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.
Body
Vertical talus is a congenital foot disorder, meaning it is present at the time of birth. It appears as an extreme case of flatfoot and may affect one or both feet. Though vertical talus is not painful for a newborn or young child, it can lead to serious problems and discomfort later in life. The talus is a small bone that connects the foot and leg, and sits between the heel bone (calcaneus) and the two bones of the lower leg (tibia and fibula). The tibia and fibula work with the talus to form the ankle joint. In vertical talus, the talus has formed in the wrong position and other foot bones have formed on top of the talus. As a result, the foot typically points up and the bottom of the foot is stiff with no arch.
Causes and risk factors
The exact cause of vertical talus is not known, though it is often associated with the following conditions:
Arthrogryposis
Spina bifida
Neurofibromatosis
Other neuromuscular diseases
Symptoms
Vertical talus is a foot disorder that’s usually diagnosed at birth, or before, if it is visible on an ultrasound.
Treatment
Vertical talus will not resolve itself and requires medical attention. It is important for vertical talus to be treated early before the deformity has time to progress. If your child learns to walk with an abnormal foot, painful problems can develop. Nonsurgical treatment options for vertical talus include:
Stretching or casting
Physical therapy
If the deformity does not correct with conservative treatment, surgery is usually required. Your pediatric orthopedic surgeon will put the bones in the correct position and fix any issues with the tendons and ligaments supporting the bones. A brace or special shoe may be recommended to prevent the deformity from returning. With treatment, you can expect your child to have a stable and functional foot.
Before becoming the St. Charles Center for Orthopedics & Neurosurgery, The Center had a long history in Central Oregon.
The Center got their start in 1958 when the Bend Orthopedic & Fracture was founded. Then, in 1979, the Bend Neurosurgical Group was founded. In 1999, the two groups merged to form The Orthopedic & Neurosurgical Center of the Cascades.
The arch of the foot helps to support us when we stand up or walk. Most children are born with very little arch in the feet. As they grow, develop, and begin to walk, the soft tissues along the bottom of the feet tighten and begin to shape into an arch. When the arch in the foot is not present, the condition is known as flatfoot. There are two types of flatfoot: flexible flatfoot and rigid flatfoot. In flexible flatfoot, the arch is present when the foot is not bearing any weight, but disappears when standing or walking. In rigid flatfoot, the arch is never present, whether bearing weight or not.
Causes and risk factors
Flatfoot is caused by abnormal foot development and can be hereditary.
Symptoms
Some children with flatfoot may have no symptoms, and children with flexible flatfoot often outgrow the condition eventually. Flexible flatfoot is typically not painful, while rigid flatfoot may cause pain during regular activities. See your pediatric orthopedic surgeon if your child experiences:
Recurring foot pain, particularly in the heel or arch area
Pain that worsens with activity
Swelling along the inside of the foot
Treatment
Children with flexible flatfoot usually outgrow the condition as their foot ligaments continue to develop. Treatment for flatfoot is only necessary if your child begins to experience pain or discomfort from the condition. Nonsurgical treatment options include:
Occasionally, flexible flatfoot can become rigid instead of correcting with growth. These cases may require surgical treatment to repair tendons or ligaments, or correct bone abnormalities.
Body
Cavus foot is a condition in which the foot develops an unusually high arch. Because of the high arch, an excessive amount of pressure is placed on different parts of the foot while standing or walking. This condition usually develops slowly during the adolescent years, and may be present in one or both feet.
Causes and risk factors
Most commonly, children develop cavus foot due to a nerve or muscle condition such as cerebral palsy, spina bifida, muscular dystrophy, or clubfoot. These conditions cause some muscles to be weaker than others, and unbalanced muscles work unevenly. Cavus foot may also occur due to an injury to the nerves in the leg or spinal cord. It may also be caused by an inherited structural abnormality.
Symptoms
The most obvious symptom of cavus foot is a very high arch in the foot, even when standing. Children may also experience the following symptoms:
Calluses or blisters on the side, heel, or balls of the feet
Bent toes (hammertoes) or flexed toes (claw toes)
Pain when walking or standing
Unstable feet due to the heel tilting inward, which can lead to frequent ankle sprains
Treatment
The first step of treating cavus foot is to determine the underlying cause. If linked to a neurological or muscular condition, it will likely worsen over time. In the very early stages or with mild cases of cavus foot, surgery may not be necessary. Non-surgical treatment options include:
Shoe inserts, such as arch supports
Shoe modifications
Bracing
If conservative treatment does not relieve pain and improve stability, your pediatric orthopedic surgeon may recommend surgery.
Body
Sinding-Larsen-Johansson syndrome is characterized by inflammation of the kneecap (patella) at its lowest point in the area of the growth center. This is the site of origin of the patellar tendon. There is traction on the kneecap at this point due to the action of the large, powerful thigh muscle (quadriceps), as well as with deep bending of the knee. The injury is usually due to repeated stress or vigorous exercise.
