Reverse total shoulder replacement is recommended for people who do not have a functioning rotator cuff. For these individuals, an anatomical total shoulder replacement can still leave them with pain and the inability to lift one’s arm past 90 degrees.

The design of this surgery is very innovative. As the name implies, the shoulder prosthesis does not recreate normal anatomy, instead the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. Patients receiving a reverse total shoulder replacement have a functioning deltoid muscle, which is the large muscle on the side of the shoulder, and a non-functioning rotator cuff, usually due to a large irreparable rotator cuff tendon tear. This procedure greatly improves the function of the shoulder by absorbing the some of the role of the absent rotator cuff. The prosthesis provides a stable and constant center of rotation, allowing the deltoid muscle to elevate the arm.

While this procedure does not make your shoulder normal, it does improve the function and reduces or eliminates shoulder pain. The prosthesis is non-atomic, but patients can expect to use the shoulder for light activities such as hunting, fishing, playing golf, riding horses, and doing lightweight training exercises in the gym. Most patients are able to drive within three weeks of surgery.

What is a quadriceps tendon tear?

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

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

Causes and risk factors

Quadriceps tendon tears are not common. They most often occur among middle-aged people who play running or jumping sports. A quadriceps tear often occurs when there is a heavy load on the leg with the foot planted and the knee partially bent. Think of an awkward landing from a jump while playing basketball. The force of the landing is too much for the tendon and it tears. Tears can also be caused by falls, direct force to the front of the knee, and lacerations (cuts).

Symptoms

When a quadriceps 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 top of your kneecap where the tendon tore
• Bruising
• Tenderness
• Cramping
• Your kneecap may sag or droop because the tendon is torn
• Difficulty walking due to the knee buckling or giving way

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

Most small, partial tears respond well to nonsurgical treatment including immobilization and physical therapy.

Most people with complete tears will require surgery to repair the torn tendon. Surgical repair reattaches the torn tendon to the top of 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.

The posterior cruciate ligament (PCL) is a band of tissue that connects the femur to the tibia at the back of the knee joint. An injury to this stabilizing ligament requires a powerful force, like a motor vehicle accident or sports injury.

Symptoms

• Knee pain
• Instability
• Swelling, stiffness, or bruising

Diagnosis and treatment

In many cases, a torn PCL will heal without surgery. Your orthopedic surgeon may recommend using the RICE method (Rest, Ice, Compression, Elevation), bracing, physical therapy, and taking non-steroidal anti-inflammatory drugs (NSAIDs). A doctor may recommend surgery if you have multiple injuries to your knee. Arthroscopic surgery is often used to rebuild the ligament. A torn PCL will be replaced with a tissue graft from another part of your body or a cadaver. Arthroscopic surgery is less invasive and results in quicker recovery times.

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. In newborns and children with developmental hip dysplasia (DDH), the hip joint has not formed normally and the ball of the femur is loose in the socket. This usually means the hip is very easily dislocated.

Causes and risk factors

DDH tends to run in families, and is more common in:

• The left hip
• Girls
• Firstborn children
• Babies born in the breech position
• Family history of DDH
• Oligohydramnios patients (low levels of amniotic fluid)

Symptoms

DDH is most often present at birth, though it may develop during the first year of childhood. Some babies born with DDH may not present any symptoms initially. Common signs of DDH include:

• Legs are different lengths
• Uneven skin folds on the thigh
• Less mobility or flexibility on one side
• Limping, walking on the toes, or waddling gait

Treatment

When DDH is diagnosed at birth, it can usually be treated conservatively with good results. If the condition is not diagnosed until a child begins walking, treatment can be a little more complicated. Nonsurgical treatment options include:

• Harnesses to hold the hip in the proper position while allowing free movement of the legs
• Bracing or casting are used if a firmer material is needed to keep the joint in the proper position

In some cases, the pediatric orthopedic surgeon will need to reposition your child’s femur into the right position, and apply a cast to hold the bones in place. This procedure is performed while the child is under anesthesia. Surgery to correct DDH is sometimes necessary to realign the hip. Download and Print Developmental Hip Dysplasia Educational Information

However hard we try, it is impossible to keep our children out of harm’s way at all times. According to the American Academy of Pediatrics, fractures are the fourth most common injury in children under the age of six. Falls cause most of the reported fractures in children, but motor vehicle crashes are also a top contributor. A broken bone sounds scary, but pediatric fractures often heal without the need for surgical repair. Children’s bones are different than adults – they are softer, more flexible, and tend to absorb shock better. A child’s bone also heals much faster than an adult’s bone. Because their bones are still growing and heal so quickly, it is important to treat a fracture quickly and properly to avoid future problems.

Symptoms

• Child may not report pain right away, but tend not to use fractured body part
• Tenderness, numbness, or tingling
• Trouble moving the injured body part
• Swelling
• Bruising or redness

If there are any physical deformities such as a bump or change in shape of the bone, or if the bone is visibly sticking out, it’s best to seek medical attention right away. Otherwise, it’s probably okay to wait to be evaluated until the next day. The St. Charles Center for Orthopedics & Neurosurgery NOWcare walk-in injury clinic provides fracture care and casting for all ages with no appointment necessary.

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.