Dr. Lowell is trained in the latest minimally invasive surgical (MIS) techniques for treatment of low back complaints, including use of the iFuse Implant System® from SI-BONE®, Inc., a medical device company pioneering MIS sacroiliac (SI) joint treatment. The SI joint is a significant cause of low back pain. Publications and clinical research show the SI joint as a pain generator in up to 25% of low back pain and up to 43% of post-lumbar and lumbosacral fusion patients.
Sacroiliac Joint (SI Joint) Anatomy
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 shock absorption to prevent impact forces during walking from reaching the spine.
Do you have SI Joint Problems?
The SI joint is a significant cause of low back pain. Publications and clinical research show the SI joint as a pain generator in up to 25% of low back pain and up to 43% of post-lumbar and lumbosacral fusion patients. Like any other joint in the body, the SI joint can become damaged. SI joint pain can be due to a number of conditions, including degeneration, disruption, inflammatory conditions such as ankylosing spondylitis, tumor, infection or other problems. When this happens, people can feel pain in their upper leg(s), buttock and sometimes even higher on the skeleton. This is especially true with sitting, lifting, running, walking or even sleeping on the involved side. It is important to note that on occasion, patients who have not had relief from lumbar or lumbosacral spine surgery may actually have had other co-existing problems. This could include the SI joint, the hip, and the spine separately or any combination of these three potential pain generators.
Making a Diagnosis
A variety of tests performed during physical examination may help reveal the SI joint as the cause of your symptoms. Sometimes, X-rays, CT-scan or MRI may be helpful in the diagnosis of SI joint-related problems. The most relied upon method to accurately determine whether the SI joint is the cause of your low back pain symptoms is to inject the SI joint with a local anesthetic. The injection will be delivered with either X-ray or CT guidance to verify accurate placement of the needle in the SI joint. If your symptoms are decreased by at least 75%, it can be concluded that the SI joint is either the source of or a major contributor to your low back pain. If the level of pain does not change after SI joint injection, it is less likely that the SI joint is the cause of your low back pain.
Once the SI joint is confirmed as the cause of your symptoms, treatment can begin. Some patients respond to physical therapy, chiropractic manipulations, use of oral medications, or injection therapy. Intermittent use of a pelvic belt may provide symptomatic relief as well. These treatments are performed repetitively, and frequently symptom improvement using these therapies is temporary.
At this point, you and your surgeon may consider other options, including minimally invasive surgery.
1. Sembrano, Jonathan N, and David W Polly. “How Often Is Low Back Pain Not Coming from the Back?” Spine 34, no. 1 (January 1, 2009): E27–32.
2. DePalma, Michael J, Jessica M Ketchum, and Thomas R Saullo. “Etiology of Chronic Low Back Pain in Patients Having Undergone Lumbar Fusion.” Pain Medicine (Malden, Mass.) (April 11, 2011). http://www.ncbi.nlm.nih.gov/pubmed/21481166.
Minimally Invasive Hip Joint Replacement
MIS Hip Joint Replacement is a step forward in hip replacement because it may provide a number of potential benefits, which may include the following: a shorter hospital stay, faster recovery, and much less scarring.
Hip replacement is a surgical procedure — performed in the US since the 1960s — in which a diseased or damaged joint is replaced with an artificial joint called a prosthesis. Made of metal alloys and high-grade plastics (which are intended to mimic the function of bone and cartilage, respectively), the prosthesis is designed to move just like a healthy human joint. Over the years, hip replacement techniques and instrumentation have undergone countless improvements. Today, hip replacement is one of the safest and most successful types of major surgery; in well over 90% of cases it is complication-free and results in significant pain relief and restoration of mobility.
Partial Knee Resurfacing
Arthritis pain affects more than 40 million Americans.1 If you’re reading this website, you may be one of them. There are many causes of knee pain and there are a variety of treatment options. This website will review the causes and treatments of knee pain, highlighting more conservative knee treatment. Alleviating the pain and restoring mobility in your knee may allow you to do the simple things — from walking to gardening, even playing with your grandchildren, and most importantly, just enjoying life again. Information is the first step toward potential relief from joint pain.
Knee Anatomy and Function
The knee is the largest joint in the body and is central to nearly every routine activity. The knee joint is formed by the ends of 3 bones: the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the knee cap (patella). Thick, tough tissue bands called ligaments connect the bones and stabilize the joint. A smooth, plastic-like lining called cartilage covers the ends of the bones and prevents them from rubbing against each other, allowing for flexible and nearly frictionless movement. Cartilage also serves as a shock absorber, cushioning the bones from the forces between them. Finally, a soft tissue called synovium lines the joint and produces a lubricating fluid that reduces friction and wear.
Knee AAOS Links
The seven bones of the spinal column in your neck (cervical vertebrae) are connected to each other by ligaments–strong bands of tissue that act like thick rubber bands. A sprain (stretch) or tear can occur in one or more of these ligaments when a sudden movement, such as a motor vehicle accident or a hard fall, causes the neck to extend to an extreme position.
