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

  • Extra-depth shoes may help alleviate foot pain for older people

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For adults over age 65 with disabling foot pain, being fitted for off-the-shelf extra-depth footwear reduced pain and improved function, according to a new study.

    This type of footwear is often marketed to people with diabetic foot ailments, for whom Medicare - the U.S. government health insurance program for people over 65 - will cover most of the cost of the shoes.

    The structure and function of the foot changes significantly with age regardless of diabetes status, said lead author Hylton B. Menz of the Lower Extremity and Gait Studies Program in the School of Allied Health at La Trobe University in Melbourne, Australia.

    "With advancing age, there is a general tendency for the foot to exhibit increased soft tissue stiffness, decreased range of motion, decreased strength, and a more pronated posture, and to function in a more pronated position with reduced range of motion and less efficient propulsion when walking," Menz told Reuters Health by email.

    A pronated foot has more weight on the inside edge of the foot, rather than evenly distributed, which can give the appearance of the ankles bending slightly toward each other.

    In addition, many older people wear ill-fitting shoes that don't accommodate the changed shape of their feet, he said.

    He and his coauthors had 120 men and women over age 65 with disabling foot pain answer a Foot Health Status Questionnaire and then divided them into two groups.

    Those in the first group were individually fitted for extra-depth shoes, while those in the second group waited until the end of the study four months later to receive their shoes. Everyone continued to receive regular podiatry care.

    Dr. Comfort, Orthofeet and Apis brand extra-depth shoes like those used in the study are available from online retailers in the U.S. for between $100 and $200 per pair.

    The extra-depth footwear group were more likely to report their foot pain had moderately or markedly improved over the four month period and developed fewer keratotic lesions, like corns or calluses, than the comparison group.

    Corns and calluses are common for older people; treating them accounts for up to 75 percent of a podiatrist's workload, Menz said.

    When the participants took the foot health questionnaire again, the special footwear group scored 11 points better for pain and 10 points better for function than the comparison group, according to the results in the Journal of Gerontology: Medical Sciences.

    Patients considered that a worthwhile improvement, Menz said. And, surprisingly, it didn't matter what the underlying cause of the foot pain was: extra-depth shoes seemed to help everyone who wore them.

    "Many older people wear ill-fitting shoes, and we know that ill-fitting shoes are associated with foot problems," he said.

    Regular footwear is generally too shallow and narrow to accommodate bunions, hammertoes and clawtoes, so the friction that develops within the shoe leads to pain and reduced function, he said.

    "Well-fitting footwear will prevent shoes pressing or rubbing against the sensitive areas of the foot including joints that have become arthritic," said Professor Wesley Vernon, head of Podiatry Services and Research Lead at Jordanthorpe Health Centre in Sheffield, UK, who was not part of the new study.

    Many patients may be reluctant to switch to "medical" footwear because of its appearance, the experts noted.

    "Some research has shown that people, particularly women, don't like the look of this extra deep and extra wide footwear and this is not age dependent," said Anita Williams, senior lecturer in the School of Health Sciences at the University of Salford in the UK.

    In her experience, many women prefer to wear pumps, she told Reuters Health by email.

    Aside from trying new shoes, maintaining a healthy body mass index may help alleviate or prevent foot pain, Menz said.

    "It is also important that older people with foot pain consult a podiatrist, particularly if they have diabetes or changing footwear does not alleviate symptoms," he said.

    SOURCE: http://bit.ly/1mUS1CV Journal of Gerontology: Medical Sciences, online September 9, 2014.

  • Young baseball pitchers at risk for shoulder damage

    By Shereen Lehman

    NEW YORK (Reuters Health) - Teenaged baseball players who throw more than 100 pitches per week are at heightened risk of an injury that could permanently mar normal shoulder development, says a new study.

    The injury, dubbed "acromial apophysiolysis" by the authors, is characterized by incomplete fusion of the bones that form the top portion of the shoulder joint, the acromion, and local swelling and fluid (edema).

