What is the rotator cuff in the shoulder?The rotator cuff is a group of flat tendons which fuse together and surround the front, back, and top of the shoulder joint like a cuff on a shirt sleeve. These tendons are connected individually to short, but very important, muscles that originate from the scapula. When the muscles contract, they pull on the rotator cuff tendon, causing the shoulder to rotate upward, inward, or outward, hence the name “rotator cuff.”
What is impingement syndrome?The uppermost tendon of the rotator cuff, the supraspinatus tendon, passes beneath the bone on the top of the shoulder, called the acromion. In some people, the space between the undersurface of the acromion and the top of the humeral head is quite narrow. The rotator cuff tendon and the adherent bursa, or lubricating tissue, can therefore be pinched when the arm is raised into a forward position. With repetitive impingement, the tendons and bursa can become inflamed and swollen and cause the painful situation known as “chronic impingement syndrome.”
How does impingement syndrome relate to rotator cuff disease?When the rotator cuff tendon and its overlying bursa become inflamed and swollen with impingement syndrome, the tendon may begin to break down near its attachment on the humerus bone. With continued impingement, the tendon is progressively damaged, and finally, may tear completely away from the bone.
Why do some people develop impingement and rotator cuff disease while others do not?There are many factors that may predispose one person to impingement and rotator cuff problems. The most common is the shape and thickness of the acromion (the bone forming the roof of the shoulder). If the acromion has a bone spur on the front edge, it is more likely to impinge on the rotator cuff when the arm is elevated forward. Activities which involve forward elevation of the arm may put an individual at higher risk for rotator cuff injury. Sometimes, the muscles of the shoulder may become imbalanced by injury or atrophy, and imbalance can cause the shoulder to move forward with certain activities which again may cause impingement.
What is Pediatric Orthopedics?Pediatric Orthopedics is the study and treatment of growing bones, joints and muscles. Pediatric Orthopedists use many techniques, including observation of growth, physical therapy, braces and splints, and occasionally surgery to treat various conditions such as congenital deformities, injuries, neurological disorders, and scoliosis. These conditions are discussed in general below, with links being added to more specific information as time goes by.
Variations of normal anatomy and congenital deformities
Frequently, young children and adolescents have conditions that are variations of normal anatomy. These include children who toe–in or toe–out excessively, children with “Bad posture” such as round–back or sway–back, and children who are delayed in learning to walk or have unusual patterns of walking such as “Toe walking”. Often these problems are variations of normal developmental patterns and do not represent an underlying disease. In such cases, the child’s growth and patterns of walking, posture, and muscular development need to be observed over time in order to establish whether the child’s growth pattern will return to normal spontaneously. A small percentage of children have birth defects. These include spinal problems such as spina bifida, limb deformities such as clubfoot, or other congenital defects such as extra fingers or toes. Pediatric Orthopedists frequently follow these children through years of growth and into adult life.
Children often break bones. With these fractures there is often a potential injury to the growth centers of the skeleton. Pediatric orthopedists evaluate the child for potential growth problems that may happen after the injury heals and treat growth disturbance if it occurs. Appropriate treatment of fractures, sprains and dislocations can ensure minimal disturbance of function and a quick return to normal childhood growth and activity.
Pediatric sports injuries
Pediatric Sports Medicine is an important part of health care. Children who engage in activities like soccer, karate, and skateboarding may have acute injuries such as broken bones, sprains, and dislocations. Many times chronic stress injuries occur, such as fractures, tendinitis, and apophysitis. Examples are Little Leaguer’s Elbow, Osgood–Schlatter’s disease of the knee, and Sever’s Disease of the foot. Treatment of these injuries is usually simple and seldom requires surgery.
Many patients seen by Pediatric orthopedists have neurological disorders such as cerebral palsy, spina bifida, or the family of diseases known as dystrophies. Most of these disorders result in muscle imbalance and deformity in the areas involved, such as drop foot, scoliosis, or paralytic clubfoot. Children with cerebral palsy or spina bifida frequently require bracing or surgery to improve their ability to function to their greatest potential.
Scoliosis and Kyphosis
These conditions are deformities of the spinal column and may occur at any time before or after birth, but are more frequent during the adolescent growth spurt. Scoliosis is curvature of the spine seen in about 5 per cent of teenage girls. Kyphosis is an excessive round–back deformity common in teenagers.