What is De Quervain’s tenosynovitis?

De Quervain’s tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain’s tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist.

Causes and risk factors

Chronic overuse of your wrist is commonly associated with this condition. Tendons are rope-like structures that attach muscle to bone. When you grip, grasp, clench, pinch or wring anything in your hand, two tendons in your wrist and lower thumb normally glide smoothly through the small tunnel that connects them to the base of the thumb. Repeating a particular motion day after day may irritate the sheath around the two tendons, causing thickening and swelling that restricts their movement.

• If you’re between the ages of 30 and 50, you have a higher risk of developing de Quervain’s tenosynovitis than do other age groups, including children.
• The condition is more common in women.
• The condition may be associated with pregnancy.
• Lifting your child repeatedly involves using your thumbs as leverage and may also be associated with the condition.
• Jobs or hobbies that involve repetitive hand and wrist motions may contribute.

Symptoms

• Pain near the base of your thumb
• Swelling near the base of your thumb
• Difficulty moving your thumb and wrist when you’re doing something that involves grasping or pinching
• A “sticking” or “stop-and-go” sensation in your thumb when moving it

Treatment

Treatment for De Quervain’s tenosynovitis is aimed at reducing inflammation, preserving movement in the thumb and preventing recurrence. If you start treatment early, your symptoms should improve within four to six weeks. If your De Quervain’s tenosynovitis starts during pregnancy, symptoms are likely to end around the end of either pregnancy or breast-feeding. If your case is more serious, your doctor may recommend outpatient surgery.

Congenital spine conditions are disorders of the spine that develop in children before birth. Usually, in these cases, the spine does not develop correctly early in fetal development, causing structural issues with the spine or spinal cord. Many spine abnormalities in children cause no problems and may only be discovered during x-rays done for other reasons. Sometimes, congenital spine conditions are progressive and can result in more serious complications. Some of these conditions our pediatric neurosurgeons treat include:

• Scoliosis
• Spina Bifida
• Tethered Spinal Cord
• Kyphosis
• Lordosis

Causes and risk factors

Medical experts do not know the exact cause of congenital spine conditions. These conditions usually affect the vertebrae that make up the spine. When present, the vertebrae may be partially formed or misshapen, fused together, or missing.

Symptoms

Congenital spine conditions can typically be detected at birth by your medical provider. In some cases, physical symptoms may not be present until early childhood as the condition begins to worsen. Symptoms might include:

• Abnormal curvature of the spine
• Uneven shoulders, hips, or legs
• Difficulty walking

Treatment

Treatment depends on your child’s specific condition, symptoms, and severity. Treatment plans are usually focused on preventing the condition from worsening, rather than completely correcting the condition. Treatment options might include:

• Bracing or casting
• Physical therapy exercises
• Surgery

­­It is estimated that one in four children sustain an unintentional injury requiring medical attention each year. Caring for pediatric injuries requires special knowledge and expertise. Children and adults have important anatomical, physiological, and psychological differences that are important to consider when treating an injury. Children tend to have less body fat, more elastic connective tissue, and a growing skeleton. The force of an impact can be transmitted widely throughout the body, resulting in multiple injuries. If your child suffers a traumatic injury, you want a medical provider who is experienced in pediatric care. For serious or life-threatening traumas, seek emergency medical attention. For traumatic injuries related to the bones, joints, muscles, and supporting structures such as broken bones, concussions, sports injuries, or motor vehicle accidents, The Center is pleased to offer our NOWcare walk-in injury clinic.

Clubfoot is a common birth abnormality that occurs in one infant out of every 1,000 births. It is a condition where the tendons that connect the leg muscles to the foot bones are short and tight, and cause the foot to turn inward. It can occur in one or both feet. It is not painful to the infant, but it does require treatment so the child can walk, wear shoes, and enjoy physical activities without pain.

Causes and risk factors

While there is no known cause of clubfoot, there is an increased risk in families with a history of clubfeet. It also occurs more often in males than females.

Symptoms

Clubfoot is diagnosed at birth but can often be detected at a prenatal ultrasound.

• Appearance of the foot is turned inwards and/or upwards
• Deep crease on the bottom of the foot
• Foot and leg are usually shorter than normal
• Calf is thinner than normal
• Foot size is smaller than normal

Diagnosis and treatment

Although it is possible to treat in older children, treatment usually starts shortly after birth and generally does not require surgery. A set of long-leg casts (toes to thigh) is applied weekly for 6-8 weeks. It gently stretches the foot until it reaches a neutral position. A small procedure is usually necessary to lengthen the Achilles tendon after the last cast is removed. After treatment, the baby wears a brace that looks like shoes attached to a bar to maintain the neutral foot position. If the baby does not wear the brace, clubfoot can come back. The brace needs to be worn consistently for three months and then only during naps and at night for several years. This method of treating clubfoot is long and can be difficult for parents, but it has proven to be very effective. If clubfoot can’t be corrected by this method or if it recurs, surgery may be necessary to lengthen or move tendons.

The St. Charles Center for Orthopedics & Neurosurgery is committed to ongoing research and development in the fields of orthopedic, neurosurgical and rehabilitation care. The physicians at St. Charles are currently involved in the use and/or development of cutting-edge technology and procedures. In order to advance medical knowledge and practice, St. Charles participates in a variety of device registries and device clinical trials. In addition, our own physicians often have novel ideas about new treatments that may improve outcomes for our patients. The Center facilitates the development of these ideas into research projects by coordinating studies and identifying potential funding sources. Research findings are reported through publications and presentations to other physicians, health care professionals and patients with the goal of improving patient care.

