The current unit supports more than 350 patients every year and those patients experience tremendous success, with about 97% of them discharged home without readmission. But the demand is far higher than what the current unit can provide – with hundreds transfered to other programs outside of the region due to lack of space each year.
That’s why St. Charles is setting out to build a new, state-of-the-art, 23-bed unit. The new space will be designed with our patients, their families and our caregivers in mind to ensure we can care for our community now and into the future.
The new unit will include larger patient rooms to accommodate families and space for world-class services and new technology that will help patients re-learn activities like walking on the trails system in Central Oregon or cooking meals for themselves in an ADA accessible kitchen.
Patients spend an average of 12-14 days particpating in occupational therapy, physical therapy, speech therapy and orthotics appointments for 3 hours/day at least 5 days/week.
This spring more than 2,000 third graders throughout Central Oregon will learn about brain injury prevention and helmet safety through the Train Your Brain program taught by local athletic trainers, now part of St. Charles Health System. This program, formerly led by The Center Foundation, provides interactive assemblies and free multi-sport helmets to local elementary students.
“St. Charles is proud to continue this injury prevention program and to continue providing athletic trainers at eight local high schools, helping to ensure the safety and education of students in Central Oregon,” said Christy McLeod, Senior Vice President of Specialty Service Lines for St. Charles.
For 15 years, the Train Your Brain program has distributed more than 1,000 free helmets for local students every year, ensuring kids have proper head protection for activities such as bicycling, skateboarding, rollerblading and scooter riding. The 2025 program begins in April, just in time to prepare students for a safe and active summer.
The presentations include interactive demonstrations on injury prevention, helmet safety, proper fitting and care. A highlight of the assembly is the melon drop, which emphasizes the importance of wearing a helmet. Following the presentation, St. Charles caregivers and volunteers will properly fit free helmets for every student who needs one.
“Helmet safety is a simple yet crucial way to prevent serious head injuries in children,” said Stuart Schmidt, Athletic Training Program Manager at St. Charles. “Through the Train Your Brain program, we aim to instill lifelong safety habits in young students, empowering them to protect their brains while having fun. We also want to thank our school districts for recognizing the significance of this safety initiative and to our partners for making it possible to provide free helmets to every third grader in Central Oregon who needs one.”
To learn more about Train Your Brain and our athletic trainers, visit our webpage.
Grand Rounds - March 14, 2025 "Heads Up: Update on Headaches and Migraine"
Speaker: Stewart J. Tepper, MD. Professor of Neurology, Dartmouth Geisel School of Medicine.
Objectives
Utilize specific questions when obtaining a headache history.
Become familiar with the wide array of pill, nasal, and injection acute migraine therapies.
Become familiar with various headache prophylaxis options, including new CGRP Inhibitors.
Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.
The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals.
Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].
Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].
Body
Joint replacement can help relieve pain and enable you to live a fuller, more active life. If you and your orthopedic surgeon have decided that you are a good candidate for shoulder joint replacement, you are in good company. Over 50,000 people in the U.S. have shoulder replacement surgery each year.
Shoulder anatomy
The shoulder joint is described as a ball and socket joint, which allows the shoulder to provide the wide range of motion required to perform many athletic activities, such as throwing, swimming, serving a tennis ball, and functional movement in many directions.
The “ball” component is made up of the head of the upper arm bone (humerus). The “socket” component, called the glenoid, is made up of the outer portion of the shoulder blade (scapula). The third bone is the collarbone (clavicle). The labrum is a rim of cartilage on the socket that helps stabilize the joint.
The stability of the shoulder joint mainly depends on the capsule, a strong envelope tissue surrounding the joint, ligaments connecting bones in the shoulder joint, tendons that attach muscles to bones, and the muscles themselves which initiate and control the position and activity of the joint. Also contributing to stability of the shoulder is the rotator cuff. The cuff formed of tendons attaches to the humerus and their four major muscles, which drape over the shoulder joint. The large muscles, which attach to the shoulder blade play a significant role in the normal function of the shoulder.
