Magnetic resonance imaging (MRI) and ultrasound. Thes imaging studies create better pictures of soft tissues. It may help your doctor identify injuries to the ligaments and tendons surrounding your shoulder joint.
Computed tomography (CT) scan. This tool combines x-rays with computer technology to produce a very detailed view of the bones in the shoulder area.
Electrical studies. Your doctor may order a tests, such as the EMG (electromyogram), to evaluate nerve function.
Arthrogram. During this x-ray study, dye is injected into the shoulder to better show the joint and its surrounding muscles and tendons.
Arthroscopy. In this surgical procedure, your doctor looks inside the joint with a fiber-optic camera. Arthroscopy may show soft tissue injuries that are not apparent from the physical examination, x-rays, and other tests. In addition to helping find the cause of pain, arthroscopy may be used to correct the problem.
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Treatment Activity Changes
Treatment generally involves rest, altering your activities, and physical therapy to help you improve shoulder strength and flexibility. Common sense solutions such as avoiding overexertion or overdoing activities in which you normally do not participate can help to prevent shoulder pain.
Medications
Your doctor may prescribe medication to reduce inflammation and pain. If medication is prescribed to relieve pain, it should be taken only as directed. Your doctor may also recommend injections of numbing medicines or steroids to relieve pain.
Surgery
Surgery may be required to resolve some shoulder problems; however, 90 percent of patients with shoulder pain will respond to simple treatment methods such as altering activities, rest, exercise, and medication.
Certain types of shoulder problems, such as recurring dislocations and some rotator cuff tears, may not benefit from exercise. In these cases, surgery may be recommended fairly early.
Surgery can involve arthroscopy to remove scar tissue or repair torn tissues, or traditional, open procedures for larger reconstructions or shoulder replacement. Top of page
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist"program on this website.
Live it Safe: Prevent Broken Hips What is a broken hip?
How serious is a broken hip? Who is at risk for a broken hip? Why do broken hips occur? Why do bones weaken? What is osteoporosis?
How can I prevent a broken hip?
What can I do to my home to make it safer? What research on broken hips is being done?
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What is a broken hip?
Hip fractures are breaks in the thighbone just below the hip joint. Most require hospitalization and surgery. In 2006, there were more than 368,000 hospitalizations for hip fractures, or more than 1,000 fractures a day. Most hip fractures occur in older women. White, postmenopausal women have a 1 in 7 chance of sustaining a hip fracture during their lifetime.
Many experts predict a future epidemic of hip fractures because the U.S. population is aging. The number of people age 65 and older is expected to double to 65 million in 2030 and those 85 and older, to increase five-fold to 15 million by 2050. The number of hip fractures could reach 650,000 by 2050.
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How serious is a broken hip?
Although modern orthopaedic care and surgical technology assist satisfactory bone healing, most hip fracture patients require extended periods of rehabilitation. Most hip fracture patients who previously lived independently will require assistance from their family or home care. Forty percent of hip fracture patients 65 and older are discharged or transferred from hospitals to long-term care facilities. All hip fracture patients require walking aids for several months after injury, and nearly half will permanently require canes or walkers to move around their house or outdoors. The death rate for hip fracture patients is higher than for other people of the same age who do not sustain the injury. About 24 percent of hip fracture patients over age 50 die within 12 months after injury because of complications related to the injury and the extended recovery period.
What is the annual cost?
The current annual cost to the U.S. health care system for acute and convalescent care for patients with hip fractures is more than $11 billion. That's an average of about $37,000 per patient.
The expected hospital stay is almost two weeks. Continuing care, including nursing homes, paid caretakers, and assistance from family members, etc., greatly increases the expense of hip fractures beyond that of hospitalization and surgery.
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Who is at risk for a broken hip?
Here are some of the common characteristics of people who are at risk: • Age. The rate increases for people 65 and older.
• Heredity. A family history of fractures in later life, particularly in Caucasians and Asians. A small-boned, slender body.
• Nutrition. A low calcium dietary intake or reduced ability to absorb calcium. • Personal habits. Smoking or excessive alcohol use.
• Physical impairments. Physical frailty. Arthritis. Poor balance and coordination. Poor eyesight.
• Mental impairments. Senility, dementia, e.g., Alzheimer's disease.
• Medications. Weakness or dizziness due to adverse side effects of medication.
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Why do broken hips occur?
The upper femur in young people is one of the strongest bones in the body, but with aging and disease, the upper femur weakens and becomes vulnerable to a fracture. Top of page
Why do bones weaken?
Bone is a living tissue, composed mainly of calcium and protein. Bones with high calcium content are strong. Healthy bone is always being remodeled; that is, small amounts are being absorbed in your body and small amounts are being replaced. If more bone calcium is absorbed than is replaced, the density or the mass of the bone is reduced. This bone becomes progressively weaker, increasing the risk that it may break.
The loss of bone tends to occur most in the spine, lower forearm above the wrist, and upper femur-the site of hip fractures. Spine fractures, wrist fractures, and hip fractures are common injuries in older people.
