Orthopedic Services



Specializing Institutions

Orthopedics is the study of the musculoskeletal system. Orthopedists specialize in the diagnosis and treatment of problems with bones, joints, ligaments, tendons, muscles and nerves. There are a lot of professions that offer non-surgical treatment alternatives for many orthopedic conditions, such as chiropractic, podiatry and occupational therapy. The most common conditions in orthopedics are musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors and congenital disorders. Currently, more than one in four Americans suffer from a musculoskeletal impairment, with back and knee being the most prevalent.

Patients looking for excellence and innovation in orthopedic procedures will find it at the South Texas Medical Center. Some of our institutions have nationally recognized orthopedic care services, Joint Replacement Clubs and support groups, pediatric and geriatric orthopedics, and rehabilitation. Procedures available to patients at the South Texas Medical Center include total knee and hip replacement, shoulder care, spine surgery, orthopedic trauma care and orthopedic rehabilitation.

Some of the best orthopedic physicians and specialists in south central Texas work and research at the South Texas Medical Center to bring patients the best and latest in sports medicine, cartilage restoration, orthopedic reconstruction, joint replacement and advanced spine procedures. Specialists are also available to help patients recover after surgery through a friendly rehabilitation process. The South Texas Medical Center is also home to the Acute Rehabilitation Center, which is accredited by The Joint Commission and The Commission on Accreditation of Rehabilitation Facilities, to assist patients during every step of the rehabilitation process.

Orthopedic Articles

  • Brain study hints at how fibromyalgia works

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Brain scans show that people with the pain disorder fibromyalgia react differently to what others would consider non-painful sights and sounds, new research suggests.

    The small new study provides clues to what might be going wrong in the nervous system of people with fibromyalgia, along with possible new approaches to alleviating their pain.

    "If we understand the mechanism, we may come up with new and potentially better forms of treatment," said lead author Marina López-Solà of the department of Psychology and Neuroscience at the University of Colorado, Boulder.

    Fibromyalgia, which patients experience as widespread muscle pain and fatigue, affects as many as five million Americans, most commonly middle-aged women, according to the U.S. Department of Health and Human Services.

    Its cause is unknown and there is no cure, but medications can treat the symptoms.

    The new results suggest not only that fibromyalgia is related to greater processing of pain-related signals, but also potentially to a misprocessing of other types of non-painful sensory signals that may be important to address during treatment, Lopez-Sola told Reuters Health by email.

    She and her team used "functional magnetic resonance imaging," which measures blood flow changes in the brain, to assess brain responses among 35 women with fibromyalgia and 25 similar women without the disorder.

    The fibromyalgia patients were more sensitive to non-painful stimulation compared to people without the disorder, they report in Arthritis and Rheumatism.

    Researchers showed the subjects some colors, played some tones and asked subjects to perform very simple motor tasks at the same time, like touching the tip of the right thumb with another finger.

    Areas of the brain's cortex primarily responsible for processing visual, auditory and motor signals were significantly activated in the healthy comparison group, but not in the fibromyalgia group.

    However, other brain regions that are not relevant for primary processing were activated in fibromyalgia sufferers but not in healthy controls.

    What seems to be happening is that the brains of fibromyalgia patients are under-processing certain forms of sensory information at the first stages of processing, but are also amplifying the signal at a later level of sensory integration of multiple sensory inputs, Lopez-Sola said.

    "When you are in pain, it is probable that you are more concentrated on your own pain than on the tasks you have to pay attention to," said Dr. Pedro Montoya of the Research Institute on Health Sciences at the Universitat Illes Balears in Palma de Mallorca, Spain, who was not part of the new study.

    "For me, these findings provide further support for the idea that psychological strategies aimed at changing the focus of attention from the body to external cues could be useful for these patients," Montoya said.

    There were only a small number of people involved in the study, and the researchers did not account for other mental health conditions the participants may have had, both factors that limit the results, said Dr. Winfried Hauser, associate professor of Psychosomatic Medicine at Technische Universitat Munchen in Germany.

    People with fibromyalgia often also have conditions like depression, so some people believe the disorder has a mental basis, said Michael E. Geisser, professor in the department of physical medicine and rehabilitation at the University of Michigan in Ann Arbor.