    "Over the years," said lead author Dr. Johannes Roedl, the study team had noticed young baseball players "who came in at the end of the season with shoulder pain, but with MRI imaging on which we really didn't see anything besides the abnormality, that edema at the acromion."

    Roedl, a radiologist in the musculoskeletal division at Thomas Jefferson University Hospital in Philadelphia, said that neither the radiologists nor orthopedic surgeons knew if these abnormalities were clinically relevant, but they knew something was going on, so they decided to take a closer look at all the cases they had seen.

    "We looked at all the clinical data that we had from the orthopedic surgery department," Roedl said. "In terms of how did the patients present, where was the pain, and of course, their history in terms of sports - what kind of sports did those patients play?"

    He said they were surprised at how many patients appeared to have the condition.

    "I mean it's still a relatively rare condition - only about 2.5 percent of patients at the age range between 15 and 25 who come in with shoulder pain have that acromial apophysiolysis," he said.

    Roedl said it is most likely an overuse injury from too much pitching because most of the patients who had it were "really avid pitchers - the majority pitched more than one hundred pitches per week."

    He and his colleagues reviewed medical records for more than 2,000 patients, both male and female, between the ages of 15 and 25 who had MRIs for shoulder pain between 1998 and 2012. Most of the patients were pitchers.

    A total of 61 patients had pain at the top of the shoulder and incomplete fusion of the acromion but no other radiological findings. The study team compared them to a control group of 61 similar patients who had other identifiable causes for their shoulder pain.

    The researchers found that 40 percent of the patients with acromial apophysiolysis threw more than 100 pitches per week compared to 8 percent of the control group, they report in the journal Radiology.

    One patient underwent surgery and all of the patients rested their pitching arms for three months and took nonsteroidal anti-inflammatory (NSAID) medications.

    The research team was also able to review follow-up images, either MRIs or X-rays, for 52 participants after they were 25 years old, the age when bone development would be complete. The average age at follow-up was 27 and a half, and the average interval since the original images was eight years.

    Of the 29 patients with apophysiolysis as teens, 25 showed incomplete bone fusion at the acromion at follow-up, compared to only one out of the 23 controls.

    Torn rotator cuff muscles were also more common - and worse - in the adult patients who had apophysiolysis than in the control group.

    "You can imagine if the bone in the shoulder doesn't fuse it's kind of unstable," Roedl said. "This is not a medical term, but it's essentially 'floating' and doesn't really have a fixed point."

    Roedl said that when a bone floats around it can press on tendons and those tendons can rupture or tear.

    "And that's what we saw in those patients - that they more often had tendon tears of the rotator cuff . . . so it actually had a long-term effect on those patients," he said.

    "Overall, I think it's a great radiology study. The authors describe the presentation of a new condition in a fairly large sample of patients that had previously not been done in that capacity," Kyle Aune told Reuters Health in an email.

    Aune is a clinical researcher with the American Sports Medicine Institute in Birmingham, Alabama. He wasn't involved in the study.

    But, Aune isn't yet convinced the condition is the sole cause of rotator cuff tears.

    "While possible, it is likely that these rotator cuff injuries would be due to a combination of factors including general overuse and impingement from biomechanical flaws within a pitcher's throwing mechanics," he said.

    Aune also wasn't sure that female softball pitchers should have been grouped with male baseball pitchers since the throwing motions are quite different.

    "The majority of the girls in the study played softball - it's a different pitching style, but they still have an over the head movement, and that's probably what causes the problem," Roedl said.

    Roedl added that in the future, they want to look closely at other sports to see if it's really just confined to pitching or if it's found in other athletes who use overhead motions, such as tennis, lacrosse or swimming.

    As for prevention, he said that not overdoing the same pitching motion over and over is the key.

    "It's important to pitch less than 100 pitches per week when you're young," Roedl said. "Take the off-season off, take a break of two or three months," he said.

    SOURCE: http://bit.ly/1uhaPcZ Radiology, online October 14, 2014.