A gradual loss of bone mass, generally beginning about age 35, is a fact of life for everyone. After growth is complete, women ultimately lose 30 to 50 percent of their bone density, and men lose 20 to 30 percent.
Women lose bone calcium at an accelerated pace once they go through menopause. Menstrual periods cease because a woman's body produces less estrogen hormone. Estrogen in women is important for the maintenance of bone mass or bone strength. Your family doctor or gynecologist may evaluate and recommend a treatment program of estrogen replacement for women near menopause. To be most effective, such treatment should begin at menopause. A measurement of bone density when menopause begins may help a woman decide whether to use estrogen replacement therapy to retard bone loss.
For more information, contact The National Osteoporosis Foundation, 1232 22nd St., NW, Washington, D.C. 20037 and The American College of Obstetricians and Gynecologists Resource Center, 409 12th St., SW, Washington, D.C. 20090.
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What is osteoporosis?
Osteoporosis means "porous bone." This condition develops when bone is no longer replaced as quickly as it is removed. More than 2 million Americans have fractures related to osteoporosis each year. Most people are unaware that they have osteoporosis until a fracture occurs.
The exact medical cause for osteoporosis is not known, but a number of factors are known to cause osteoporosis: aging, physical inactivity, reduced levels of estrogen, heredity, excessive cortisone or thyroid hormone, smoking, and excessive alcohol intake.
Although osteoporosis will occur in all people as they age, its rate of progression and effects can be modified with proper early diagnosis and treatment.
Your family doctor working with your orthopaedic surgeon can evaluate whether your bone density has been reduced, and can evaluate the cause for the reduction. Early treatment for osteoporosis is the most effective way to reduce bone loss and
prevent fractures. However, treatment programs after a fracture also are of value and may help to prevent future fractures.
Current treatment can reduce bone loss, but there are no proven methods of restoring lost bone. Building bones through adequate calcium intake and exercise when you are young is an investment that will pay off years later with a reduced risk of hip and other fractures.
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How can I prevent a broken hip?
Orthopaedic surgeons are experts in the care and treatment of patients with fractured hips. They are concerned about the epidemic of hip fractures and the impact these severe injuries has on patients, their families, and on society. Orthopaedic surgeons know that prevention of hip fractures is far better, and far less costly, than treatment after the bone is broken.
Here's what you can do:
Calcium and Vitamin D
Be sure your diet contains the necessary calcium and Vitamin D during childhood, adolescence, and adulthood. The typical American diet provides about 300 milligrams (mg.) of calcium a day from non-milk sources. Each dairy product serving provides an additional 300 mg.
A recommendation by the National Research Council for a daily dietary intake of 800 mg. of calcium is thought to be too low.
The National Institutes of Health (NIH) recommends the following daily calcium intake:
• 11 - 24 years: 1,200 mg.
• Pregnant or nursing women under age 19: 2,000 mg. • Pregnant or nursing women 19 or older: 1,400 mg.
• Before menopause: 1,000 mg.
• Menopausal, postmenopausal women not taking estrogen: 1,500 mg. • Menopausal, postmenopausal women taking estrogen: 1,000 mg. • Middle-aged men: 1,000 mg.
Vitamin D plays a major role in calcium absorption and its incorporation in bone. The Food and Drug Administration's USRDA (Recommended Daily Allowance) for Vitamin D is 400 international units (IU). One glass of milk contains 100 IU. Your doctor may recommend an increase in your intake of Vitamin D after menopause. Because elderly people may consume less Vitamin D and absorb calcium poorly, they should ask their doctor about increasing their daily intake of Vitamin D.
Exercise
Exercise to minimize bone loss. You should engage in weight-bearing exercises, such as walking (considered one of the best methods of maintaining bone strength), jogging, hiking, climbing stairs, dancing, aquatic exercises, treadmill exercises, and weight training. Consult your doctor before beginning any vigorous exercise program. Your doctor can evaluate your physical condition and help you decide which activity suits you best.
The National Institute of Aging recommends you begin exercising slowly, especially if you have been inactive. Start with short periods of about 5 to 10 minutes twice a week and build up slowly, adding a few minutes each week. You can build up to exercise periods of 15 to 30 minutes, three or four times a week.
Talk With Your Doctor
• Proper diagnosis and early treatment can help reduce the risks of osteoporosis. Consult your medical doctor because a treatment must be prescribed individually.
• Treatment plans should be initiated as early as possible because once bone is lost it is difficult to replace.
• Ask your physician about medication to prevent menopausal bone loss such as estrogen replacement therapy, calcitonin or other medications currently under development.
• Eliminate smoking and excessive alcohol use which cause bone loss and increase your risk for a fracture.
• Consult with your physician if you require medications regularly that can alter your balance or cause dizziness. Certain drugs, such as benzodiazepines, that are common treatments for anxiety or insomnia, may cause dizziness and falls.
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What can I do to my home to make it safer?