    But evidence for a neuro-anatomical basis for fibromyalgia is growing, said Geisser, who was not part of the new study.

    "There is increasing evidence that fibromyalgia is not just a pain condition," he told Reuters Health by email. "More recent research done on persons with fibromyalgia, such as the research by Lopez-Sola and colleagues, suggests that persons with fibromyalgia suffer from a central processing deficit of multiple types of sensory stimuli, not just pain."

    "It's as if the volume control for sensation in persons with fibromyalgia is turned up, or louder, for many types of sensation compared to persons without the disorder," he said.

    That might help explain why many people with fibromyalgia also often suffer from fatigue, cognitive problems or mood disturbance, Geisser said.

    Currently, people with the disorder can take anticonvulsant medications, such as pregabalin (Lyrica), and antidepressants such as duloxetine (Cymbalta) and milnacipran (Savella), which have been FDA approved for treating fibromyalgia.

    Further research to improve understanding of where there are problems in the brain for people with the disorder could lead to the development of new treatments, Geisser said.

    For example, it would be interesting to see if a treatment targeted at dampening response in an area of the brain that "overreacted" in this study helped to treat fibromyalgia symptoms, he said.

    SOURCE: http://bit.ly/1mbOikg Arthritis and Rheumatism, online September 15, 2014.

  • REFILE-Falls indoors may signal frailty, linked to shorter survival

    (corrects third paragraph to say study was led by Bailly)

    By Shereen Lehman

    NEW YORK (Reuters Health) - Women in their eighties who fell indoors, rather than outdoors or from a height like a ladder, died sooner than their peers, a new French study finds.

    Indoor falls could be an indicator of frailty and a sign that protective measures should be taken, say the authors.

    The study was led by Sebastien Bailly, a researcher with Hospices Civils de Lyon in France. He and his coauthors write in the journal Maturitas, "The mean survival time of women with inside falls was nearly 1.6 years shorter than that of women with other falling profiles."

    Bailly and his colleagues studied 4,574 women who were over the age of 74 when they joined the study, could walk by themselves and were not living in institutional settings.

    The researchers called the women every four months for the first four years of the study to find out if they had fallen at some time during the previous week and where.

    The study team distinguished among falls by their location, whether they were due to inattention or to an environmental obstacle, and how serious the resulting injuries were.

    Along these lines, they classified the falls as environmental falls, such as slipping or tripping on something outdoors, falls from a height like a ladder or stairs, and inside or outside falls in general.

    Looking at information on 329 women who had fallen the week before the phone call follow-ups, the researchers found that 26 percent were so-called environmental falls, 19 percent were outside falls, 43 percent were inside falls and 12 percent were falls from height.

    The study team followed up again after another 13 years and found that 269 women had died. And those who had fallen indoors had an average survival time of 7.6 years, compared with 9.2 years for women who had any other type of fall.

    Separate from the type of falls women had, the researchers also found that women with advanced age, signs of frailty, slow walking speeds and comorbidities - that is, other health conditions - also had shorter survival times.

    However, women with frailties, for example, "who experienced outside falls or falls from height had no increased mortality despite more serious injuries," the researchers note.

    "Among community-dwelling women, some fall more frequently than others," the study team concludes. "These women should draw the caregivers' attention because their falls may be indicators of frailty. Non-injurious falls are also of concern because women experiencing this type of fall may suffer from unfavourable underlying conditions and be at risk of short survival."

    "The study is very well done," Dr. Kathleen Walsh told Reuters Health. "It has been shown in prior studies that for indoor falls the mortality tends to be worse, and longevity is diminished," said Walsh, who was not involved in the French research.

    Walsh, a geriatric and emergency medicine specialist at the University of Wisconsin Hospital in Madison, said there are different reasons that people fall inside and one of the questions that would be have been interesting to ask was how much time the patients were spending indoors or outdoors.

    "In general, people who fall inside have to stay inside for a reason and that's because of comorbidities - they're not super active and may not be active for different reasons," she said.

    But, Walsh said, family members shouldn't panic and tell their elderly loved ones that they need to move into assisted living after they've had a fall.

