What is bursitis of the elbow?

Bursitis is an inflammation of the elbow, in the small sacs of fluid (bursae) that cushion and lubricate the areas between tendons and bones. Bursae are located throughout the body. In the elbow they cushion between the pointy bone at the back and the loose skin. Should this become irritated, additional fluid will fill up the bursa and create bursitis.

Causes and risk factors

• Extended pressure on the tip of the elbow
• Trauma to the elbow, allowing extra fluid to fill the bursa
• Infection such as puncture or insect bite, allowing for bacteria to enter the bursa
• Medical conditions such as rheumatoid arthritis and gout

Symptoms

• Swelling
• Pain at the tip of elbow
• Paint with elbow movement
• Irritated skin at infection site

Diagnosis and treatment

Diagnosis and treatment are important with this condition, as with any damage to the elbow. If the bursitis is not related to an infection, nonsurgical treatments such as rest, ice, elbow pads, change of activity, and anti-inflammatory medicines can be effective. Occasionally, this can be treated with aspiration of the fluid and injection of a corticosteroid. If symptoms do not resolve, your doctor may discuss surgical treatment.

A traumatic brain injury (TBI) occurs when a blow to the head or penetrating head injury disrupts normal function of the brain. About 1.7 million cases of TBI occur every year, according to the American Association of Neurological Surgeons. A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. It is a serious condition that requires specialized medical expertise. Visit the St. Charles Center’s concussion center to learn more about our comprehensive program to assess, treat, and rehabilitate individuals who have had a concussion.

Symptoms

Symptoms vary greatly and may be mild, moderate, or severe. They may include the following:

• Vomiting
• Lethargy
• Headache
• Confusion
• Paralysis
• Loss of consciousness
• Dilated pupils
• Vision changes (blurred vision or seeing double, not able to tolerate bright light, loss of eye movement, blindness)
• Cerebrospinal fluid (CSF) (which may be clear or blood-tinged) coming out of the ears or nose
• Dizziness and balance problems
• Breathing problems
• Slow pulse
• Slow breathing rate, with an increase in blood pressure
• Ringing in the ears or changes in hearing
• Cognitive difficulties
• Inappropriate emotional responses
• Speech difficulties (slurred speech, inability to understand and/or articulate words)
• Difficulty swallowing
• Body numbness or tingling
• Droopy eyelid or facial weakness
• Loss of bowel control or bladder control

Treatment

Treatment option may involve emergency care to prevent further damage to your brain. If you had a penetrating head injury, you may need surgical procedures to correct damage to tissues and your skull, as well as medications to control fluid and prevent seizures. When a violent blow to the brain or concussion has occurred, patients will get a customized plan to return to activity and restore function.

Hydrocephalus is often described as water on the brain because it is derived from two words “hydro” meaning water, and “cephalus” referring to the head. It is a condition where excess cerebrospinal fluid (CSF) builds up within the fluid-containing cavities of the brain called ventricles. This fluid is necessary for brain function, but too much can increase pressure in the brain and damage brain tissue. Hydrocephalus can occur at any age, but is most common in infants and adults age 60 and older.

Causes and risk factors

Hydrocephalus is usually caused by a disruption of the drainage system for CSF. This colorless fluid is produced in the brain and carries nutrients to cells, absorbs shock, and regulates pressure. It normally flows through and around the brain and then down the spinal cord, where it is absorbed by the blood stream. When the drainage system does not work properly, the ventricles swell with excess fluid and this raises the pressure within the brain.

Symptoms

Symptoms very greatly, but some common symptoms include the following:

Infants/Toddlers:

• Abnormal enlargement of head
• Nausea/vomiting
• Downward deviation of an infant’s eyes
• Drowsiness
• Irritability

Adults:

• Headache
• Difficulty in waking up or staying awake
• Loss of coordination or balance
• Vision impairment
• Memory loss

Treatment

Treatment may involve implanting a device called a shunt. This allows the excess fluid to drain out of the skull and into another area such as the abdomen or heart, where it is absorbed in the body. Once inserted, the shunt usually stays in place for the duration of the patient’s life. Sometimes additional surgeries are required to revise the shunt system. This ongoing condition requires continued follow-up care, but any complications that arise can usually be dealt with successfully.

A brain tumor is a mass of abnormal cells. It can be located inside your brain or next to it. Tumors can cause a wide range of problems throughout your body when they grow and press harmfully against the brain tissue. There are many types of tumors that can either originate in the brain itself, or come from another part of the body and travel to the brain (metastasize). Brain tumors may be classified as either benign (non-cancerous) or malignant (cancerous), depending on their behavior.

