If your child experiences a traumatic brain or spine injury, they will need to be evaluated by a neurosurgeon who is experienced in pediatric care. Your physician may use a neurological exam, diagnostic imaging, or other test to help diagnose the injury. Depending on the severity of the injury, your child’s treatment may include:

• Observation and/or monitoring
• Medication
• Surgery

Treatment may include emergency care to prevent further damage. Our pediatric neurosurgeons make it a priority to clearly communicate with patients and their families so they can make well informed decisions about brain and spine injuries.

Together, the brain and spinal cord make up the central nervous system (CNS). The brain controls thought, memory, movement, speech, vision, hearing, and more. The spinal cord is responsible for carrying messages between the brain and the rest of the body. A brain or spinal cord tumor is a mass formed by an abnormal growth of cells in the tissues of the brain or spinal cord. Tumors that begin in the CNS are known as primary tumors, while tumors that begin in another part of the body and travel to the CNS are known as secondary tumors. It is important to distinguish the difference between benign and malignant tumors. Benign tumors are non-cancerous and do not spread to nearby tissues or other distant areas. Malignant tumors are cancerous, and can spread to tissues throughout the body.

Causes and risk factors

The cause of most brain and spinal cord tumors is unknown, but there are certain risk factors to be aware of. Risk factors include:

• Radiation exposure
• Inherited or genetic conditions such as neurofibromatosis, Tuberous sclerosis, Von Hippel-Lindau disease, or Li-Fraumeni syndrome

Symptoms

Signs and symptoms of a brain or spinal cord tumor may occur gradually and get worse over time, or they may happen suddenly. Your child’s symptoms will depend on the location and size of their tumor, and whether it effects the brain or the spinal cord. Common symptoms of a brain or spinal cord symptom include:

• Headache
• Nausea or vomiting
• Changes in vision, hearing, or other senses
• Problems with balance or movement
• Changes in personality, mood, or behavior
• Seizures
• Drowsiness or another change in energy levels

It is important to note that many of these symptoms can be caused by other health issues. It is important to meet with your child’s primary care provider to determine the cause.

Treatment

Treatment for brain or spinal cord tumors greatly depends on a variety of factors. Your child’s neurological team will come up with a personalized treatment plan based on their age, the size of their tumor, the location of their tumor, and more. Common treatment options include:

• Radiation therapy
• Chemotherapy
• Targeted therapy drugs
• Surgery

There are several types of procedures that may be performed depending on your child’s tumor. Surgery is typically performed to take a sample of the tumor to learn more about it, to remove or destroy the tumor, or to help prevent or treat symptoms associated with the tumor.

Patellofemoral pain, or runners knee, is an irritation of the cartilage on the back of the patella (kneecap) that causes pain in one or both knees. This type of knee pain can develop because of overuse; it is common in athletes that participate in high-impact sports, but it can occur in non-athletes as well. Patellofemoral pain can be caused by abnormal tracking of the kneecap. This abnormality may cause increased pressure at the back of the patella and irritate soft tissues.

Symptoms

• Dull aching sensation under and around the kneecap
• Knee pain worsens after long periods of sitting
• Knee may also catch, grind, or pop

Diagnosis and treatment

In many cases, patellofemoral pain will improve with activity changes, using the RICE method (Rest, Ice, Compression, Elevation) and taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen to reduce swelling and relieve knee pain. If pain persists or worsens, you should see an orthopedic doctor. A doctor may recommend physical therapy or orthotics to relive pain and restore range of motion. Surgical treatment is rarely necessary, but in severe cases surgery is used to remove damaged cartilage or realign the kneecap.

What's a patellar tendon tear?

Tendons are strong cords of fibrous tissue that attach muscles to bones. The patellar tendon works with the muscles in the front of your thigh to straighten your leg.

Small tears of the tendon can make it difficult to walk and participate in other daily activities. A large tear of the patellar tendon is a disabling injury. It usually requires surgery and physical therapy to regain full knee function.

Causes and risk factors

A very strong force is required to tear the patellar tendon.

Falls – Direct impact to the front of the knee from a fall or other blow is a common cause of tears.

Cuts – often associated with this type of injury.

Jumping – The patellar tendon usually tears when the knee is bent and the foot planted, like when landing from a jump or jumping up.

A weakened patellar tendon is more likely to tear. Several things can lead to tendon weakness such as patellar tendinitis, chronic disease, and steroid use.

Patellar tendon tear symptoms

When a patellar tendon tears there is often a tearing or popping sensation. Pain and swelling typically follow, and you may not be able to straighten your knee. Additional symptoms include:

• An indentation at the bottom of your kneecap where the patellar tendon tore
• Bruising
• Tenderness
• Cramping
• Your kneecap may move up into the thigh because it is no longer anchored to your shinbone
• Difficulty walking due to the knee buckling or giving way

Patellar tendon tear diagnosis and treatment

Your doctor will consider several things when planning your treatment, including:

• The type and size of your tear
• Your activity level
• Your age

Very small, partial tears respond well to nonsurgical treatment including immobilization and physical therapy. Most people require surgery to regain knee function. Surgical repair reattaches the torn tendon to the kneecap. People who require surgery do better if the repair is performed soon after the injury. Early repair may prevent the tendon from scarring and tightening into a shortened position.