    "Because if you panic without having things evaluated by the physician that person will probably not tell you again when they have fallen," she said. "Staying calm is the number one thing."

    Walsh also said that physicians should ask their elderly patients if they have fallen within the previous year. If they have fallen, the doctors should find out what the patient remembers about the fall and if it was caused by certain movements, or if the patient could get up after the fall.

    "The red flags are, did they pass out before they fell," she said. "It's all in the history, if you take a good history you can usually figure things out."

    Walsh said that family members help to prevent falls by doing things like removing rugs and putting bars in bathrooms. In addition, she suggests elderly patients take classes to improve their balance and strength, such as the Stepping On class (http://www.steppingon.com).

    "Stepping is usually held at a local hospital or senior center and it's all about things that you can do while you're washing dishes or doing odds and ends around the house so you don't have to go to the physical therapist," she said.

    SOURCE: http://bit.ly/1oHXLKv Maturitas, online August 4, 2014.

  • REFILE-Falls indoors may signal frailty, linked to shorter survival

    (corrects third paragraph to say study was led by Bailly)

    By Shereen Lehman

    NEW YORK (Reuters Health) - Women in their eighties who fell indoors, rather than outdoors or from a height like a ladder, died sooner than their peers, a new French study finds.

    Indoor falls could be an indicator of frailty and a sign that protective measures should be taken, say the authors.

    The study was led by Sebastien Bailly, a researcher with Hospices Civils de Lyon in France. He and his coauthors write in the journal Maturitas, "The mean survival time of women with inside falls was nearly 1.6 years shorter than that of women with other falling profiles."

    Bailly and his colleagues studied 4,574 women who were over the age of 74 when they joined the study, could walk by themselves and were not living in institutional settings.

    The researchers called the women every four months for the first four years of the study to find out if they had fallen at some time during the previous week and where.

    The study team distinguished among falls by their location, whether they were due to inattention or to an environmental obstacle, and how serious the resulting injuries were.

    Along these lines, they classified the falls as environmental falls, such as slipping or tripping on something outdoors, falls from a height like a ladder or stairs, and inside or outside falls in general.

    Looking at information on 329 women who had fallen the week before the phone call follow-ups, the researchers found that 26 percent were so-called environmental falls, 19 percent were outside falls, 43 percent were inside falls and 12 percent were falls from height.

    The study team followed up again after another 13 years and found that 269 women had died. And those who had fallen indoors had an average survival time of 7.6 years, compared with 9.2 years for women who had any other type of fall.

    Separate from the type of falls women had, the researchers also found that women with advanced age, signs of frailty, slow walking speeds and comorbidities - that is, other health conditions - also had shorter survival times.

    However, women with frailties, for example, "who experienced outside falls or falls from height had no increased mortality despite more serious injuries," the researchers note.

    "Among community-dwelling women, some fall more frequently than others," the study team concludes. "These women should draw the caregivers' attention because their falls may be indicators of frailty. Non-injurious falls are also of concern because women experiencing this type of fall may suffer from unfavourable underlying conditions and be at risk of short survival."

    "The study is very well done," Dr. Kathleen Walsh told Reuters Health. "It has been shown in prior studies that for indoor falls the mortality tends to be worse, and longevity is diminished," said Walsh, who was not involved in the French research.

    Walsh, a geriatric and emergency medicine specialist at the University of Wisconsin Hospital in Madison, said there are different reasons that people fall inside and one of the questions that would be have been interesting to ask was how much time the patients were spending indoors or outdoors.

    "In general, people who fall inside have to stay inside for a reason and that's because of comorbidities - they're not super active and may not be active for different reasons," she said.

    But, Walsh said, family members shouldn't panic and tell their elderly loved ones that they need to move into assisted living after they've had a fall.

    "Because if you panic without having things evaluated by the physician that person will probably not tell you again when they have fallen," she said. "Staying calm is the number one thing."

    Walsh also said that physicians should ask their elderly patients if they have fallen within the previous year. If they have fallen, the doctors should find out what the patient remembers about the fall and if it was caused by certain movements, or if the patient could get up after the fall.