Common types of brain tumors

Meningiomas are the most common benign intracranial tumors, comprising 10 to 15 percent of all brain neoplasms. These tumors arise from the membrane-like structures (meninges) that surround the brain and spinal cord. Often, meningiomas cause no symptoms and require no immediate treatment.

Schwannomas are benign tumors in adults that arise along nerves. They account for about 8% of all brain tumors and commonly occur at the nerve of hearing (the 8th cranial nerve), which travels from the brain to the ear. Although these tumors are benign, they can cause serious complications and even death if they grow and exert pressure on nerves and eventually on the brain. Common symptoms include one-sided hearing loss and buzzing or ringing in the ears.

Gliomas are the most prevalent type of adult brain tumor, accounting for 78 percent of malignant brain tumors. They arise from the supporting cells of the brain, called the glia. The glia help to keep neurons in place and functioning well.

• Astrocytomas develop from astrocytes, star-shaped glial cells that make up the supportive tissue of the brain. They may occur in many parts of the brain, but most commonly in the cerebrum. Astrocytomas can appear in various parts of the brain and can develop in people of all ages, but they are more prevalent in adults, particularly middle-aged men. Symptoms vary, but headaches, seizures, memory loss, and behavior changes are common.
• Glioblastoma (GBM)also develop from astrocytes, but these aggressive tumors tend to grow rapidly and spread to other tissues. They are generally found in the cerebral hemispheres of the brain. GBM is more common in people ages 50 to 70, and more prevalent in men than women. Because they form and grow so rapidly, the increased pressure in the brain will create symptoms such as headache, nausea, vomiting, and drowsiness.

Causes

Brain tumors can occur due to a variety of factors, both genetic and environmental. Some brain tumors may be caused by genetic mutations that are inherited from a parent, while others may arise spontaneously due to mutations that occur during a person’s lifetime. While the exact cause of many brain tumors is still unknown, ongoing research is helping to uncover more about the underlying factors that contribute to their development.

Risk factors

Patients with certain genetic conditions (i.e., neurofibromatosis, von Hippel-Lindau disease, Li-Fraumeni syndrome, and retinoblastoma) also have an increased risk to develop tumors of the central nervous system. Exposure to certain chemicals may also increase the risk of brain tumors. Patients who have received radiation therapy to the head are also at an increased risk for new brain tumors.

Brain tumor symptoms

Brain tumors are complex and symptoms depend on the type and location of the tumor. Physical symptoms such as headache, nausea, loss of balance, weakness in one side of the body, vision or hearing changes, and seizures may occur. Behavioral changes may also be symptoms, such as confusion, impulsiveness, difficulty thinking, or personality changes.

Brain tumor treatment

Neurosurgeons use imaging techniques such as MRI or CT scans to help diagnose a tumor, and sometimes a biopsy is necessary. The treatment options for brain tumors (whether primary or metastatic, benign or malignant) depend on the type, size, and location of the tumor, as well as the overall health of the patient. The most common treatments include surgery, radiation therapy, and chemotherapy, either alone or in combination. Surgery may be used to remove all or part of the tumor, while radiation therapy uses high-energy beams to destroy cancer cells. Chemotherapy involves the use of drugs to kill cancer cells and may be given orally or intravenously.

Treatment plans are tailored to each individual’s needs and may involve a combination of different therapies. Close monitoring and follow-up care are also essential to manage any potential side effects and monitor for recurrence.

A cerebral arteriovenous malformation (AVM) is an abnormal connection between the arteries and veins in the brain. This tangle of blood vessels can restrict or alter normal blood flow. Typically, blood flows from small arteries to capillaries, then into veins of increasing size and back to the heart. In AVMs, the blood flows directly from arteries into veins without passing through capillaries. As a result, blood that is under high pressure is allowed to flow through thin walled veins, and can lead to a hemorrhage.

Symptoms

Most people do not experience symptoms prior to a hemorrhage. If there are any symptoms, they may include:

• Headache
• Whooshing or pulsing sounds in the head
• Seizures
• Muscle weakness
• Memory, vision, or coordination problems
• Numbness or tingling
• Hallucinations

Causes and risk factors

AVMs are uncommon, with only about 2500 new cases identified each year in the United States. They occur more often in men than in women and neurological symptoms generally appear between the ages of 20 and 40. The exact cause of AVMs is unknown, but the malformation is believed to develop before birth in early development.