Falling directly onto your kneecap is a common cause of patellar fractures. These fractures are serious injuries and often require surgery to heal. Though they only account for about 1% of all fractures according to the American Academy of Orthopedic Surgeons, they vary a lot. The kneecap can crack slightly or be broken into many pieces and can occur in any area of the kneecap.

Symptoms

• Pain and swelling in the front of the knee
• Bruising
• Inability to straighten knee and/or walk

Diagnosis and treatment

You may not need surgery if the pieces of broken bone have not been displaced. If surgery is necessary, the orthopedic surgeon secures the bone using wires and pins or small screws, and removes bone fragments too small to be fixed back into place.

When pain, stiffness, and limited range of motion in your knee keep you from your daily activities, you may need a knee replacement. For patients with osteoarthritis, the most common source of debilitating knee pain, the goal of knee replacement is to restore function and decrease pain. A partial knee replacement (or unicompartmental knee replacement) is an option for patients with osteoarthritis in just one part of the knee. Unlike total knee replacement surgery, this less invasive procedure replaces only the damaged or arthritic parts of the knee. According to the American Academy of Orthopedic Surgeons (AAOS), multiple studies have shown that partial knee replacement performs very well in the vast majority of patients who are appropriate candidates. Advantages over full knee replacement include quicker recovery, less pain, and less blood loss.

Knee Anatomy

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 joint pain, stiffness, and swelling of the knee joint. The knee is divided into three major compartments: the medial compartment (the inside part of the knee), the lateral compartment (the outside part), and the patellofemoral compartment (the front of the knee between the kneecap and thighbone). In a partial knee replacement, only the damaged compartment is replaced. The healthy cartilage and bone in the rest of the knee remain intact.

Evaluation

Your doctor may recommend joint replacement surgery if conservative treatment methods have not relieved your knee pain or allowed you to continue with daily activities. An orthopedic surgeon will give you a thorough evaluation that includes your medical history, a physical exam to test range of motion, ligament, and muscle strength, and to identify the source of the pain. He or she will order imaging tests such as x-ray or MRI to see where the arthritis is and to evaluate the cartilage. A good candidate for partial knee replacement will only have osteoarthritis in one compartment of the knee.

Mako Robotic-Arm Assisted Surgery

Mako Robotic-Arm Assisted Technology can be used for partial knee replacements. It provides patients with a personalized surgical plan based on your unique knee anatomy. By accurately targeting the damaged part of your knee and leaving the healthy, unaffected parts intact, your knee is able to move smoothly and without pain again.

How Mako Robotic-Arm Assisted Surgery works:

1. Personalized Plan

A CT scan is used to generate a three dimensional virtual model of your knee anatomy. This virtual model is loaded into the MAKO robotic-arm software for your orthopedic surgeon to create your personal pre-operative plan.

2. Operating Room

Using your personalized pre-operative plan, the surgeon guides the robotic arm within the pre-defined area and helps prevent the surgeon from moving outside the boundaries. This allows your surgeon to align, position, and secure the knee implant with extreme accuracy.

3. After Surgery

After surgery you will be taken to the recovery room, where you will remain until you have recovered from the anesthesia, are breathing well, and your blood pressure and pulse are stable. You will begin putting weight on your knee immediately after surgery. A walker, cane, or crutches will be necessary at first until you gain strength. Your physical therapist will give you exercises to help maintain range of motion and restore strength. You will continue to see your orthopedic surgeon for follow-up visits until you are able to return to normal activities.

Muscular dystrophy (MD) is a group of diseases that cause muscles to weaken and deteriorate over time. MD is caused by a gene abnormality, or mutation, that interferes with the body’s production of proteins needed to create healthy muscle. There are more than 30 different types of muscular dystrophy. Most types of MD affect voluntary muscles that control movement in the arms, legs and torso. MD may also affect involuntary muscles, such as the heart or respiratory system. 

Causes and risk factors 

Muscular dystrophy (MD) is a genetic disorder that is often inherited from parent to child. However, it is possible for muscular dystrophy to occur due to a new genetic abnormality, or spontaneous mutation. Certain genes in our bodies are involved in making proteins that protect our muscles from damage. Muscular dystrophy occurs when these genes are defective. Each type of muscular dystrophy is caused by a genetic mutation particular to that type of the disease. The most common variety of MD, Duchenne Muscular Dystrophy, occurs more commonly in young boys than girls. 