Causes and risk factors
Shoulder injuries Shoulder injuries can result from genetic factors, from overuse activities, or from a single traumatic injury. Many repetitive sporting activities that use the arm overhead, such as tennis, swimming, and baseball can result in injury to the capsule, ligaments, and muscles that surround the shoulder joint. Lifting weights too frequently or incorrectly can also lead to a shoulder injury. Immediate effects of these injuries can lead to pain, swelling, and instability of the shoulder.
Depending on the severity of the injury, the function of the injured arm can often be greatly compromised. Unfortunately, some structures of the shoulder joint do not readily heal themselves. Even with treatment, such as physical therapy, some of the symptoms or limitations may remain. Therefore, without surgical intervention, many individuals are unable to participate in their desired sports or functional activities at the pre-injury level.
Osteoarthritis This is an age-related “wear and tear” type of arthritis and a common reason that people have shoulder replacement surgery. The cartilage that cushions the bones wears away and the bones then rub against one another. Over time, the shoulder joint slowly becomes stiff and painful. In order to improve the function of the shoulder and restore motion, replacing the surfaces of the shoulder joint can be the most effective treatment to improve function and relieve pain. This can be accomplished by performing a shoulder replacement, which is also known as shoulder arthroplasty.
Surgery
The most common types of surgery are total shoulder replacement and reverse total shoulder replacement. In general, total shoulder replacement consists of putting new surfaces on the socket and humeral head. Reverse total shoulder replacement also allows for replacement of both surfaces, but does not rely on a functioning rotator cuff for motion or stability of the joint replacement. The decision to have shoulder replacement surgery, and which type, should be a collaborative one between you, your family, your primary care physician, and your orthopedic surgeon.
After surgery
Most patients are discharged home on the day of surgery unless medical issues dictate otherwise. You will be instructed how to put on and take off the sling or shoulder immobilizer and when to use it. Watch this video to learn more:
Cryotherapy, the use of cold to treat your shoulder surgery, is important to help decrease pain and reduce swelling and inflammation. You will be provided with a cold therapy unit to take home with you. Begin using it as soon as possible after you arrive home and continue using it for at least 5-7 days, during the day and night.
Your care team will provide you with prescriptions for pain medication, let you know how long to keep the dressing on, and detailed information on what to do after surgery for optimal recovery.
Recovery timeline
While not true for all patients, many will follow a similar plan during their recovery from surgery. In order to give you a sense of what is common following many shoulder surgeries we have outlined a normal post-operative timeline.
Weeks 1-2
You will work to get your pain under control, minimize swelling, and protect your repair.
You will be able to use your arm for tasks at the waist such as typing and cutting food. However, you will likely need assistance around the house.
You will wear your sling except for prescribed exercises.
Driving will not be permitted while wearing your sling or on narcotic pain medications.
Your first post-operative visit will be scheduled in the office during this time.
Weeks 3-6
Depending on your surgery, sling weaning may start between 3-6 weeks.
Continue with basic shoulder exercises.
Gradually reduce or eliminate the use of any narcotic pain medication prescribed after surgery.
Typically, you’ll have your second post-op visit scheduled in the office.
Week 6-8
Your sling can be removed.
It may be necessary to gradually wean your way out of the sling. Start by keeping your sling off while at home, Then progress to having it off in public.
Avoid heavy lifting during this phase of recovery.
Week 8-12
Patients can start to strengthen their shoulder by increasing their activities.
Activity can be increased as pain and strength allow.
Most patients do not attend formal physical therapy.
Week 12 and beyond
Most patients are working on functional activities in therapy or have discontinued them as they have reached their goals.
By six months after surgery, most patients will reach 80-90% of their final improvements.