Treatment

In many cases, an AVM is discovered because of a hemorrhage, or because a CT or MRI was ordered for another reason. The decision to treat a cerebral AVM depends on its location, the risk of future complications if it is left untreated, and the extent of neurological deficits that may be associated with its treatment. There are a number of surgical techniques, which may be used in combination for the treatment of AVMs, including stereotactic radiosurgery (highly targeted radiation therapy), endovascular embolization, and microsurgical resection of the AVM. These are complex lesions and the decision how to treat depends on the location and risk of complications.

What is Achilles tendonitis?

The Achilles tendon is the largest tendon in the body. It connects the calf muscles to the heel bone. Achilles tendinitis is a common condition that occurs when the large tendon that runs down the back of your lower leg becomes irritated and inflamed. Tendons, unlike bone, can’t repair themselves. After tendons are torn, they create a “scar like” attempt to repair themselves and that tissue does not have the same properties as the original tendon in terms of strength and elasticity.

Causes and risk factors

Achilles tendinitis can result from an acute injury or repetitive stress to the tendon.

• Increase in the amount or intensity of physical exercise, doing too much too soon
• Tight calves
• Bone spur where the tendon attaches to the heel can rub against the tendon and cause pain (insertional tendinitis)

Symptoms

• Pain on the back of the heel that worsens with activity
• Pain or stiffness along the tendon in the morning
• Pain after exercising
• Swelling

Diagnosis and treatment

Treatment of Achilles Tendonitis in the acute stage, or just a few weeks after the initial injury, are often immobilized in a boot or cast. That allows the tendon a chance to rest and not be stressed, helping with inflammation, swelling and pain. For more chronic patients that have had ongoing Achilles pain, using ice and heat alternatively often helps decrease pain. Treatment early allows for better, quicker results.

Patients should seek treatment from an orthopedic surgeon that specializes in foot and ankle conditions when they have significant swelling, changes in the soft tissues, or persistent pain for several weeks.

Foot and ankle injuries

The foot and ankle are complex structures used in nearly every form of human movement. They provide support, shock absorption, and balance. There are three bones that make up the ankle joint: the tibia, fibula, and talus. The ankle joint allows the foot to flex and extend. There are a total of 28 bones in the foot, and more than 30 joints that allow for a wide range of movement. Tough bands of tissue called ligaments are located on either side of the ankle joint to provide stability. Muscles and tendons are also located throughout the foot to allow for motion and to support the joints.

Cartilage covers the ends of the bones, allowing the bones to glide smoothly during movement. Loss of the cartilage due to arthritis can produce pain, stiffness, and swelling. When the bones begin to grind on each other it can result in constant pain during standing or walking, and loss of mobility.

Ankle arthritis

There are three common forms of arthritis that affect the ankle joint. Osteoarthritis is common in older adults. It is also known as degenerative or “wear and tear” arthritis. The protective cartilage wears away over time, resulting in bone rubbing on bone and ankle pain. Rheumatoid arthritis is an autoimmune disease where the immune cells attack the joint lining. It can also attack the ligaments and tendons and cause serious joint disability. Posttraumatic arthritis often occurs after an injury to the foot or ankle, such as motor vehicle accident or sports injury.

Symptoms

Ankle arthritis symptoms can include one or more of the following:

• Swelling and tenderness
• Increased pain with movement, in the morning, or after sitting
• Pain flares up with activity
• Difficulty in walking

Diagnosis and treatment

Your orthopedic surgeon will examine your foot and ankle for swelling and tenderness, do a gait analysis, and ask about your medical history. Generally, x-rays are taken to provide a detailed picture of your foot and ankle structure. There is no cure for arthritis, but treatments are designed to relieve pain and restore motion.

Nonsurgical treatments include modifying your lifestyle, physical therapy, braces, orthotics, and non-steroidal anti-inflammatories (NSAIDS). If your pain is not relieved with conservative treatments, your doctor may recommend a total ankle replacement.

Total Ankle Replacement

Ankle replacements offer patients more mobility than fusion and relieves the pain of arthritis. The prostheses is modeled after human anatomy and helps to reproduce natural movement of the ankle. Your orthopedic surgeon will make an incision on the front of the ankle. The diseased cartilage and bone are then removed from the tibia and talus. Lastly, a metal and plastic implant is inserted. Sometimes additional procedures are performed depending on the extent of your arthritis and ankle injuries.

Full recovery can take from 6-12 months, but most people can resume daily activities within two weeks. Your movement will be restricted for 6-8 weeks, and then you will start physical therapy to restore strength and range of motion. Your doctor will advise you on other restrictions depending on your lifestyle and goals.

This website offers general information about your surgery. Please follow the instructions from your doctor and medical team, even if those instructions are different from what you read here.

What is spondylolisthesis?

Spondylolisthesis occurs when one vertebrae slips forward out of alignment, usually in the lumbar spine. It is one of the most common causes of persistent back pain in children and adolescents.

