connecting bones and by bracing the joint against abnormal types of motion. Another important structure, the meniscus, is a wedge of soft cartilage between the femur and tibia that serves to cushion the knee and helps it absorb shock during motion.
Many athletes experience injuries to their knee ligaments. Of the four major ligaments found in the knee, the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) are often injured in sports. The posterior cruciate ligament (PCL) may also be injured.
- ACL injury - Changing direction rapidly, slowing down when running, and landing from a jump may cause tears in the ACL. Athletes who participate in skiing and basketball, and athletes who wear cleats, such as football players, are susceptible to ACL injuries.
- MCL injury - Injuries to the MCL are usually caused by a direct blow to the outside of the knee. These types of injuries often occur in contact sports, such as football or soccer.
- PCL injury - The PCL is often injured when an athlete receives a blow to the front of the knee or makes a simple misstep on the playing field.
- Torn cartilage - When people talk about torn knee cartilage, they are usually referring to a torn meniscus. The mensicus is a tough, rubbery cartilage that is attached to the knee's ligaments. The meniscus acts like a shock absorber. In athletic activities, tears in the meniscus can occur when twisting, cutting, pivoting, decelerating, or being tackled. Direct contact is often involved.
Foot and Ankle Injuries
A sprained ankle is a very common injury. Approximately 25,000 people experience it each day. A sprained ankle can happen to athletes and non-athletes, children and adults. It can happen when you take part in sports and physical fitness activities. It can also happen when you simply step on an uneven surface, or step down at an angle.
The ligaments of the ankle hold the ankle bones and joint in position. They protect the ankle joint from abnormal movements-especially twisting, turning, and rolling of the foot.
A ligament is an elastic structure. Ligaments usually stretch within their limits, and then go back to their normal positions. When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers.
Ankle Fractures (Broken Ankle)
A broken ankle is also known as an ankle "fracture." This means that one or more of the bones that make up the ankle joint are broken.
A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you not put weight on it for a few months. Simply put, the more bones that are broken, the more unstable the ankle becomes. There may be ligaments damaged as well. The ligaments of the ankle hold the ankle bones and joint in position.