    "The red flags are, did they pass out before they fell," she said. "It's all in the history, if you take a good history you can usually figure things out."

    Walsh said that family members help to prevent falls by doing things like removing rugs and putting bars in bathrooms. In addition, she suggests elderly patients take classes to improve their balance and strength, such as the Stepping On class (http://www.steppingon.com).

    "Stepping is usually held at a local hospital or senior center and it's all about things that you can do while you're washing dishes or doing odds and ends around the house so you don't have to go to the physical therapist," she said.

    SOURCE: http://bit.ly/1oHXLKv Maturitas, online August 4, 2014.

  • Salt and smoking may interact to raise RA risk

    By Shereen Lehman

    NEW YORK (Reuters Health) - Eating a diet high in salt may increase the risk of rheumatoid arthritis among smokers, according to a large study from Sweden.

    Researchers set out to see if a salty diet might be linked to the onset of RA, but found a connection only among smokers - who were more than twice as likely as anyone with a low-salt diet to develop the condition.

    "Although we could not confirm our original hypothesis, we were surprised by the large influence of sodium intake on smoking as a risk factor," Björn Sundström told Reuters Health in an email.

    "Smoking is a strong risk factor for developing rheumatoid arthritis, and this risk is further amplified by less than ideal food habits with high sodium intake," said Sundström, a researcher in the departments of public health and clinical medicine at Umea University who led the new study.

    Rheumatoid arthritis is a chronic disease that causes pain and swelling in the joints. About 1.5 million Americans, three-quarters of them women, have been diagnosed with the condition, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

    The cause of rheumatoid arthritis isn't known, but it results from a person's own immune system attacking joint tissues. Genetics and lifestyle factors, such as smoking, hormone and cholesterol levels and obesity, have all been identified as risk factors.

    Previous laboratory research on animals and human cells also suggests sodium may provoke inflammatory molecules that are often elevated in people several years before RA appears, the authors write in the journal Rheumatology.

    To see if there is a link between sodium in the diet and risk for developing RA, Sundström and colleagues looked at health records and lifestyle information for almost 100,000 participants in a screening and intervention program that began in 1991 in Vasterbotton County in northern Sweden.

    The study team identified 386 cases of people who developed rheumatoid arthritis by 2011. Then for each case, they identified five participants who were similar in age and sex, but did not develop disease, for comparison.

    The researchers accounted for dietary habits, education, cholesterol and triglyceride levels, weight and other factors for all the participants and found no significant associations between sodium in the diet and who went on to develop RA.

    But when they looked just at smokers, they found those who consumed the most sodium were 2.26 times as likely as smokers who consumed the least sodium to develop RA.

    Smokers who consumed the least sodium had similar risk to nonsmokers in the study, leading the researchers to conclude that smoking and heavy sodium intake interact somehow to promote RA.

    "Ideally, these results needs to be repeated in an independent population," Sundström, said.

    More research is also needed to identify the biological pathways through which sodium intake can affect smoking as a risk factor, he said.

    "The study provides the first evidence in rheumatoid arthritis that sodium intake may influence risk for onset of the disease," Dr. Lars Klareskog told Reuters Health in an email.

    Klareskog, a rheumatologist and researcher at the Karolinska Institute and Karolinska University Hospital in Stockholm, was not involved in the study.

    "In addition, the study demonstrates that the impact of high salt diet is restricted to individuals who smoke," he said.

    Klareskog noted that smoking is an important risk factor for rheumatoid arthritis.

    "The contribution of smoking to risk for rheumatoid arthritis overall is such that 25 percent of all rheumatoid arthritis in our country, Sweden, would not have happened without smoking," he said. One third of all cases with the more severe form of rheumatoid arthritis would not have happened without smoking, he added.

    The present study suggests that reducing salt intake may be added to this list of lifestyle advice for avoiding rheumatoid arthritis, Klareskog said.

    "Confirmatory studies are, however, needed before recommendations on salt intake can be made to the public as ways to protect against getting rheumatoid arthritis," he said.

    SOURCE: http://bit.ly/1piaEeE Rheumatology, online September 10, 2014.

