DEAR MAYO CLINIC: I've been diagnosed with a rotator cuff tear. What factors determine the best treatment approach, and what can I expect during recovery?

ANSWER: To better understand whether a rotator cuff tear may require surgery, it helps to first understand what the rotator cuff is and how it works.

The rotator cuff is a group of muscles and tendons that connects the shoulder blade to the upper arm bone. Together, these muscles help provide shoulder motion, strength and stability. A rotator cuff tear occurs when one or more of these tendons partially or completely detach from the upper arm bone.

Such tears can vary considerably. Some are small and may cause few or no symptoms, while others can lead to substantial pain, weakness and limitations in shoulder function. The best treatment depends on several factors, including the type of tear, your symptoms and your specific circumstances.

What determines treatment for a rotator cuff tear?

How the tear occurred is one of the most important considerations. Tears that happen suddenly because of an injury, known as acute traumatic tears, generally are more likely to require surgical repair.

Chronic tears, which develop over time from wear and tear, often can improve without surgery. The torn tendon itself doesn't heal with nonsurgical treatment, but physical therapy can strengthen and retrain other muscles so they compensate for the damaged rotator cuff.

For a chronic tear, your healthcare professional will consider factors such as:

• How long you have had pain and limitations.
• The size and location of the tear.
• Your age and overall health.
• Whether the shoulder muscles have developed wasting, or atrophy, or have been partly replaced by fat.

Surgery may be recommended when pain and functional limitations continue despite several months of well-executed physical therapy. Surgery also may be considered for a large tear when the muscles remain in good condition, particularly in a younger person, because the goal may be to repair the tendon before progressive muscle loss occurs.

Can a rotator cuff tear heal without surgery?

Physical therapy is the most important element of nonsurgical treatment. Exercises focus on restoring shoulder motion and improving strength to help rebalance the shoulder and compensate for the torn rotator cuff.

Pain can make therapy difficult at first. Over-the-counter anti-inflammatory medicines may help with discomfort for some people. A cortisone injection also may help some shoulders, although multiple repeated cortisone injections should be avoided.

You and your healthcare professional can judge whether treatment is working by assessing improvement in:

• Pain.
• Shoulder motion.
• Strength.

Within about three to four months after beginning a therapy program, you generally should have a better sense of whether this approach is helping.

The most common surgical procedure is a tendon repair, typically performed arthroscopically, meaning through small incisions using a camera and specialized instruments. Some large tears can't be repaired. In those cases, other operations, such as transferring another tendon or performing a reverse shoulder replacement, may be considered.

Recovery after rotator cuff repair takes patience. Typical milestones include:

• First six weeks: Most people protect the shoulder in a sling-like immobilizer.
• After six weeks: Physical therapy focuses first on restoring motion and later, the focus is on rebuilding strength.
• Four to six months: Many patients feel substantially recovered.
• Up to one year: Complete recovery often takes this long.

Protecting the shoulder during the first six weeks and completing the prescribed physical therapy program are particularly important. An injury to the shoulder during early healing can damage the repair.

Before deciding on surgery, ask whether your tear can be repaired and, if so, whether delaying repair could make it irreparable over time. Understanding the type of tear, the condition of the shoulder muscles and the expected recovery can help you and your healthcare professional choose the treatment approach that best fits your situation.

Joaquin Sanchez-Sotelo, M.D., Ph.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q&A: How are rotator cuff tears treated? appeared first on Mayo Clinic News Network.

After unexplained pain, stiffness and abnormal movements led to dystonia diagnoses, Mayo Clinic specialists tailored deep brain stimulation and ongoing care to Emma and Lauren Fink's individual symptoms and goals. 

In September 2024, 14-year-old Emma Fink reached for a volleyball during gym class when something suddenly went wrong. 

"I went to bump the ball, and my shoulder blade popped out of place," Emma says.  

Her right shoulder blade shifted sharply upward and remained fixed in place. She describes the pain as feeling like "someone was punching me over and over." 

At the emergency department, imaging showed that Emma's shoulder was not dislocated. The cause of her shoulder blade's fixed position remained unclear, and muscle relaxants provided no relief. 

Watch: Deep brain stimulation helps sisters with dystonia return to the activities they love

Journalists: Broadcast-quality video (4:49) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

When Emma's symptoms pointed to a movement disorder 

For months, Emma could not raise her arm, sleep comfortably, write with her dominant hand or wash her hair. Emma, a normally laid-back teenager who loved drawing, archery and spending time with friends, had to relearn everyday tasks with her left hand while living with constant pain. 