- Pain, especially in the back of the neck, that worsens with movement
- Pain that peaks a day or so after the injury, instead of immediately
- Muscle spasms and pain in the upper shoulder
- Headache in the back of the head
- Sore throat
- Increased irritability, fatigue, difficulty sleeping, and difficulty concentrating
- Numbness in the arm or hand
- Neck stiffness or decreased range of motion (side to side, up and down, circular)
- Tingling or weakness in the arms
To diagnosis a neck sprain, your doctor will perform a comprehensive physical examination. During the physical examination, the doctor will ask you how the injury occurred, measure the range of motion of your neck, and check for any point tenderness.
Radiographs (X-rays) may be requested so the doctor can look closely at the bones in your neck. This evaluation will help the doctor rule out or identify other sources of neck pain, such as spinal fractures, dislocations, arthritis, and other serious conditions.
All sprains or strains, no matter where they are located in the body, are treated in a similar manner. Neck sprains, like other sprains, will usually heal gradually, given time and appropriate treatment. You may have to wear a soft collar around your neck to help support the head and relieve pressure on the ligaments so they have time to heal.
Pain relievers such as aspirin or ibuprofen can help reduce the pain and any swelling. Muscle relaxants can help ease spasms. You can apply an ice pack for 15 to 30 minutes at a time, several times a day for the first 2 or 3 days after the injury. This will help reduce inflammation and discomfort. Although heat, particularly moist heat, can help loosen cramped muscles, it should not be applied too quickly.
Other treatment options include:
- Massaging the tender area
- Cervical (neck) traction
- Aerobic and isometric exercise
Most symptoms of neck sprain will go away in 4 to 6 weeks. However, severe injuries, may take longer to heal completely.
Fractured means broken. Whether you have a complete or a partial fracture, you have a broken bone.
A bone may be completely fractured or partially fractured in any number of ways (cross-wise, lengthwise, in the middle).
How Do Fractures Happen?
Fractures can happen in a variety of ways, but there are three common causes:
Trauma accounts for most fractures. For example, a fall, a motor vehicle accident or a tackle during a football game can all result in a fracture.
Osteoporosis also can contribute to fractures. Osteoporosis is a bone disease that results in the “thinning” of the bone. The bones become fragile and easily broken.
Overuse sometimes results in stress fractures. These are common among athletes.
Usually, you will know immediately if you have broken a bone. You may hear a snap or cracking sound. The area around the fracture will be tender and swollen. A limb may be deformed, or a part of the bone may puncture through the skin.
Doctors usually use an X-ray to verify the diagnosis. Stress fractures are more difficult to diagnose, because they may not immediately appear on an X-ray; however, there may be pain, tenderness and mild swelling.
Types of Fractures
Closed or simple fracture. The bone is broken, but the skin is not lacerated.
Open or compound fracture. The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. The bone may or may not be visible in the wound.
Transverse fracture. The fracture is at right angles to the long axis of the bone.
Greenstick fracture. Fracture on one side of the bone, causing a bend on the other side of the bone.
Comminuted fracture. A fracture that results in three or more bone fragments.
The Orthopaedic Evaluation
While every orthopaedic evaluation is different, there are many commonly used tests that an orthopaedic surgeon may consider in evaluating a patient’s condition.
In general, the orthopaedic evaluation usually consists of:
- A thorough medical history
- A physical examination
- Additional tests, as needed
Your medical history is taken to assist Dr. Lowell in evaluating your overall health and the possible causes of your joint pain. In addition, it will help Dr. Lowell determine to what degree your joint pain is interfering with your ability to perform everyday activities.
What the physician sees during the physical examination — which includes examination of standing posture, gait analysis (watching how you walk), sitting down, and lying down — helps to confirm (or to rule out) the possible diagnosis. The physical exam will also enable the orthopaedic surgeon to evaluate other important aspects of your hips and knees, including:
- Size and length
- Range of motion
- Skin condition
If you are experiencing pain in your hip joint, your back may be examined because hip pain may actually be the result of problems in the lower spine.
After the physical examination, X-ray evaluation is usually the next step in making the diagnosis. The X-rays help show how much joint damage or deformity exists. An abnormal X-ray may reveal:
- Narrowing of the joint space
- Cysts in the bone
- Spurs on the edge of the bone
- Areas of bony thickening called sclerosis
- Deformity or incorrect alignment
Occasionally, additional tests may be needed to confirm the diagnosis. Laboratory testing of your blood, urine, or joint fluid can be helpful in identifying specific types of arthritis and in ruling out certain diseases. Specialized X-rays of the back can help confirm that hip pain isn’t being caused by a back problem. Magnetic Resonance Imaging (MRI) or a bone scan may be needed to determine the condition of the bone and soft tissues of the affected joint.
In order to assist the orthopaedic surgeon in making a diagnosis, it may be helpful to write down your answers to the following questions before the appointment:
Where and when do I have pain?
How long have I had this pain?
Do I have any redness or swelling around my joints?
What daily tasks are hard to do now?
Did I ever hurt the joint or overuse it?
Does anyone in my family have similar problems, such as spurs on the edge of the bone?