University Health System
4502 Medical Drive, San Antonio, TX 78229
210.358.4000 | www.universityhealthsystem.com
St. Luke’s Baptist Hospital
7930 Floyd Curl Dr., San Antonio, TX 78229
210.297.5000 | www.baptisthealthsystem.com
CHRISTUS Santa Rosa Hospital
2827 Babcock Rd. , San Antonio, TX 78229
210.705.6300 | www.christussantarosa.org
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.
"Wandering eye" may raise risk of falls for older adults
By Shereen Lehman
(Reuters Health) - Older people with strabismus, where one eye points slightly inward or outward affecting vision, are about 27 percent more likely than people without the condition to be injured by a fall, according to a new study.
The disorder, often called "wandering eye," becomes more common with age and can cause double vision or depth perception problems because the two eyes are not pointing in the same direction.
Previous studies have shown that having other eye disorders like cataracts, glaucoma or age-related macular degeneration increases the risk of injuries, fractures or falls, the study team writes in JAMA Opthalmology. But this is the first to examine whether so-called binocular vision problems have the same effect.
"Strabismus in adults is becoming more prevalent as the aging population increases and we do not know the impact of strabismus on patient quality of life and morbidity," lead author Dr. Stacy Pineles told Reuters Health in an email.
"We hypothesized that strabismus could cause double vision or diminished depth perception, and we wanted to see whether this was associated with injuries such as falls, fractures, and musculoskeletal injuries," said Pineles, an ophthalmologist with the Jules Stein Eye Institute at the University of California, Los Angeles.
Pineles and her colleagues looked at a random sample of Medicare claims for more than two million beneficiaries over the years 2002 to 2011.
They found almost 100,000 diagnoses of binocular vision problems. The great majority were either strabismus or diplopia, meaning double vision, which often goes along with strabismus. On average the patients were older, white, were more often male and had other health problems like diabetes and heart disease.
About 75 percent of those with binocular vision problems had also reported some type of musculoskeletal injury, fall or fracture during that 10-year time span, compared to about 60 percent of patients without a binocular visual disorder.
After taking into consideration age, region and other potential contributors to falling, such as other illnesses, the researchers calculated that people with binocular vision disorders had a 27 percent higher risk of falls, fractures and injuries overall.
For people with a specific diagnosis of diplopia, the risk was 36 percent higher.
The study team cautions that they don't know if the injuries occurred before the vision problems were diagnosed or afterward, so they can't say for certain that the eye disorders are to blame for the falls. They also don't know which patients were being treated for their vision problems.
Still, Pineles said that elderly patients with vision problems should be sure they optimize lighting in their homes, get help when navigating unfamiliar areas and use low-vision aids if necessary.
Dr. Jamie Rosenberg, an ophthalmologist at Montefiore Medical Center in New York who specializes in strabismus, said that eye problems can sometimes seem less important to elderly patients compared to other illnesses they may have. But "they can affect their life in a significant way and keeping them safe from falls is a huge part of keeping older people healthy."
Rosenberg, who wasn't involved in the new study, said there are treatment options for strabismus, such as wearing special glasses with prisms that help align the double images seen by people with diplopia.
"Even though the eyes aren't straight the two images that are being processed by the brain will be one," she said.
Surgery may also be an option. "A lot of people think that older people can't have strabismus surgery to straighten their eyes but that's actually not true at all," Rosenberg said.
The new study may underestimate the magnitude of the problem, noted Priscilla Rogers, an aging and vision loss expert at the American Foundation for the Blind's Vision Aware program.
"Only people who seek medical care from a fall would be included, so the problem is probably bigger and greater than this study suggests," she told Reuters Health in an email.
Access to eye care may be one obstacle keeping older people from getting help for vision disorders, she noted. "Medicare does not pay for new glasses and people on a fixed income may not want to buy new glasses because they cost too much," Rogers said. "They can, after all, see - they just may not see well enough to avoid a trip or fall."
Rogers said that fall prevention programs such as "A Matter of Balance" offered in several states (http://bit.ly/1FZWPgF ) can help reduce the risk of injuries among people with visual impairments.
SOURCE: http://bit.ly/1wylK5I JAMA Ophthalmology, online October 23, 2014.
People with celiac disease more likely to fracture bones
By Katryn Doyle
(Reuters Health) - People diagnosed with celiac disease are almost twice as likely as those without it to break a bone, according to a new review of the evidence.
More studies are needed, though, to see if people whose celiac hasn't been diagnosed yet are at similar risk, researchers say.
About two million Americans have celiac disease - in which the immune system attacks the small intestine in response to gluten, a protein found in wheat, rye and barley - according to the National Institutes of Health.