Causes and risk factors

Spondylolisthesis is most commonly caused in adults by osteoarthritis. In children, it is usually due to a genetic condition or overuse. Individuals that participate in sports such as gymnastics, weight lifting, and football are at higher risk due to the stress on the spine and repeated hyperextension required.

Symptoms

The symptoms of spondylolisthesis vary greatly and it may or may not cause back pain. If pain is present, it may only be during certain activities or positions. It may also include muscle tightness, stiffness, tenderness, and pain in the thighs and buttocks. If the disk slips too far forward, the bones may begin to press on nerves and cause pain that radiates, numbness, and weakness in the leg or arm.

Treatment

Treatment for spondylolisthesis usually begins with a back brace, anti-inflammatory medication, and physical therapy. If conservative options fail to provide relief of symptoms or the vertebrae slips further, your neurosurgeon may recommend spinal fusion surgery to stabilize the spine.

What is spinal stenosis?

Spinal stenosis is a condition in which the spinal canal narrows. This puts pressure on the spinal cord and the spinal nerves, leading to low back pain that radiates down into the legs and buttocks. It can be caused by herniated discs, arthritis, spinal injury, tumors, or bone disease. It is most common in older adults, resulting from a combination of aging and degeneration of the spine.

Symptoms

The most common symptoms are lumbar pain, numbness, or tingling in the neck, shoulders, arms, buttocks, back, or thighs. Weakness in one part of the leg or arm is also common. When stenosis is located in the lower back, it can also affect posture, gait, and bladder and bowel function. While many patients note some relief when sitting and leaning forward, standing and walking may bring on severe pain and weakness.

Causes and risk factors

Arthritis is the most common cause of spinal stenosis due to degeneration. Anything that narrows the spinal canal makes the spinal cord and nerves vulnerable to pressure that causes irritation and inflammation. Other conditions that can narrow the spinal canal include herniated discs, arthritis, swollen ligaments, bone spurs, and spondylolisthesis. A small number of people who have a narrow spinal canal from birth are at risk for developing stenosis earlier in life.

Treatment

Diagnosing spinal stenosis requires several tests. In addition to a detailed medical history, your doctor will complete a physical exam and diagnostic tests such as x-ray or magnetic resonance imaging (MRI). These tests can help the physician rule out other conditions and provide you with an accurate diagnosis.

Back pain from spinal stenosis may be alleviated with conservative care, such as anti-inflammatory pain medications, physical therapy, steroid injections, acupuncture, or chiropractic manipulation. These nonsurgical treatments do not improve the narrowing of the spinal canal, but they can relieve pain, especially in early stages.

When surgery is necessary, the main goal is to remove the pressure on the nerve roots in the lumbar spinal canal. There are two main surgical options to consider: laminectomy or spinal fusion. Your neurosurgeon will discuss the advantages and disadvantages of both with you. In a laminectomy, your surgeon will enlarge the tube of the spinal canal and remove any bone spurs that are pushing into the nerve roots to decompress the lumbar spine. If arthritis has progressed to cause instability in the spine, spinal fusion may be performed to eliminate motion between painful vertebrae and fuse them together into one solid bone.

What's a sacroiliac (SI) joint?

The sacroiliac joint (SI joint) is located in the pelvis; it links the iliac bones (pelvis) to the sacrum (lowest part of the spine above the tailbone). It is an essential component for energy transfer between the legs and the torso.

Symptoms

• Lower back pain (below L5)
• Sensation in lower extremity; pain, numbness, tingling, weakness
• Pelvis/buttock pain
• Hip/groin pain
• Feeling of leg instability (buckling, giving way)
• Disturbed sleep patterns due to pain
• Disturbed sitting patterns (unable to sit for long periods, sitting on one side)
• Pain when going from sitting to standing

Causes and risk factors

Trauma and degeneration are two leading causes of SI joint dysfunction. Sacroiliac joint trauma can occur during motor vehicle accidents, falls on the buttocks, lifting and/or twisting, pregnancy and childbirth. Sacroiliac joint degeneration can occur as a result of previous lumbar spine surgery, stresses to the SI Joint due to leg length differences, osteoarthritis, and prior infection of the SI joint.

Treatment

Once the SI joint is confirmed as the cause of your symptoms, treatment can begin. Some patients respond well to physical therapy, use of oral medications, or injection therapy. These treatments are often performed repetitively, and frequently symptom improvement using these therapies is temporary. If non-surgical treatment options have been tried and do not provide long-term relief, your surgeon may consider other options, including the minimally invasive iFuse procedure.