Symptoms 

The main sign of muscular dystrophy is progressive muscle weakness. Different signs and symptoms may begin at different ages, and in different muscle groups, depending on the type of MD. Symptoms might include:

• A waddling gate
• Late or abnormal walking
• Frequent falling or stumbling
• Difficulty running or jumping
• Large calf muscles
• Difficulty standing up from a sitting position

Symptoms for certain types of MD begin in early childhood, while symptoms for other types of MD may not appear until the teenage years or later. Generally speaking, it is a good idea to speak with your doctor if you notice signs of muscle weakness in your child. Muscular dystrophy is a progressive disease, meaning that the condition worsens over time. Depending on the type of MD, children or adults may gradually lose physical abilities. In later stages of the disease, heart and breathing difficulties may develop if the involuntary muscles are affected. 

Treatment

There is currently no cure for MD, but there are treatment options to slow the rate of muscle degeneration and improve function. Certain medications may help to increase muscle strength and delay the progression of some types of MD. Physical and occupational therapy are often used to improve function and assist in daily activities. Braces or other mobility aids may be recommended to increase function and mobility. Some patients benefit from a pediatric neurosurgeon performing a procedure that releases tight muscles or tendons, or a surgery that is related to conditions of the spine.

A torn meniscus is a common knee injury, causing knee pain and limited mobility. The meniscus is a wedge shaped piece of cartilage that acts as a shock absorber between your thighbone and shinbone. Menisci tear in different ways. Sports injuries often cause sudden meniscus tears from direct contact, or as a result of twisting or turning the knee. Older people are more likely to have degenerative meniscus tears. As the cartilage weakens over time, twisting while squatting or getting up from a chair can cause a tear.

Symptoms of meniscus tears:

• Feeling a “pop” in your knee
• Knee pain
• Stiffness and swelling on or around knee
• Catching or locking of your knee
• Limited range of motion

Diagnosis and treatment:

Along with the type of meniscus tear you have, your age, activity level, and any related injuries will factor into your treatment plan. Nonsurgical treatment includes the RICE protocol and taking non-steroidal anti-inflammatory drugs. Non-steroidal anti-inflammatory drugs (NSAIDs) are over-the-counter pain relievers, such as ibuprofen and aspirin. They are popular treatments for muscular aches and pains as well as arthritis and help in reducing swelling, pain, and joint stiffness. Surgical treatment usually involves arthroscopic surgery. An orthopedic surgeon will insert a small camera and instruments in two or three tiny incisions around your knee, repair the meniscus, and/or trim away damaged tissue.

What is a medial collateral ligament (MCL) injury?

Your knee ligaments connect your thighbone to your lower leg bones. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) are found on the sides of your knee. Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection. Because the knee joint relies just on these ligaments and surrounding muscles for stability, it is easily injured. Any direct contact to the knee or hard muscle contraction — such as changing direction rapidly while running — can injure a knee ligament.

Causes and risk factors

Knee ligament sprains or tears are a common sports injury.  Athletes who participate in direct contact sports like football or soccer are more likely to injure their collateral ligaments. The MCL is injured more often than the LCL. Due to the more complex anatomy of the outside of the knee, if you injure your LCL, you usually injure other structures in the joint, as well.

Symptoms

• Pain at the sides of your knee. If there is an MCL injury, the pain is on the inside of the knee; an LCL injury may cause pain on the outside of the knee.
• Swelling over the site of the injury.
• Instability — the feeling that your knee is giving way.

Diagnosis and treatment

Injuries to the MCL rarely require surgery. If you have injured just your LCL, treatment is similar to an MCL sprain. But if your LCL injury involves other structures in your knee, your treatment will address those, as well.

Ice. Icing your injury is important in the healing process. The proper way to ice an injury is to use crushed ice directly to the injured area for 15 to 20 minutes at a time, with at least 1 hour between icing sessions. Chemical cold products (“blue” ice) should not be placed directly on the skin and are not as effective.

Bracing. Your knee must be protected from the same sideways force that caused the injury. You may need to change your daily activities to avoid risky movements. Your doctor may recommend a brace to protect the injured ligament from stress. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.

Physical therapy. Your doctor may suggest strengthening exercises. Specific exercises will restore function to your knee and strengthen the leg muscles that support it.

If the collateral ligament is torn in such a way that it cannot heal or is associated with other ligament injuries, your doctor may suggest surgery to repair it.

Frozen shoulder, also called adhesive capsulitis, occurs when the tissues of the shoulder capsule become thick, stiff and inflamed. It is most common in people between the ages of 40 and 60, and occurs in women more often than men.

Causes and risk factors

The cause of this condition is not fully understood. It may occur after the shoulder has been immobilized for a period of time due to a surgery or injury. Frozen shoulder occurs more in people with diabetes and certain medical problems such as Parkinson’s disease, hypothyroidism, hyperthyroidism and cardiac disease.

Symptoms

• Limited motion (or freezing) of the shoulder
• Can be accompanied by a dull, aching pain in the outer shoulder area

Treatment

Most patients improve with non-surgical treatment options, including anti-inflammatory medications, cortisone injections and physical therapy. Surgery may be recommended if the condition does not improve.