For the new review, researchers from the University of Tampere and Seinäjoki Central Hospital in Finland, and the University of Nottingham in the UK analyzed 16 studies that compared the incidence of bone fractures among people with and without a celiac disease diagnosis.
In studies that looked at one point in time, people with celiac disease were almost twice as likely to have had a bone fracture in the past.
In studies that followed people over time, those who had a diagnosis of celiac disease at the start were about 30 percent more likely to suffer a bone fracture and 69 percent more likely to have a hip fracture than others, according to the analysis published in the Journal of Clinical Endocrinology and Metabolism.
There were only two studies of bone fractures among people with undiagnosed celiac disease - but whose blood tests showed celiac-specific antibodies - and it was not clear if there was a link to broken bones, the authors write.
Since the disease affects nutrient absorption in the small intestine, it could lead to poor absorption of vitamin D and calcium, or chronic intestinal inflammation could interfere with bone formation, they write.
Other possibilities to explain the connection to bone breaks include hormonal changes or a gluten-free diet, which is often low in minerals, they write.
Other studies have found that bone density tends to go down as symptoms become worse for people with celiac disease, according to Professor Julio C. Bai at the Hospital de Gastroenterologia Dr. Carlos Bonorio Udaondo in Buenos Aires, Argentina.
"Therefore and based on our findings, it seems reasonable to consider to evaluate bone density in those patients with symptomatic celiac disease," said Bai, who was not involved in the new study.
Symptoms can include abdominal bloating and pain, chronic diarrhea, constipation and weight loss.
Physical activity can help strengthen bones, he said.
"Some areas of bone are more vulnerable to the damage induced by celiac disease," said Dr. Peter H.R. Green, an expert on celiac disease at Columbia University in New York who wasn't involved in the new review. "This relates to the type of bone and its rate of turnover."
Everyone newly diagnosed with celiac disease is routinely given a bone density scan, as they should be, he told Reuters Health by email.
"We have shown that a gluten free diet together with replacement of calcium and vitamin D, when necessary, results in improvement in bone density," he said.
SOURCE: http://bit.ly/1yrO6yQ Journal of Clinical Endocrinology and Metabolism, online October 3, 2014.
Weak muscles can put diabetics at risk on stairs
By Janice Neumann
(Reuters Health) - When nerves in the legs and feet are damaged from diabetes, people often have trouble on stairs, but a new report suggests exercise might help lower their risk of falling.
People with so-called diabetic peripheral neuropathy go up and down stairs more slowly and clumsily than healthy people because of weak muscles, sensory damage (loss of feeling) and poor coordination, say the authors of the report.
Resistance exercises could help these individuals build up strength and avoid future falls, they wrote in the journal Diabetes Care.
For people with diabetic peripheral neuropathy, falls "whilst walking down stairs are nearly unrecoverable," and as a result, account for a large proportion of fall-related deaths, said Joseph C. Handsaker of Manchester Metropolitan University in Manchester, UK, who led the research.
"The aim of the study was to provide potential explanations for why patients with neuropathy are at a high risk of falling during the dangerous tasks of stair ascent and descent, in the hope that by identifying why falls occur, we can then suggest solutions for how to reduce the risk of falling," Handsaker told Reuters Health.
An estimated 347 million people worldwide have diabetes, according to the World Health Organization. About half of patients with diabetes develop peripheral neuropathy after 10 years, Handsaker said.
It's been known for a while that these patients have trouble on stairs, but the underlying reason hasn't been clear, Handsaker added.
He and his colleagues compared 21 patients with diabetic neuropathy, 21 who had only diabetes, and 21 healthy individuals as they walked up and down a custom-built staircase.
The researchers analyzed the electrical activity of participants' muscle tissue to determine when the muscles were "switched on and off" and when they reached peak activation.
Overall, the patients with diabetic peripheral neuropathy were significantly slower at activating their knee and ankle muscles than the healthy group, and significantly slower at reaching peak knee-muscle activation.
"The slower speed of strength generation is the key finding in this study, with alterations to muscle activation expected to contribute to the observed reductions," said Handsaker.
For diabetics with peripheral neuropathy who'd like to strengthen their muscles and reduce their risk of falling, Handsaker suggested using isometric exercises like calf raises and knee extensions. Individuals should rapidly stretch these muscles for a second and then relax for three seconds, he said.
His paper also advises that resistance training might be helpful, such as with weight machines, free weights or calisthenics.
(Before starting to exercise, however, patients should get clearance from their doctors. As the American College of Sports Medicine advises, "Not all exercise programs are suitable for everyone, and some programs may result in injury.")