Emma was initially treated for a suspected sports injury. When her shoulder did not improve with treatment, Mayo Clinic sports medicine specialists in Rochester, Minnesota, contacted Dr. Amy Rabatin, a physical medicine and rehabilitation specialist at Mayo Clinic. 

Before seeing Emma in person, Dr. Rabatin was brainstorming with the sports medicine team, reviewing photographs, considering ways to control Emma's pain and asking another question: Who else needed to be involved? 

Suspecting a neurologic cause, Dr. Rabatin helped connect Emma with Dr. Keith A. Coffman, a Mayo Clinic neurologist who specializes in pediatric-onset movement disorders. 

Dystonia diagnosis brings answers 

When Dr. Coffman evaluated Emma, he recognized signs of dystonia, a movement disorder that can cause involuntary muscle contractions and painful, sustained tightening. He compares the sensation to a charley horse that does not release. 

Dystonia can affect any voluntary muscle and can look very different from one person to the next. Emma's presentation was especially unusual, Dr. Coffman says, because her arm had remained locked in position for months. 

The diagnosis brought clarity but not a quick fix. Drs. Rabatin and Coffman continued coordinating Emma's medication management, rehabilitation and evaluation of additional treatment options to address her pain, movement and function. 

Considering deep brain stimulation for dystonia 

When medications did not adequately control Emma’s worsening symptoms, Dr. Coffman recommended deep brain stimulation (DBS). 

DBS uses implanted electrodes to deliver adjustable electrical stimulation to areas of the brain involved in movement. It can lessen symptoms of dystonia, but it is not a cure.

For Emma and her family, the next step did not require starting over with a new care team. Dr. Coffman could evaluate her for DBS alongside Dr. Kai Miller, a Mayo Clinic neurosurgeon, through Mayo Clinic's Pediatric Deep Brain Stimulation Program in Rochester. 

At first, Emma was hesitant about brain surgery. 

Dr. Coffman and Dr. Miller talked with Emma and her parents, Angie and Andy Fink, about the potential benefits, limitations and risks. They also addressed Emma's questions, including how much of her hair would need to be shaved. As the physicians answered her questions, Emma became more comfortable considering the procedure. 

"I just wanted to be better," Emma says. "Anything to make me better." 

Emma notices a change after DBS activation 

Dr. Miller performed Emma's DBS surgery in April 2025. When Dr. Coffman activated the device several weeks later, Emma felt the muscles around her shoulder release. 

"I could feel my shoulder shift down, and then all my muscles finally relaxed," she says. "It felt like it was floating." 

Within minutes, Emma could move an arm she had been unable to use for nearly eight months. 

After watching Emma live with persistent pain, Angie struggled to believe the change could last. 

"I remember thinking, 'We're going to wake up tomorrow, and it's going to be back to the way it was. This can't be real,'" Angie says. "I had some disbelief that it worked so well, so quickly, and then gratitude that we had the expert team to make it happen for her." 

The moment affected Emma's care team too. 

"When we turned Emma's device on and she got relief, we all cried," Dr. Coffman says. 

A second dystonia diagnosis in the family 

As Emma recovered and rebuilt her strength through occupational therapy with Katie Cossette, OT, and physical therapy, her younger sister, Lauren, began experiencing rapid blinking and unusual movements of her head and neck. 

She also had a long history of tightness and pain in her legs that worsened with activity. 

During one of Emma's DBS programming appointments, Angie described Lauren's symptoms. Dr. Coffman asked to see Lauren and later confirmed that she, too, had dystonia. 

Their specific condition is classified as presumed monogenic dystonia, meaning it is likely tied to a change in a single gene that has not yet been identified. Dr. Coffman says this is the second most common form of dystonia in children. 

Individualizing care for each sister 

Sharing the same condition did not mean Lauren's treatment would mirror Emma's. Still, like her sister, Lauren wanted to try medication before considering DBS. 

The team gave her time to make the decision on her own terms. But as Lauren's symptoms worsened, the effects became harder to ignore. Softball, a sport she loves, grew more difficult as her bat speed slowed and fatigue set in more quickly. 

After watching her sister benefit from DBS and talking through her own concerns with her care team, Lauren underwent DBS surgery in February 2026. 

When her device was activated, Lauren noticed almost immediately that walking felt easier. 

"I didn't realize I wasn't supposed to feel that uncomfortable tightness in my legs when I moved," she says. 