Common signs and symptoms
Slightly swollen, warm and tender bump below the kneecap
Pain with activity, especially when straightening the leg against force (such as with stair climbing, jumping, deep knee bends, or weightlifting) or following an extended period of vigorous exercise in an adolescent
In more severe cases, pain during less vigorous activity
Causes
Sinding-Larsen-Johansson syndrome results from stress (a single sudden incident or repeated) or injury of the lower patella that interferes with development, causing inflammation. This may be inflammation of the cartilage of the growing patella, death of tendon cells from repeated stress, or pulling off of the lining of the patellar bone.
Risk factors
Overzealous conditioning routines, such as running, jumping or jogging
Being overweight
Boys between 10 and 15
Rapid skeletal growth
Poor physical conditioning (strength and flexibility)
Preventative measures
Appropriately warm up and stretch before practice or competition
Maintain appropriate conditioning
Thigh and knee strength
Cardiovascular fitness
Exercise moderately, avoiding extremes
Use proper technique
Flexibility and endurance
Maintain ideal body weight
Treatment
Mild cases can be resolved with a slight reduction in activity level, whereas moderate to severe cases may require significantly reduced activity (12-16 weeks) and even immobilization (cast/brace) at times. Initial treatment consists of medications and ice to relieve pain, stretching and strengthening exercises, and modification of activities. Specifically, kneeling, jumping, squatting, stair climbing, and running on the affected knee should be avoided. The exercises can all be carried out at home for acute cases. Chronic cases often require a referral to a physical therapist or athletic trainer for further evaluation or treatment.
Uncommonly, the affected leg may be immobilized for 6 to 8 weeks (in a cast, splint, or reinforced elastic knee support). A patellar band (brace between the kneecap and tibial tubercle on top of the patellar tendon) may help relieve symptoms. Rarely, surgery is needed (if conservative treatment fails) in the growing patient. In addition, surgery may be necessary after skeletal maturity if the ossicle becomes painful.
The spine is made up of small bones called vertebrae, which are stacked on top of one another. The bones connect to create a tube that protects the spinal cord. Spondylolysis is a common cause of low back pain in adolescents that is caused by a crack or stress fracture in one of the vertebrae. The injury most commonly occurs in the lower spine and can occur on one or both sides of the vertebrae.
Causes and risk factors
Spondylolysis is commonly seen in young athletes who participate in sports that involve ongoing stress on the back, such as gymnastics, football, or weight lifting. Spondylolysis can occur in people of all ages, but children and adolescents are most susceptible as their spines are still developing. Genetics may also play a role in spondylolysis. Some people are born with vertebrae that are thinner than usual, which may make them more vulnerable to fractures.
Symptoms
Many patients with spondylolysis do not have any symptoms. The condition may not be discovered until an x-ray is taken for an unrelated reason.
If symptoms are present, the most common are:
Back pain similar to muscle strain
Pain that radiates to the buttocks or back of the thighs
Pain worsens with activity and improves with rest
Treatment
For most children with spondylolysis, the condition will improve with conservative treatment. The first step is usually a period of rest from sports or other strenuous activities. Other nonsurgical treatment options include:
Anti-inflammatory medications to help reduce swelling and relieve pain
Physical therapy exercises to improve flexibility and strengthen muscles
Bracing to limit the movement of the spine and allow fractures to heal
Surgery is not required for spondylolysis, but may be necessary if the condition progresses into spondylolisthesis.
The hip is a ball-and-socket joint. The rounded head of the upper femur (thighbone) fits firmly into the socket of the pelvis, and together they make up the hip joint. The socket is lined by a layer of articular cartilage known as the labrum. The labrum aids in stability of the hip joint and acts as a cushion to reduce friction and distribute force evenly. Sometimes different injuries or structural abnormalities can lead to a tear in the labrum.
Causes and risk factors
Hip labral tears can be caused by degenerative or traumatic factors. Typically, tears in the labrum are caused by sports or other activities that involve the hip, such as soccer, ballet, football, ice hockey, or golf. Hip labral tears can also be associated with other conditions of the hip such as hip dysplasia or hip impingement.
Symptoms
Occasional sharp pain in the hip or groin area
Stiffness and/or limited range of motion of the hip
A locking, clicking, or catching sensation in the hip joint
Pain with certain movements such as getting into or out of the car
Sometimes patients experience no pain or symptoms while at rest
Treatment
Treatment for a labral tear depends on the severity of your symptoms. Many people will recover fully with conservative treatment, while some cases may require surgery. Nonsurgical treatment options include:
Anti-inflammatory medications to relieve pain and control swelling
Physical therapy exercises to help with strength, stability, and range of motion
Rest from activities causing symptoms
Generally, if conservative treatment does not relieve symptoms within 3-6 months, surgery may be recommended. If the labrum does not heal on its own, a minimally invasive surgery is usually performed arthroscopically to repair or remove damaged tissue.