Improving the strength and response of the extensor muscles will result in faster strength generation, which should improve stability during stair ascent and descent, said Handsaker.
Dr. Michael Polydefkis, who directs the Johns Hopkins Cutaneous Nerve Laboratory and the Bayview EMG Laboratory and Diabetic Neuropathy Center, said he was glad to see a study that emphasized the effect of diabetes on people's ability to move around.
He said people recognize the devastating effects of diseases like multiple sclerosis, Parkinson's and ALS but often don't realize how much diabetic neuropathy compromises quality of life.
"Oftentimes peripheral neuropathy is not always given its due respect," said Polydefkis in a phone interview. "People don't really appreciate the impact this has on people's lives."
Polydefkis, who was not involved in the study, said his patients typically complain of pain and numbness in their feet, rather than weakness. But the study showed that falls might be related to subtle muscle problems that aren't easy to detect. He often suggests balance exercises for his patients.
Dr. Peter Dyck, who directs the Peripheral Nerve Research Laboratory at the Mayo Clinic in Rochester, Minnesota, told Reuters Health in a phone interview that the study helps confirm some of the reasons for the unsteady gait of diabetics. But Dyck, who was not involved in the study, said he wasn't convinced that exercise would help these individuals because of their sensory loss.
"I think it's a worthwhile study, it was fun to read, but I'm not sure the take-home message is quite correct," said Dyck. "The emphasis needs to be on preventing polyneuropathy by good diabetic control."
SOURCE: http://bit.ly/1DBSe2g Diabetes Care, online October 14, 2014.
Ibuprofen good as morphine, and safer, for kids with fractures
By Kathryn Doyle
(Reuters Health) - The narcotic drug morphine is not the best choice for pain relief in kids with broken bones, a new study suggests.
Kids in the study took either morphine or ibuprofen by mouth. The morphine was associated with side effects like drowsiness, nausea and vomiting - but it wasn't any better than ibuprofen at relieving pain.
"Both ibuprofen and oral morphine provided pain relief but there were no significant differences between the two agents," said lead author Dr. Naveen Poonai, a pediatric emergency physician at the London Health Sciences Centre in Ontario.
"In our study, we found that drowsiness and nausea were the most common side effects but patients also reported dizziness and vomiting," Poonai told Reuters Health by email.
The study involved 134 children between ages five and 17 who arrived at the emergency department with a broken bone of the arm or leg that didn't require surgery.
Half of the kids were randomly assigned to receive oral morphine, dosed to 0.5 milligrams per kilogram of the child's weight, while the others received 10 mg/kg of ibuprofen, every six hours as needed for 24 hours after hospital discharge with a cast or sling. The medicines were not marked or labeled so the children and the parents did not know which painkiller they had received.
Doctors told parents to use acetaminophen if needed for breakthrough pain.
Patients received self-report pain measurement forms and were instructed to rate their pain on a scale of zero to five immediately before and 30 minutes after a painkiller dose.
Both morphine and ibuprofen lowered pain scores by an average of 1 to 1.5 points from before administration to 30 minutes after a dose, according to results in the Canadian Medical Association Journal.
The two groups did not differ in their overall pain reduction or in the use of acetaminophen for breakthrough pain.
More than half of the morphine group reported a side effect of the medicine, most often drowsiness, compared to 31 percent of the ibuprofen group.
In the morphine group, 18 patients reported nausea, compared to four in the ibuprofen group.
Ibuprofen is a safe and effective choice for managing bone fracture pain for kids, the authors write.
"Ibuprofen is the safer choice for the simple reason that we have a lot more experience with it in children and both health care workers and parents know what to expect when it is given," Poonai said.
"There is very little pediatric acute pain research done in the 'at-home' setting where these analgesics are actually used," said Amy L. Drendel, an associate professor of Pediatric Emergency Medicine at the Medical College of Wisconsin in Milwaukee. "This provides real-life data about how these medications work in the outpatient setting."
Drendel was not involved in the new study.
"Many variables go into the decisions doctors make about pain management for children," she told Reuters Health by email. "I always recommend that parents talk with their doctor about their child's treatment to make sure their child receives the best care possible."
Although it is understandably a big fear for doctors and parents, there is no evidence that children are at risk of opioid dependence to the same degree as adults, Poonai said.
"Pain in the ER before a fracture is immobilized with a cast or splint is likely more severe than pain at home," he said. "But in our study we found that over 70 percent of children had pain severe enough to require pain medication after discharge."
"This tells us that nurses and doctors should be teaching parents to recognize and manage pain at home and likely offering a dose of ibuprofen at discharge," he said.
SOURCE: http://bit.ly/1xxCsBt Canadian Medical Association Journal, online October 27, 2014.