Body
The Anterior Cruciate Ligament (ACL) connects the front top of the tibia (the lower leg bone) to the rear bottom of the femur (the thigh bone). Athletes are often diagnosed with this common sports knee injury.
Causes
An ACL (anterior cruciate ligament) injury can occur due to a variety of causes including:
Sports-related activities: Sudden stops, changes in direction, or jumping in sports can stress the ACL.
Direct trauma: Knee injuries from car accidents or falls can strain or tear the ACL.
Improper landing techniques: Poor form during jumping or landing on a flexed knee or with excessive force can increase ACL injury risk.
Overuse and repetitive stress: Continuous strain on the knee joint, especially in activities that stress the ACL, can make individuals more susceptible to ACL tears.
Previous injury: Individuals with a history of ACL injury are at increased risk of re-injury.
Risk factors
Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports, possibly due to pelvic or lower leg alignment. Also, engaging in sports and physical activities that involve cutting, pivoting, jumping, or sudden changes in direction can significantly increase the risk of ACL injuries. Sports such as soccer, basketball, football, skiing, and gymnastics are particularly associated with a higher incidence of ACL tears.
Symptoms
Symptoms of an ACL (anterior cruciate ligament) injury can include:
“Popping” noise and feeling of knee “giving out”: Many individuals report hearing or feeling a distinct “popping” sound or sensation at the time of injury. This can occur during a sudden change in direction, landing from a jump, or a direct impact to the knee.
Pain with swelling: After an ACL injury, the affected individual may experience pain in the knee. The pain can range from mild to severe, depending on the extent of the injury. Swelling around the knee joint is also a common symptom, often occurring within the first few hours following the injury.
Loss of full range of motion: The individual may find it difficult or impossible to fully bend or straighten the knee after an ACL injury. The range of motion is often limited due to the instability caused by the ligament damage.
Tenderness along the joint line: The area along the joint line, where the ACL is located, can become tender to touch. Pressing on or palpating this area may elicit pain or discomfort.
Difficulty and discomfort while walking: Walking can become challenging and uncomfortable following an ACL injury. The knee may feel unstable, causing the individual to have difficulty bearing weight on the affected leg. This can result in a noticeable limp or an altered gait pattern.
Diagnosis and treatment
Diagnosis usually involves a physical examination from an orthopedic surgeon, although sometimes imaging tests such as an x-ray or MRI scan help the doctor confirm diagnosis.
Nonsurgical treatment can include bracing or physical therapy, but a torn ACL will not repair itself. Surgical treatment usually involves arthroscopy, where a tiny camera is inserted in the knee through a small incision and connected to a video monitor in the operating room. Your surgeon uses the camera to repair the damaged ACL with tissue from another part of your body, typically a tendon from your knee or hamstring, or from a cadaver. There are risks and benefits to each kind of replacement tissue. ACL reconstruction is usually very successful and rehabilitation includes physical therapy. The patient may return to sports when there is no longer pain or swelling, when full knee range of motion has been achieved, and when muscle strength, endurance and functional use of the leg have been fully restored, typically 4-6 months.
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Shoulder impingement is also known as rotator cuff tendinitis. It occurs when the rotator cuff tendons rub against (or impinge) on the shoulder blade, which causes pain and irritation.
Causes and risk factors
This condition is common in young athletes, especially for tennis players, baseball players, and swimmers. It is also common for those with occupations that require repetitive overhead movement, such as painting or construction. Several factors can contribute to the development of shoulder impingement, including:
Repetitive overhead activities: People who engage in repetitive overhead movements or activities that involve raising the arm, such as swimming, tennis, or weightlifting, are at a higher risk of developing shoulder impingement.
Poor posture: Rounded shoulders or forward head posture can alter the alignment of the shoulder joint, increasing the likelihood of impingement.
Shoulder instability: Individuals with shoulder instability, where the shoulder joint is loose or prone to dislocation, may experience impingement due to the abnormal movement of the humeral head within the joint.
