Dr. Nicholas Cappello

Sixty years ago, people who suffered from scoliosis, a side-to-side curving of the spine that pulls it into an S or C shape, were given a bleak prognosis. Doctors told them they would have shortened lives, and wouldn’t be able to have children or hold active jobs. Surgery was frequently recommended for almost everyone.

Now that doctors know more, they give their patients a much brighter picture.

“There’s a very low chance of scoliosis causing a medical problem,” says Mark Spoonamore, MD, an orthopedic surgeon in the Keck School of Medicine of USC. “Actually, most curves have a low chance of getting worse and don’t require treatment.”

A study that tracked patients with scoliosis for 50 years found that even in people with a large curvature that goes untreated, researchers were unlikely to find any health effects other than an increase in back pain, Spoonamore says.

Only in cases that occur before or during adolescence, when a growth spurt causes faster bone growth, is treatment usually considered to keep a curve from getting worse. Plastic torso braces, which bend the spine into a straighter position, are commonly used to halt curves with a 20 degree bend or more.

While small curves occur with equal frequency among boys and girls, adolescent girls are about 10 times more likely to have a curve that would get worse without a brace. However, boys are much more likely to require surgery for curves of 45 degrees or more.

“One of the hardest things for a young adolescent girl is to wear the brace,” says Spoonamore. Doctors have made it easier with new options that allow patients to wear them all day outside of school or only at night, instead of all day.

Less than 10 percent of scoliosis patients have surgery to correct severe curvatures that can cause problems walking. Stronger, lighter titanium metal rods and screws have been developed that reduce the chance of complications, such as a rod breaking inside a patient after a hard impact, Spoonamore says.

“Most of the time, they never have to do any further surgery to change the rod,” he said. They can even participate in non-contact sports.

While birth defects, paralysis or other health problems can lead to scoliosis, doctors don’t know what causes most cases, although they do know that the condition runs in families. Spoonamore recommends keeping tabs on a child’s spine by having his or her pediatrician do a simple test for scoliosis during regular check-ups.

Study participants were coached in specific exercises aimed at building bone in key fracture points of the wrist, hip and spine. Mission Pharmacal Company supplied Citracal� calcium citrate for the study. Women were encouraged to take two Citracal� tablets twice a day, morning and evening, to ensure at least 800 mg of calcium. The balance of the remaining recommended dietary allowance (RDA) of 1,000 mg per day was to be supplied by their food intake. The women who regularly took the recommended level of 800 mg of calcium supplement daily and continued to consume calcium in their meals showed greater improvement than those who consumed less than the RDA, and women who kept up the with the exercises showed greater improvement than less frequent exercisers. In addition, the study reinforced evidence that long-term, consistent calcium intake and exercise are valuable, as they provided significant improvement in BMD. The UA investigators developed the BEST regimen, which they found effective in building bone in typically vulnerable areas. The regimen includes six core exercises:

Simply put it is a repetitive stress disorder. These are injuries caused by frequent unvarying use of part of the musculoskeletal system.

CTS are the most recognized occupational diseases as well as one of the most reported. Marked by numbness, weakness, and pain in the wrist and hand – particularly the thumb and index finger, and frequently shooting up the arm – CTS occurs when the median nerve, which runs from the forearm to the base of the palm, becomes compressed. This constriction or pinching is commonly attributed to repetitive motion. Yet, in spite of its association with heavy computer use, carpal tunnel syndrome is not confined to data entry workers. Butchers, mechanics, musicians, dental hygienists, tennis players and golfers are vulnerable. According to recent studies, CTS affects about 3 percent of the general population, whether on the job or at play. Women are more likely than men to develop it. Individuals with rheumatoid arthritis are also at high risk.

There is no universally accepted therapy. Mild cases are usually left untreated. Moderate cases may be treated with local injections of corticosteroids, if patients fail to respond to splinting and anti-inflammatory drugs like ibuprofen. In severe cases, with the threat of permanent loss of sensation, the preferred treatment is surgery. Surgery, however, is often recommended to patients before trying less invasive and less expensive treatments. Is surgery always the best course for carpal tunnel syndrome’s sufferers? No.

