UVA Orthopedics Center Resolves Issue of Fragmented Care

 Led by Dr. Bobby Chhabra, the University of Virginia (UVA) Orthopedics Center offers comprehensive facilities spanning sports medicine, joint replacements, and orthopedic trauma. Dr. Chhabra and the UVA Orthopedics Center were featured in a March 2022 UVA University News article about the newly opened center.

As he describes it, the facility represents a culmination of efforts over the course of a decade to make the state-of-the-art medical location a reality. Breaking ground in late 2017, the building took three-and-a-half years to complete and is one of four similar facilities located in New York City, at Emory University in Georgia, and at the University of Florida.

The patient-centric 195,000-square-foot orthopedic and musculoskeletal care facility spans 90 exam rooms, four operating rooms, a retail pharmacy, and imaging and support services. As Dr. Chhabra describes it, one major upgrade has involved placing UVA Orthopedics’ previously dispersed outpatient clinics under one roof. This means patients with multiple and complex injuries, requiring specialized support from various departments, can receive care at a single location rather than visiting multiple clinics across Charlottesville.

Spinal Surgery for Scoliosis

 While it’s difficult to determine the exact causes of scoliosis, this medical condition is linked to various genes. As it affects 3 percent of the population in the United States, scoliosis impacts an individual's spinal curvature that can cause musculoskeletal problems. Different treatment modalities target varying degrees of scoliosis severity.

Scoliosis refers to the lateral curvature of the spine. A minimum curvature of 10 degrees is often indicative of the condition. While early-stage scoliosis patients rarely report symptoms, more severe curvatures with increased degrees result in noticeable pain, muscle spasms, and balance issues.

Before deciding which treatment method is most suitable for a scoliosis patient, orthopedic specialists conduct serial x-ray imaging to monitor the patient’s progress. X-ray imaging allows a doctor to determine the exact degree of curvature, which dictates the severity of the condition and corresponding treatment plans.

Curvatures under 25 degrees require regular observation with x-ray tests held every four to six months. The test results demonstrate whether the spinal curvature is increasing or not, thus guiding the doctor’s decision regarding treatment.

Adolescents with scoliosis reaching 20 to 25 degrees or more may require back bracing. Bracing supports the patient’s spine and halts any further curvature. Successful bracing reduces the need for surgery.

However, if spinal curvature continues to worsen, reaching 40 or more degrees, or if bracing is not ideal for the patient, surgery becomes the recommended treatment. Spinal surgery for scoliosis treatment targets three functions: preventing the progression of the curvature, fixing deformity, and restoring trunk balance.

Multiple surgical procedures can alleviate the symptoms of severe scoliosis. Spinal fusion surgery (SFS) is the most common method. SFS entails the fusion of several vertebrae into a single immobile bone. The procedure can take from four to six hours. SFS decreases the spinal curvature and prevents it from getting worse.

The success of SFS varies based on the patient’s initial curvature. Typically, the surgery can reduce curvature to 25 degrees or less. However, fusing vertebrae into a single bone decreases their mobility. Therefore, the surgery outcomes depend on the severity of scoliosis. The surgery rarely causes complications. Risks such as infection, bleeding, and nerve injury rarely occur.

Unfortunately, SFS is not optimal in young patients. Doctors deem girls under 10 and boys under the age of 12 unsuitable for SFS because the procedure may interfere with the growth of the trunk, which may also affect the development of the lungs.

Alternative surgical solutions for such patients include growing rods and fusion-less tethering systems. Growing rods is an intermediate modality that can delay SFS. Usually, doctors utilize growing rods in children with severe scoliosis. The anchored rods keep the spine in place to limit its curvature. The doctor lengthens the rods every six to 12 months to accommodate the child’s spinal growth. Upon reaching skeletal maturity, patients can undergo SFS.

The fusion-less tethering system is a more recent surgical approach. Doctors straighten the spine by pulling a cord attached to screws on the spine. While this promising approach can be safer than SFS, it’s still in its early phases.