Bone abnormalities: Certain anatomical variations, such as the shape of the acromion (a bony process of the shoulder blade), can contribute to the narrowing of the subacromial space and impingement.
Aging: As we age, the structures in the shoulder can degenerate, including the tendons and bursa. This degeneration can increase the risk of impingement.
Trauma or injury: A previous shoulder injury or trauma, such as a dislocation or fracture, can lead to structural abnormalities or inflammation that predispose an individual to impingement.
These factors increase the risk of developing shoulder impingement, but they may not always directly cause the condition. A comprehensive evaluation by a healthcare professional is essential to determine the underlying causes and provide appropriate treatment.
Symptoms
Shoulder impingement can cause a range of symptoms that typically involve pain and limited range of motion in the affected shoulder. Common symptoms of shoulder impingement include:
Shoulder pain: The most common symptom of shoulder impingement is pain, which is often felt on the front or side of the shoulder. The pain may be dull and aching or sharp and intense. It can worsen with certain movements, especially when raising the arm overhead or reaching behind the back.
Painful movements: Activities that involve raising the arm or reaching across the body can trigger or worsen the pain. Pain may also be experienced during activities like lifting, throwing, or even simple tasks such as reaching for objects on high shelves.
Weakness: Shoulder impingement can cause weakness in the affected shoulder, making it difficult to perform certain movements or lift objects. Weakness may be particularly noticeable when trying to lift the arm against resistance or when performing tasks that require strength.
Limited range of motion: Impingement can restrict the normal range of motion in the shoulder joint. You may experience difficulty in fully raising the arm, rotating it, or reaching behind the back. Activities like putting on clothes, combing hair, or fastening a bra may become challenging.
Shoulder stiffness: Impingement can lead to shoulder stiffness, making it feel tight and difficult to move the joint freely. This can affect daily activities and result in decreased mobility.
Treatment
Treatment for shoulder impingement typically begins with conservative measures and may progress to surgical intervention if symptoms persist. Conservative options include rest, anti-inflammatory medications, cortisone injections, and physical therapy. Resting the shoulder helps promote healing and reduces irritation, while anti-inflammatory medications help reduce pain and inflammation. Cortisone injections deliver powerful anti-inflammatory medication directly to the joint for temporary relief. Physical therapy plays a vital role in strengthening the shoulder muscles and improving mechanics through tailored exercises and manual therapy techniques.
If conservative treatments do not provide sufficient relief, surgical intervention may be considered. Arthroscopic surgery is the most common approach, involving small incisions for the insertion of a camera and surgical instruments. The surgeon removes inflamed tissues and may trim the acromion bone to create more space in the joint. In some cases, an open surgical technique with a larger incision may be chosen to directly access the joint and address impingement or structural abnormalities. Post-surgical rehabilitation, including physical therapy, is crucial to restore strength, range of motion, and function to the shoulder joint gradually.
It’s important to consult with a healthcare professional to determine the most appropriate treatment plan for shoulder impingement based on individual factors such as symptom severity, underlying causes, and overall health.
Body
Knee replacement can help relieve knee pain and enable you to live a fuller, more active life. If you and your orthopedic surgeon have decided that you are a good candidate for a full joint replacement, you are in good company. Almost one million hip and knee replacement surgeries are performed in the United States annually, making it one of the most common orthopedic procedures performed today.
The knee functions as a hinge joint. The joint is made from the end of the thigh bone (femur), where it meets the shin bone (tibia) and the knee cap (patella). Normally, the cartilage coating over the bones makes the joint move smoothly and provides an additional shock-absorbent cushion. In an arthritic knee, the cartilage surface wears out and begins rubbing bone on bone which causes pain, stiffness, and swelling of the knee joint.
In a total knee replacement surgery, the arthritic surfaces of the knee joint are removed and new surfaces are provided with metal and poly (plastic) parts. This relieves knee pain and allows the joint to move smoothly again.