Steroid injection at the 3-month mark, results in a 94 percent significant improvement – a response of 20 percent or better – for the nocturnal symptoms, compared with 75 percent of wrists in the surgery group. At the 6-month mark, 85.5 percent of wrists in the injection group achieved a 20 percent or better response for the nocturnal symptoms, compared with 76.3 percent in the surgery group. At the 12-month mark, 69.9 percent of the wrists in the injection group achieved a 20 percent or better response for the nocturnal symptoms, compared with 70 percent in the surgery group. Throughout follow-up, results for two other symptoms measured – daily pain in the wrist area and self-perceived functional impairment – were similar.

“This is the first randomized controlled clinical trial comparing the two most common therapies for CTS,” notes one of its authors, Dr. Domingo Ly-Pen. “Our findings suggest that both local steroid injections and surgical decompression are highly effective in alleviating the symptoms of primary CTS at 12 months of follow-up. Nevertheless, local injection seems superior to surgery in the short term.”

These days, arthroscopy is the standard of care for repairing rotator cuffs. Most patients who have this procedure have excellent clinical results, but surprisingly the results sometimes don’t correlate to whether the rotator cuff is healed or not. “When your rotator cuff is torn, you attribute all your pain and dysfunction to your torn rotator cuff, then you have it fixed and you feel better, but sometimes when you take an ultrasound or an MRI, the rotator cuff looks exactly like it did before you had the surgery,” said Lawrence Gulotta, M.D., who led the study and is a sports medicine and shoulder surgeon at HSS. “Before this study, we thought that once a rotator cuff had re-torn or failed to heal following surgery, it had no capacity to heal in the future. Now we know that the rotator cuff does have the capacity to heal itself, even if early radiographic studies showed there was a defect at the repair site

Patients receiving anterior cruciate ligament (ACL) knee reconstruction with a hamstring tendon graft rather than a knee tendon graft were less likely to suffer from pain and mobility issues15 years after surgery, said researchers

A new study shows that bisphosphonates such as Fosamax and Boniva may reduce patients’ risk of developing colon cancer. Women in particular tend to take these prescriptions after menopause and now have up to a 59% reduced risk of colon cancer development

In a three-month randomized trial, self-reported injury rates that prevented running for more than three days were 16% both among the 600 participants who stretched before starting their regular runs and in the 798 who were told not to stretch.

On the other hand, stretching did appear to protect against injuries that were bad enough to send the runner to a clinician for diagnosis, with an odds ratio of 0.60 (P=0.005) after adjusting for prior illness, chronic injury, age, body mass index, and high running mileage, reported Daniel Pereles, MD, an orthopedic surgeon and sports medicine specialist in Kensington, Md.

“We’re talking about an amount of nitrate equivalent to what is found in two or three red beets or a plate of spinach,” said Eddie Weitzberg of the Karolinska Institutet in Sweden. “We know that diets rich in fruits and vegetables can help prevent cardiovascular disease and diabetes but the active nutrients haven’t been clear. This shows inorganic nitrate as a candidate to explain those benefits

Tart cherries could help athletes reduce muscle damage to recover faster from a tough workout, according to new research published in the American College of Sports Medicine’s journal Medicine & Science in Sports & Exercise.

Researchers at the Sports and Exercise Science Research Center at London South Bank University in the UK gave 10 trained athletes 1 ounce of an antioxidant-packed tart cherry juice concentrate (provided by CherryActive) twice daily for seven days prior to and two days after an intense round of strength training. The athletes’ recovery after the cherry juice concentrate was significantly faster compared to when they drank juice without the same phytonutrient content of cherry juice.

A recently discovered biomarker could help doctors diagnose a common type of knee injury, according to a new study.

A team of researchers led by Gaetano Scuderi, MD, clinical assistant professor of orthopaedic surgery at Stanford University School of Medicine and an orthopaedic surgeon at Stanford Hospital & Clinics, has confirmed that a particular protein complex appears in patients with painful meniscal tears. The finding, to be published Feb. 16 in /i>The Journal of Bone and Joint Surgery, could be used to prevent needless surgery and to save billions of dollars in medical-imaging costs.