Orthopedic Rehabilitation - Overview and Treatment Types

 

Musculoskeletal disorders can affect a person’s daily life and ability to perform everyday tasks. These include arthritis, fractures, spinal injuries, and joint replacements. Additionally, an individual may be unable to perform these tasks after musculoskeletal surgeries. In many of these cases, doctors recommend orthopedic rehabilitation to ensure that patients restore normal body functioning of the affected areas.

Also known as musculoskeletal rehabilitation, orthopedic rehabilitation is a physician-supervised medical program that helps patients manage musculoskeletal conditions and injuries and recover from surgeries. It aims to restore motion and flexibility while strengthening the specific body parts needing rehabilitation.

An orthopedic surgeon oversees orthopedic rehabilitation. This is a doctor who prevents, treats, and rehabilitates bone and joint conditions using medical and surgical methods. Besides orthopedic surgeons, rehabilitation involves physical therapists, exercise physiologists, occupational therapists, and rehab specialists.

There are three areas of orthopedic rehabilitation: physical therapy, occupational therapy, and sports rehabilitation. Orthopedic physical therapy involves caring for the whole musculoskeletal system comprising the bones, joints, muscles, ligaments, tendons, and connective tissues.

Usually administered in skilled nursing facilities, outpatient clinics, hospitals, sports facilities, and at home, orthopedic physical therapy entails determining movement diagnosis, creating a treatment plan, and giving therapeutic care. The patient also receives guidance on managing a condition or injury and preventing these from occurring in the future.

Physical therapists specialize in treating specific patients. For instance, some therapists work with elderly patients, assisting them through medical programs that improve their balance, strength, and mobility to prevent incidents such as falls. Additionally, they help them recover after surgeries.

In occupational therapy, the patient learns how to better perform daily tasks and activities. This may involve splitting a task into small manageable activities or learning new and simple ways of doing things. Besides, it may call for the individual to change environments to perform some activities. Sometimes, a patient may use adaptive equipment such as canes, splints, orthotics, and reachers.

Last, sports rehabilitation centers on exercise-induced and sports-related conditions and injuries. Here, therapists guide athletes on how to move safely and avoid injury. If they become injured, they help them recover.

Patients require orthopedic rehabilitation in three broad scenarios. First, after a surgery, orthopedic rehabilitation aids in normalizing walking, reducing pain, preventing scar tissue buildup, and improving motion range. Again, it helps restore balance, mobility, and strength. Common surgeries requiring orthopedic rehabilitation include rotator cuff repair, knee replacement, hip replacement, and knee arthroscopy.

Second, an individual requires orthopedic rehabilitation after an acute injury. Acute injuries result from trauma to the body, and include ankle sprain and Achilles tendon rupture. A physical therapist will help an individual manage pain, restore movement, and rebuild strength.

Third, some patients experience chronic injuries. These injuries happen over time, affecting movement by injuring the bones, joints, and ligaments. Tennis elbow and shin splints are common examples. Orthopedic rehabilitation helps manage chronic injuries by isolating the injury’s source and managing symptoms.

There are various treatment types in use, including exercise therapy, hydrotherapy, joint mobilization, soft tissue manipulation, dry needling, and laser therapy. Exercise therapy involves creating an exercise plan. Included in the plan are balance-building, mobility, and strengthening exercises. Thermotherapy and cryotherapy use heat and cold, respectively, to manage musculoskeletal swelling and pain.

In hydrotherapy, a physical therapist guides the patient in a water environment such as a swimming pool. Since water has gentle resistance, it is good for people with joint conditions. Additionally, the buoyancy from the water minimizes the impact on the joints.

A common manual treatment method is joint mobilization, where a physical therapist moves a patient’s joints firmly and carefully in a specific direction. Similarly, soft tissue manipulation involves using the hands to perform certain techniques on the fascia, ligaments, and muscles.

Other advanced methods include dry needling and laser therapy. With dry needling, the therapist inserts thin needles to specific body parts, similar to acupuncture, while laser therapy uses a low-level laser to treat muscle fatigue and enhance muscle repair.