Clinical trials

The National Institutes of Health (NIH) defines a clinical trial as research study in human volunteers to answer specific health questions. At the St. Charles Center for Orthopedics & Neurosurgery, the majority of our studies are interventional as we test new treatments and devices under controlled environments to determine if the intervention is safe and effective. Participants in clinical trials often gain access to new treatments before they are widely available and help others by advancing medical research. If you are interested in participating in a research study or curious about the St. Charles Center’s clinical trials, below is a list of procedures and conditions that we study.

Clinical research study for patients with frozen shoulder

Principal investigators: James Verheyden, M.D., Tim Bollom, M.D., James Nelson, M.D.

Ascension MCP finger implant post-approval study

PyroCarbon Metacarpophalangeal Joint Prosthesis. Clinical Study Protocol #CP-MCP-002 Principal investigator: James Verheyden, M.D.

Sapphire WW

Stenting and Angioplasty with Protection In Patients at High-risk for Endarterectomy SAPPHIRE WW – P06-3603 Principal investigator: Raymond Tien, M.D.

Cordis enterprise

Vascular Reconstruction Device and Delivery System Principal investigator: Raymond Tien, M.D.

Neuroform

Neuroform Microdelivery Stent System, Humanitarian Device Exemption (HDE) Principal investigator: Raymond Tien, M.D.

Onyx

HD500 Liquid Embolic System Principal investigator: Raymond Tien, M.D.

Wingspan stent system

with Gateway PTA Balloon Catheter, HUD #03-0101 Principal investigator: Raymond Tien, M.D.

Jump test

Comparison of Single leg Squat Test to Jump Test as a Predictor for Risk of Lower Extremity Injury in Older Children and Adolescents Principal investigator: Viviane Ugalde, M.D. Contact our center for more information: (541) 330-8653 or Email us here.

A Chiari malformation occurs when brain tissue extends outside of the skull and into the spinal cord. The cerebellum is a lower part of the brain that controls balance, coordination, and muscle movement. Normally, the cerebellum sits above an opening in the skull where the spinal cord passes through, called the foramen magnum. When part of the cerebellum extends below the foramen magnum and into the upper spinal canal, a Chiara malformation is present. There are several different types of Chiari malformations that are classified by the severity of the disorder and the part of the brain that is affected.

Causes and risk factors

• Most often caused by structural defects in the brain and spinal cord that occur during fetal development
• Excessive draining of spinal fluid due to traumatic injury, disease or infection
• May be hereditary

Symptoms

Many people with Chiari malformation have no signs or symptoms and don’t require treatment. However, depending on the severity of the condition, there are some common symptoms:

• Headaches, especially after coughing, sneezing or straining
• Severe neck pain
• Dizziness and balance problems
• Blurred or double vision
• Difficulty swallowing, which may cause gagging, choking or vomiting
• Sleep apnea
• Loss of sensation or tingling in the hands and arms
• Developmental delays

Treatment

Treatment for Chiari malformation depends on the severity of the condition and symptoms. If no symptoms are present, your doctor will likely recommend no further treatment beyond monitoring with regular examinations. If headaches are the main symptoms, medications may be prescribed by your doctor. When more serious symptoms are present, surgery is usually necessary to relieve pressure on the spinal cord.

Cerebral palsy affects approximately two of every 1,000 live births in the United States. This condition is usually the result of damage or abnormalities to the brain that occur before, during or shortly after birth. Cerebral palsy affects the parts of the brain that are involved with movement and coordination, and a child’s ability to control his or her muscles.

Cerebral palsy causes and risk factors

It is difficult to determine how damage or abnormalities to the brain are caused. Before a child is born, the brain is extremely sensitive to damage from maternal infections and toxins, as well as exposure to drugs or alcohol. A lack of oxygen during birth has also been linked to the development of cerebral palsy in some cases. After birth, infection, lack of oxygen and head injuries can all be contributing factors. Children born prematurely may be at a greater risk for developing cerebral palsy.

Symptoms

In most cases, cerebral palsy begins before a child is born, but this condition can also present itself at birth or during the early years of life. The physical disabilities resulting from cerebral palsy can be mild, moderate or severe, depending on which part and how much of the brain has been damaged. Early symptoms of cerebral palsy include:

• Delayed milestones like learning to roll over, sit up, crawl or walk
• Exaggerated reflexes
• Involuntary movement
• Stiffness or floppiness in the limbs

Treatment

There is no cure for cerebral palsy, but treatment for the symptoms is available. Treatment such as physical therapy, occupational therapy, speech therapy, medication or braces can help children significantly improve their functional capabilities. The condition will not worsen as children get older, but it is important to start treatment as soon as possible for the best results. In some cases, a pediatric neurosurgeon can do a surgical procedure to help manage the spasticity that can be associated with cerebral palsy.

Bursitis is a condition caused by inflammation of one or both of the fluid-filled cushioning sacs between the rotator cuff and part of the shoulder blade (acromion). This condition often occurs with rotator cuff tendinitis.

Causes and risk factors

• Excessive use
• Long periods of pressure on joint (leaning on elbows)
• Gout
• Trauma
• Rheumatoid arthritis

Symptoms

The many tissues of the shoulder become inflamed and painful with this condition. The shoulder area may have stiffness, swelling, and/or redness. Daily activities such as washing your hair and getting dressed may become painful.

Treatment

Bursitis is usually treated without surgery. Many people experience relief with lifestyle changes such as:

• Activity modification
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Crutches/walking cane
• Physical therapy
• Steroid injection

In some cases surgery is required to repair torn tissues. A comprehensive examination from an orthopedic surgeon is required to find the causes of your shoulder pain and treat it appropriately.

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.

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 or spine injuries.