Fine-tuning deep brain stimulation over time 

As Emma and Lauren grow and their symptoms change, they return to Dr. Coffman to fine-tune their DBS settings around the activities that matter most to them. For Lauren, that means softball. 

During a recent appointment, she stood in the clinic swinging a bat while Dr. Coffman adjusted her DBS settings on a tablet. With each change, she described what she felt. 

When the stiffness eased and her swing felt natural again, they knew they had found the right setting. 

Returning to school, sports and everyday life 

Across specialties, Emma and Lauren's care team continues to share updates about their symptoms, rehabilitation and personal goals, so their treatment can adjust as their needs evolve.  

Although the family may meet with each specialist separately, Angie says their care has never felt divided. 

"It feels like when we talk to one of them, we're talking to all of them," she says.  

Today, Emma is returning to archery, drawing and time with friends. Lauren continues to practice softball, work on her strength training and has plenty of energy for her family and friends. 

Looking back on how far both girls have come, Angie and Andy say they are grateful for the Mayo Clinic care teams that helped Emma and Lauren return to the rhythms of teenage life. 

"Through this all, we felt like we were in good hands," Andy says. "If there’s any place in the world we would have wanted this done, it would have been right here."

The post Deep brain stimulation helps sisters with dystonia return to the activities they love (VIDEO) appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: Our daughter plays field hockey, and it can get physical on the field with collisions and falls. We're worried that we won't know if she gets a concussion. What signs should we watch for? 

ANSWER: With school team sports amping up, student-athletes are at greater risk of concussion. In addition to coaches, parents play a role in spotting signs of symptoms. A possible concussion isn't something to brush off. It's a form of mild traumatic brain injury.  

During a concussion, the brain moves within the inner walls, sliding back and forth. This can be due to a violent blow to the head and neck or upper body, a collision, or a hard fall during practice or a game. Typical symptoms include: 

• Headache. 

• Ringing in the ears. 

• Upset stomach. 

• Vomiting, nausea.  

• Fatigue or drowsiness. 

• Blurry vision or hazy spots in their vision field. 

• Confusion or feeling as if in a fog. 

• Amnesia about what happened. 

• Dizziness. 

• Slowness getting up after a play. 

• Changes in behavior, such as irritability and crankiness. 

• Loss of balance or unsteadiness in walking. 

• Ringing in the ears that doesn't go away. 

It's important to know that no two concussions are the same. While student-athletes often compare themselves with teammates or friends who have had concussions, one athlete may experience only one symptom, and another may have several. The absence of a particular symptom doesn't rule out a concussion; all potential symptoms should be taken seriously. 

Concussion symptoms may not appear immediately. An athlete may seem fine at first but develop symptoms later. Athletes may also minimize or hide symptoms because they're worried about being removed from a game or missing future competitions. That makes it especially important for parents, coaches and athletic trainers to pay attention not only to what an athlete says but also to changes in how they look or behave.  

A concussion doesn't require a direct blow to the head. If someone is pushed, falls backward or experiences a whiplash-type motion, that action can cause the brain to move within the skull. If parents see that type of injury or their child reports concussion-like symptoms afterward, they should be alert for changes. For younger athletes, it may be difficult to explain exactly what they're feeling. Parents know what's typical for their child, so recognizing that something seems "off" can be important. 

Today's school sports concussion protocols require that if a student-athlete has possible concussion symptoms, they shouldn't return to play that day and not return until cleared by a healthcare professional. 

At home, parents should continue monitoring symptoms. If their child's symptoms get worse, they should receive medical attention right away. Parents also should watch how symptoms change in the following days. Symptoms often begin to improve within the first several days, with recovery typically progressing over about 7 to 14 days. If symptoms aren't resolving after about two weeks, more evaluation may be needed. This could include referral for physical therapy and therapies that address lingering problems, such as problems with balance and dizziness. 

Recovery also involves more than getting an athlete back onto the field. Returning to school should come before returning to sport. If a student can't tolerate a full school day, they shouldn't be participating fully in athletics. Some students may need temporary academic adjustments, such as additional time for tests, help with note-taking, or reduced exposure to screens if computers or projected displays make symptoms worse. 

Concussions can be challenging because there's often no outward sign of injury, such as a cast or crutches, that shows others something is wrong. That can make it tempting for an athlete — or the people around them — to underestimate the injury. Protecting the brain and giving it adequate time to recover needs to be the priority. For young people, that means remembering they are students first and athletes second. 