Body
The rotator cuff is a common source of pain or injury in the shoulder. It plays a role in the normal function of the shoulder by contributing to the stability of the joint. It is formed of tendons which attach to the humerus, as well as four major muscles which drape over the shoulder joint.
Causes and risk factors
A rotator cuff injury can occur due to various causes and risk factors, including:
Direct blow, fall, or sports-related injury: Traumatic events such as a direct blow to the shoulder, a fall onto an outstretched arm, or sports-related injuries can damage the rotator cuff. These injuries may result from contact sports, accidents, or sudden impacts.
Degenerative conditions, such as arthritis: Degenerative changes in the shoulder joint, commonly associated with arthritis, can contribute to a rotator cuff injury. Arthritis can lead to the wearing down of the cartilage and bones in the shoulder, making the rotator cuff more susceptible to damage.
Repetitive stress: Certain sports and activities that involve repetitive shoulder movements can increase the risk of developing a rotator cuff injury. Athletes involved in overhead sports like baseball, tennis, swimming, or weightlifting, which require frequent and forceful use of the shoulder joint, may experience repetitive stress on the rotator cuff. Over time, this can lead to inflammation, tendon degeneration, and eventual injury.
Bone spurs: Bone spurs, also known as osteophytes, are bony projections that can develop on the edges of bones. In the case of the shoulder joint, bone spurs can form on the acromion (a part of the shoulder blade) or other structures, potentially impinging on the rotator cuff tendons. The presence of bone spurs can increase the risk of rotator cuff tears by causing friction, irritation, and impingement on the tendons during shoulder movements.
Symptoms
A rotator cuff injury can present with various symptoms, including:
Shoulder pain: One of the primary symptoms of a rotator cuff injury is shoulder pain. This pain can be constant or may occur when you are at rest, especially during nighttime when lying on the affected shoulder. The pain is often localized to the front or outer part of the shoulder and can radiate down the arm.
Pain or weakness when lifting or lowering your arm: Another common symptom is experiencing pain or weakness when lifting or lowering your arm. Activities such as reaching overhead, carrying heavy objects, or performing certain movements may exacerbate the pain. You may also notice a decrease in strength and difficulty in performing tasks that require arm movements, especially those involving lifting or reaching.
Limited range of motion: A rotator cuff injury can lead to a decrease in your shoulder’s range of motion. You may find it challenging to move your arm fully or lift it above a certain point. Activities like combing your hair, reaching behind your back, or putting on clothes may become difficult due to this restricted mobility.
Clicking or popping: In some cases, individuals with a rotator cuff injury may experience clicking or popping sensations in the shoulder joint during certain movements. These sounds can indicate structural abnormalities, such as a tear or impingement within the rotator cuff.
Diagnosis and treatment
Your doctor will evaluate your shoulder by conducting a physical examination. They will assess your range of motion, strength, and areas of tenderness or pain. To confirm the diagnosis and assess the extent of the injury, imaging tests may be ordered. These can include X-rays to rule out other conditions and provide information about the bone structures, as well as MRI (Magnetic Resonance Imaging) or ultrasound to visualize the soft tissues, including the rotator cuff tendons.
Non-surgical treatments include anti-inflammatory medications, rest, ice, corticosteroid injections, and/or physical therapy. Surgical repair may be an option, depending on the severity of the injury. Your orthopedic surgeon may recommend surgery to repair a torn rotator cuff if your symptoms don’t go away after conservative treatment, you have a large tear (more than 3cm), or if it was caused by a recent trauma.
Recovery after surgery
Most patients will go home the same day of surgery. After your surgery, your care team will put the brace on your arm before you wake up. Your doctor will let you know when it’s okay to take the brace off. You’ll need to remove it for showering and dressing.
This video provides detailed instructions for using your shoulder sling after surgery.
Recovery timeline
First week: Immediate post-surgery
Rest: Keep your shoulder in a sling. Rest and manage pain with medications and ice.