Most hip fractures occur as a result of a fall and most falls and injuries occur in the home. Many are preventable by recognizing the dangers and taking the necessary steps to minimize the risks of preventable falls from known home hazards. Here are some safety tips:
Stairways
• Provide enough light to see clearly each step and the top and bottom landings
• Repair loose stairway rugs or boards immediately • Do not leave objects on the stairs
• Do not use patterned or dark carpeting on stairs
• Install full-length handrails on both sides of the stairway Bathrooms
• Place a slip-resistant rug next to the bathtub for safe exit and entry • Place nonskid textured adhesive strips on the bathtub and shower floor • Install grab bars on the walls around the bathtub
• Keep the floor clear of clutter
• Place a lamp and flashlight near your bed
• Install a night-light along the route between the bedroom and the bathroom Living areas
• Arrange furniture to provide a clear pathway between rooms
• Remove low-rise tables, magazine racks, footrests, and plants from pathways • Keep electrical and telephone cords out of pathways
• Secure loose area rugs and runners with double-faced tape, tacks, or slip- resistant backing
• Do not stand on unsteady stools, chairs, ladders, etc. Kitchen
• Clean up spills, dropped food, etc., from floors immediately • Use nonskid floor wax
• Use step stools with an attached handrail Top of page
What research on broken hips is being done?
Hip fractures have a major impact on society, however, only a very small portion of medical research funds are devoted to improving our ability to prevent hip fractures. More research must be done by government agencies, private foundations, and orthopaedic scientists to shed new light on bone metabolism, treatment programs to prevent bone loss, and injury programs to prevent falls and fractures. Support for this research through increased private and public funding will be necessary to curb the coming epidemic of hip fractures in the decades ahead. For more information contact the Orthopaedic Research Education Foundation, 6300 N. River Rd. Rosemont, IL 60018 (847) 698-9980.
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AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist"program on this website.
Shoes: Finding the Right Fit Types of Shoes
Shoe Buying Recommendations How To Evaluate Shoe Quality Parts of a Shoe
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The average person will walk thousands of miles over a lifetime. Unfortunately, many of these miles will be walked in uncomfortable shoes that do not fit properly. Shoes that are too tight, too loose, or without enough support, can lead to unwanted stress on the feet, ankles, lower leg, hip, and spine. This ongoing pressure can cause pain and injuries that may limit or prevent participation in work, sports, and hobbies.
According to the National Ambulatory Medical Care Survey (NAMCS), nearly 7 million Americans visited a doctor for foot- and toe-related discomfort in 2009. Fortunately, many foot-related problems can be prevented with shoes that are appropriate for an individual's feet, body, and lifestyle.
Types of Shoes Children's Shoes
In the early infant stages, a baby needs only booties or socks for warmth and protection. As the infant grows and begins to walk upright, bare feet are appropriate
indoors as they allow the child to touch and feel the ground, developing proper sensory input; strengthen their intrinsic muscles (small, deep muscles of the foot); and develop their arches. To prevent injury, shoes should be worn outside of the house at all times.
When purchasing your child's first shoes:
• Consider a store that specializes in shoes for growing feet. In the early years, a child's foot may be wide through the arch, so proper fitting in the width is important.
• A sneaker or soft soled shoe is a good choice. A typical, low-cut sneaker allows the child to develop the ligaments and muscles around the ankle that are necessary for developing good balance and stabilization.
• The toe box should be roomy and wide enough for the toes to wiggle. A finger's breadth of extra length will usually allow for about 3-to-6 months of growth, depending on the child's age and growth rate.
Your child's foot may grow faster than you expect at different ages and stages, so it is important to check the fit of your child's shoes regularly. If the shoes become difficult to place on the foot, and/or the child consistently wants their shoes off, it may mean that the shoes have become too small.
Women's Shoes
Over time, wearing high heels with a narrow toe box can cause the foot to take the shape of the shoe and result in deformities like hammer toes and corns.
There are a variety of women's shoes on the market ranging from comfortable, casual everyday shoes, to more formal shoes with four-inch heels. An ideal choice is a shoe that has a square or wide toe box, with a heel that is lower than two inches high.
Higher heeled, pointed shoes can cause bunions, knee pain, and lower back pain. In addition, high-heeled shoes place tremendous pressure on the fat pad under the ball of the foot (forefoot). The higher the heel, the greater the pressure and the likelihood for injury. If a high-heeled shoe has a pointed toe, it creates even more pressure in the forefoot.
If you prefer to wear higher heels, look for shoes with a platform under the toe box, which will decrease the overall stress on the foot. If you are purchasing a lower- heeled shoe, make sure that the heel is secure and that there is ample room in the toe box. Ballerina flats should have elastic along the top sides of the shoe so that they grip onto your foot better.
Men's Shoes
In general, men's shoes are constructed to conform to the shape of the foot. Leather soled shoes are more durable and stable. If you regularly walk long distances, a softer soled shoe may be more comfortable.
Sandals
While popular in warm weather, sandals generally do not offer much foot support and stability. For example, a "flip flop" sandal puts stress on the toes because toes must grip the shoe to keep it on the foot while walking.
If you do purchase a sandal, choose one that has one or more straps to secure