Kimberly Penkert, Sports Medicine, Mayo Clinic Health System, Mankato and New Prague, Minnesota 

The post Mayo Clinic Q&A: Signs of concussion to watch for in student-athletes  appeared first on Mayo Clinic News Network.

For nearly six years, Bob Morreale has lived with a shoulder replacement. Most days, he does not think about it at all. 

That, he says, is the point. 

For Bob, 56, of Rochester, Minnesota, the road to shoulder replacement began decades earlier. A former Division III college baseball pitcher, he sustained shoulder injuries that led to instability, tissue damage, previous surgeries, and eventually, osteoarthritis. Over time, pain became part of daily life.  

“Turning a doorknob, holding a coffee cup, sleeping on my right side, and throwing became difficult,” Bob says. “It didn’t completely stop me from doing things, but I was constantly making adjustments.” 

Bob knew he needed a more permanent solution to manage his pain. At Mayo Clinic in Rochester, he met with Joaquin Sanchez Sotelo, M.D., Ph.D., an orthopedic surgeon, to discuss whether total shoulder replacement could be an option. 

Like many patients considering joint replacement, Bob wanted to know how long an implant might last and whether he could expect to regain comfortable motion. Dr. Sanchez Sotelo could answer those questions with confidence, drawing on decades of outcomes data from thousands of joint replacement patients treated at Mayo Clinic. 

How decades of patient follow-up help guide your care 

That confidence comes from more than 50 years of systematically tracking patient-reported outcomes. Since performing the first FDA-approved total hip replacement in the United States in 1969, Mayo Clinic has followed joint replacement patients throughout their lives, creating one of the world's largest collections of long-term outcomes data. 

"After surgery, we connect with patients on a regular basis. Even after a surgeon retires, another will step in and continue to check in with patients throughout the remainder of their life," says Matthew Abdel, M.D., chair of the Surgical and Procedural Practice at Mayo Clinic. 

For patients like Bob, that depth of follow-up matters. It allows surgeons to have more informed and honest conversations about what patients can expect — including pain relief, function, durability and whether another surgery may be needed in the future. 

Making an informed decision 

After discussing the benefits, risks and alternatives with his surgeon, Bob decided to move forward with an anatomic total shoulder replacement. Based on his age, anatomy and overall shoulder condition, the procedure offered the best opportunity to relieve pain, restore function and return to the activities he enjoyed.  

Recovery from surgery required patience. Bob spent weeks in a sling and worked through physical therapy to rebuild strength and motion. But as movement returned, so did the ordinary parts of life he had been missing. 

"The results have been remarkable," Bob says. "I have no pain, full range of motion, and can do everything I want to do. My sons are now adults, but I can still play catch with them!" 

How every patient helps improve joint replacement 

Every patient who participates in follow-up contributes to a deeper understanding of long-term outcomes, helping Mayo Clinic refine care and better guide future patients. 

For patients, that means care informed by decades of real-world outcomes, helping surgeons provide clearer expectations about recovery, function and long-term results. 

Like more than 200,000 joint replacement patients treated at Mayo Clinic, Bob continues to participate in periodic follow-up after surgery. 

Nearly six years later, he rarely thinks about his shoulder anymore. 

That's exactly what he hoped for. 

The post Why decades of patient follow-up make a difference in joint replacement care  appeared first on Mayo Clinic News Network.

For millions of people, cartilage damage can lead to chronic pain, limited mobility and require difficult decisions about surgery. Unlike bone, cartilage has little ability to heal itself, leaving many patients with treatment plans that require multiple procedures, lengthy rehabilitation or, eventually, joint replacement. But what if damaged cartilage could be encouraged to repair itself? 

In this episode of "Tomorrow's Cure," orthopedic researchers from Mayo Clinic and Mass General Brigham discuss RECLAIM, an investigational regenerative medicine approach designed to help restore damaged cartilage. The approach uses a patient's own cartilage cells combined with specialized donor cells that help create a healthier environment for healing. Rather than simply filling damaged areas, RECLAIM aims to support the body's natural repair process in a single procedure instead of multiple surgeries.  

Host Lindsey Sievert talks with Daniel B.F. Saris, M.D., Ph.D., and Mario Hevesi, M.D., Ph.D.,  orthopedic surgeons at Mayo Clinic and Christian Lattermann, M.D., chief of the Division of Sports Medicine at Brigham and Women's Hospital and director of research for Mass General Brigham Sports Medicine. Together, they discuss why cartilage injuries have challenged orthopedic medicine for decades and how advances in cell biology, minimally invasive surgery and artificial intelligence (AI) are creating new possibilities. They also explain how collaboration across specialties helped adapt the RECLAIM technology from the knee to the hip, why preserving a patient's natural joint is especially important for active people and what researchers still need to learn before treatments like RECLAIM become more widely available. 