Wound Care: Follow instructions for keeping the surgical site clean and dry.
Weeks 2-4: Early rehabilitation
Healing: Continue using the sling. Begin gentle passive range-of-motion exercises as advised by your physical therapist.
Follow-Up: Attend appointments to monitor progress and adjust treatment.
Weeks 5-8: Progressive rehabilitation
Physical Therapy: Start more active exercises to restore range of motion and strength. Gradually resume light activities.
Sling: Your surgeon will advise when to stop using the sling.
Months 2-4: Strengthening and Functional Recovery
Advanced Therapy: Focus on strengthening exercises and return to normal activities. Continue supervised physical therapy.
Activity: Gradually resume sports or heavier lifting with your surgeon’s approval.
Months 4-6: Full Recovery
Normal Activities: Most normal activities can be resumed. Maintain a regular exercise routine to support shoulder health.
Final Assessment: Confirm recovery status with your healthcare provider.
Beyond 6 Months: Long-Term Maintenance
Preventive Care: Continue shoulder exercises and good posture practices. Schedule regular check-ups to monitor long-term health.
This timeline provides a general guide; individual recovery may vary based on specific circumstances. Always follow your healthcare provider’s recommendations.
Body
The spine is made up of a stack of vertebrae that normally appear in a fairly straight line. When scoliosis is present, the spine has a sideways curve that can appear as an S or C. The condition is usually present in children and adolescents. Most cases of scoliosis are mild, and a small curve will likely not cause major problems. More severe cases of scoliosis can have more debilitating effects.
Causes and risk factors
There are several types of scoliosis that are caused by different things.
Idiopathic scoliosis causes 80-85% of scoliosis cases and the cause is unknown. It tends to run in families, but there is nothing that can be done to prevent the condition. Signs and symptoms usually present themselves prior to puberty.
Congenital scoliosis begins to affect the spine before birth. The vertebrae do not form completely or separate properly. Because abnormalities are present at birth, congenital scoliosis is usually diagnosed at a younger age than idiopathic scoliosis.
Neuromuscular scoliosis occurs when another condition that affects the nerves and muscles leads to scoliosis. This is commonly due to muscle imbalance and/or weakness. Common neuromuscular conditions that may lead to scoliosis include cerebral palsy, muscular dystrophy, or a spinal cord injury.
Symptoms
Uneven shoulders
One shoulder blade that is more prominent than the other
One or both hips appear raised or unusually high
Uneven waist
Head does not appear centered with the rest of the body
Asymmetric ribcage
Treatment
Most children with mild scoliosis will not require any treatment. Your doctor will likely monitor your child closely every four to six months to make sure there are no changes in the curvature of the spine. If your doctor is concerned that the curve may worsen over time, they may recommend bracing. A brace can help prevent the curve from getting worse as your child continues to grow.
More severe cases of scoliosis may require surgery to reduce the severity of the curve and prevent it from getting any worse.
Osteoarthritis usually develops after years of use. It is common in the knees because the knees bear the weight of the body. Over time, the cartilage in the knee wears down and stops protecting the ends of bones in the joint.
Causes and risk factors
Wear and tear of aging
Traumatic injury to the joint
Developmental dysplasia
Inflammatory arthritis
Osteonecrosis
Infection
Metabolic disorders
Hemoglobinopathies and other blood disorders
Autoimmune disorders
Obesity
Symptoms
Pain, swelling, and stiffness
The knee may lock or buckle when walking
Trouble bending or straightening the knee
Standing or walking for long periods may worsen pain
Diagnosis and treatment
Nonoperative treatment options include injections, physical therapy, taking anti-inflammatories, activity modification, weight loss, bracing, and using a cane/walker. If these are not helpful, an orthopedic surgeon may recommend surgery such as total knee replacement (knee arthroplasty) to relieve pain and preserve mobility.