  • Chiropractic care may ease back-related leg pain

    By Shereen Lehman

    NEW YORK (Reuters Health) - People with leg pain related to back problems had more short-term relief if they received chiropractic care along with exercise and advice, rather than exercise and advice alone, a new study has found.

    Patients with back-related leg pain, such as sciatica, are usually treated with prescription medications, injections and surgery.

    Increasingly, spinal manipulative therapy by chiropractors, exercise and self-management are being recommended as low-risk strategies for back-related leg pain, but good research studies have been lacking, experts say.

    "Spinal manipulation combined with home exercise may be worth trying for those with back-related leg pain that has lasted more than four weeks," Gert Bronfort told Reuters Health in an email.

    Bronfort, who led the study, is a researcher with the Integrative Health and Wellbeing Research Program at the University of Minnesota in Minneapolis.

    "This combination resulted in advantages in pain reduction, disability, global improvement, satisfaction, medication use and general physical health status after 12 weeks," he said.

    Nine months after the treatment ended, patients who received chiropractic therapy were still doing better than the other group in terms of global improvement, medication use and satisfaction, he added.

    Bronfort said that about four out of five people will develop low back pain during their lifetime, and up to 40 percent of them will develop back-related leg pain.

    As reported in Annals of Internal Medicine, Bronfort and colleagues enrolled 192 adults with back pain that had been radiating into the leg for at least four weeks. Patients were recruited through newspaper advertisements, direct mail, and community posters.

    Half the patients received instructions for specific exercises to do at home plus simple pain management techniques. In addition, during the first 12 weeks, they visited a chiropractor up to 20 times for 10 to 20 minutes of spinal manipulation at each visit.

    Patients in the other group also received the instructions for exercises and pain management techniques. They too met with a chiropractor, exercise therapist, or personal trainer during the first 12 weeks, but for four one-hour sessions without spinal manipulation.

    The patients were asked to rate their pain at the beginning of the study, after the 12 weeks of treatments and again at the end of the year.

    At 12 weeks, 37 percent of the spinal manipulation group felt their pain was reduced by at least three-quarters, compared to 19 percent of those who received exercise and advice only.

    In addition, the patients who had spinal manipulation had higher scores for overall improvement and satisfaction.

    By the one-year follow-up, the no-manipulation group had caught up, and there was no longer a significant difference in pain relief. But the scores for overall improvement and satisfaction remained higher for the patients who received spinal manipulative therapy.

    "We actually find the outcomes of the home exercise alone group to be very interesting," Bronfort said.

    Almost half of these patients experienced a 50 percent reduction in leg pain symptoms in both the short (at 12 weeks) and long term (at 52 weeks), Bronfort said.

    "That's an important improvement and warrants future research," he said, "We look forward to investigating how home exercise alone may compare to usual medical treatment and/or no treatment at all."

    "This is a well-conducted study by a group of well-respected chiropractic researchers," Sidney Rubinstein told Reuters Health in an email.

    Rubinstein is a researcher with the Department of Health Sciences at the University of Amsterdam in The Netherlands. He wasn't involved in the study, but has recently published a paper analyzing previous studies on spinal manipulative therapy.

    "It is perhaps the only study of good methodological quality using a robust sample of patients which examines the additional benefit of spinal manipulative therapy in those with sub-acute or chronic back-related leg pain," Rubinstein said.

    Rubinstein said it would be necessary to conduct an economic evaluation to determine if the use of spinal manipulative therapy in addition to home exercises is worth the cost.

    "This of course, must be considered in light of alternatives for this condition, such as epidural steroid injections or surgery, which are not only much more costly but also associated with important (and serious) adverse events," he said.

    Bronfort said his team feels that as long as there are no serious medical complications, patients can focus on self-management strategies.

    "Try and keep moving . . . simple activities like taking short walks and changing positions frequently (both advised in the home exercise program) may be helpful," he said.

    But, he added, for people who have pain that is too severe for to deal with on their own, seeing a chiropractor, physical therapist, or osteopath who can use spinal manipulation might help relieve their pain - possibly without the use of medications.

    SOURCE: http://bit.ly/1s3PM2z Annals of Internal Medicine, online September 15, 2014.