The conversation also explores the future of regenerative medicine, including how AI could help identify patients most likely to benefit from these therapies and how insights from this research may eventually extend beyond cartilage to other tissues throughout the body. While RECLAIM remains under clinical investigation, the episode offers an inside look at how scientific discovery and patient collaboration are shaping the next generation of orthopedic care. 

Listen to the latest episode of "Tomorrow's Cure" wherever you get your podcasts. You can also explore the show's full library of episodes and guests on the show's playlist.  

The post From joint damage to regeneration   appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My back pain keeps getting worse. I've tried all the nonsurgical options, but is it time to consider surgery? 

ANSWER: It might be. The back is a highly complex part of the human body with several potential sources of pain — bones, joints, muscles and nerves.  

Joints: On the back of each spinal vertebra is a pair of facet joints that allow you to bend and twist. These two facet joints, together with the disc, enable the bones of the spine to move. Lower in the back is the sacroiliac joint, which connects the spine to the pelvis. As with any joint, these can be affected by arthritis and injury. The discs, which provide cushioning between the vertebrae, can slip out of place, allowing the bones to rub together. 

Muscles: An intricate muscle structure supports the spine. Strains, overuse and underuse can weaken and damage these muscles. 

Nerves: The spinal cord, which is a bundle of nerves, runs through the spine, ending where the mid back and lower back connect — about at your belly button. From there, nerve roots branch to each leg, providing function to your legs. Anywhere along the spine, but especially in the lower back, the nerves can become compressed. It's radiating leg pain that frequently drives patients to seek relief through surgery. 

The first step in finding back pain relief is to be assessed by a healthcare professional, who, as part of the examination, will check your ability to sit, stand, walk and lift your legs. You also may undergo some imaging. This assessment will help your clinician develop a treatment plan.  

Nonsurgical pain-relief options include: 

• Physical therapy. A physical therapist can teach you exercises to increase flexibility, strengthen back and abdominal muscles, and improve posture. Building these exercises into your daily routine can help prevent pain from returning. The therapist also can show you how to modify the exercises and your movement during a back pain episode.  

• Ice/heat. The use of an ice pack or heating pad can help relieve pain from muscle tension and spasms. 

• Pain relievers. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil); acetaminophen(Tylenol); topical creams and patches that deliver substances through the skin; medicines containing opioids, such as oxycodone or hydrocodone (rarely used); and some antidepressants, including duloxetine (Cymbalta).  

• Muscle relaxants. If mild to moderate back pain doesn't improve with ice, heat or pain relievers, a muscle relaxant is another option.  

• Injections. If other measures don't relieve pain that radiates down the leg, an injection of cortisone plus a numbing medicine might help. 

• Other treatments. Yoga, massage, chiropractic adjustments and acupuncture also may bring relief. 

When these measures are no longer effective, patients typically seek out surgical options. For the best outcomes, it's essential that the surgical procedure matches the problem that needs to be addressed. These can include neurological compression, instability or spine deformity issues.  

A consultation with a surgeon usually includes an examination and imaging to pinpoint the problem, followed by a discussion of what surgical approach will provide the greatest benefit. After the consultation, you may want to talk over your options with family and friends or seek a second opinion to ensure you're comfortable with the plan. 

Before surgery, you'll be thoroughly assessed to determine if you're physically ready for the procedure. This will include evaluating your bone health and ensuring that any medical conditions are stable or optimized. 

The surgery depends entirely on what is needed to correct the problem. Some surgeries are relatively simple, while others may be quite complex. 

Recovery and healing depend on how extensive the surgery was. For instance, a herniated disc may require only a small incision, followed by a short period of limited activity. Recovery from a more involved surgery requiring a large incision may take months. 

However, most people fall somewhere in the middle of this spectrum. They generally feel pretty good within six to 12 weeks, although full recovery typically takes six to 12 months. 

Once a person has recovered, the key is developing a lifestyle that helps prevent back issues from returning. These include building good core muscle strength, increasing mobility, staying active, not smoking, and maintaining a healthy weight and diet. 

Being active and maintaining good core strength not only are essential to recovery from surgery, but they also are key to preventing back pain. 

Mel Helgeson, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota  

The post Mayo Clinic Q&A: What’s up with my aching back? Do I need surgery? appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: Our teenagers are both student athletes and active in their sports year-round. I'm concerned about injuries that could sideline them. What should we watch for?

ANSWER: As the school year ends, summer sports heat up for students and adults alike. Summer may be a prime season for a sport, such as baseball or running, but athletes of all types also may be on a traveling team, heading to a sports camp or just honing their skills with off-season practices.

No matter an athlete's age, they need to be aware of and condition their body to prevent injuries that can put their sport on hold. Here are several to watch for:

Heat-related injuries. When it's hot and humid, proper hydration is essential. Signs of overheating include not sweating, feeling extremely thirsty, becoming dizzy, experiencing a headache or vision changes. These symptoms call for immediate attention. All athletes should hydrate before, during and after their activity. Water is best, as are drinks that replenish electrolytes lost through perspiration.

Sprains and strains. These common injuries can affect ankles, knees, hips and shoulders. However, they aren't traumatic injuries like fractures or a complete ligament tear, and they tend not to require long-term recovery.

Tendons attach muscles to bones, while ligaments attach bones to bones. A sprain is the stretching or partial tearing of the fibers in a ligament. A muscle or tendon strain may result from overuse, leading to inflammation. Both are treated by modifying activity, rest, icing, and taking over-the-counter pain and anti-inflammation medications. Physical therapy may be needed to rebuild strength and range of motion.

Fractures. A fracture is a broken bone. Fractures often occur during falls, such as when skateboarding, or from collisions with other players or objects. Fractures can be cracks or complete breaks that may or may not require surgery. Treatment and recovery depend on the severity of the injury. Athletes should plan to be in recovery for at least 6 weeks.

Overuse injuries. With the emphasis on early sports specialization, young athletes often spend more time practicing or competing, increasing the risk of injury. This injury risk is especially true for young athletes who are still skeletally immature. That means they still have open growth plates in their bones, making them susceptible to injury, particularly from repetitive motion.

Athletes understand that repetitive motion is the way to improve. However, if a young athlete is pitching every day or repeatedly practicing a volleyball serve, they can overuse a single part of their body. This can lead to inflammation or even damage those areas. One indication of overuse is pain after a game or practice that takes longer to resolve, increasing recovery time.

Safeguards such as pitch counts, which limit the number of pitches a player throws during a game, and built-in rest days are important to preventing overuse injuries.

Another way to avoid overuse injuries —and burnout — is cross-training. For instance, a hockey player may add swimming to their routine, a runner may add weight training, or a soccer player may shoot hoops with friends. This allows an athlete to use different muscles and movements to build strength, flexibility and coordination, while also giving them a mental break.

Concussion. A concussion is a mild traumatic brain injury that affects brain function. Effects are often short-term and can include headaches and trouble with concentration, memory, balance, mood and sleep. Concussions can happen in any sport, not just those in which players intentionally run into each other, such as football or hockey.

If a player experiences dizziness, headache or nausea after an incident during a game or practice, they shouldn't shrug it off — they should step out of the game and tell a coach or parent. Today, most coaches are trained in concussion and return-to-play protocols developed for most sports. Athletes, parents and coaches should take concussions seriously to prevent further injury or long-term symptoms.

Injuries in older athletes. Older athletes returning to a sport or trying a new one are susceptible to the same injuries as young athletes. However, osteoarthritis, or the wearing down of the cushioning cartilage in joints, increases with age. This can lead to pain, swelling and a decrease in range of mobility. Once again, cross-training is key, no matter your age.

All athletes can reduce the risk of injury by getting plenty of sleep, developing healthy eating habits, hydrating and warming up properly before any sports activity.

For parents, if your child finds a sport they enjoy and are passionate about, encourage them, but don't let it become a "job." As a former professional athlete, I advise that, first and foremost, sports should be fun.

Michael Stuart, M.D., Orthopedics & Orthopedic Surgery, Mayo Clinic Health System, Owatonna, Minnesota

The post Mayo Clinic Q&A: Watch out for summer sports injuries in youth and adult athletes appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My nephew is in his 20s and has been complaining about ongoing hip pain, especially after working out. When it didn’t improve, he saw an orthopedic specialist and was diagnosed with hip impingement. What is that?

ANSWER: Hip impingement, also called femoroacetabular impingement, is a condition that often affects young, active adults. It occurs when the shape of the hip joint causes the ball and socket to pinch during movement. Over time, that can lead to pain, stiffness and wear in the joint.

Hip impingement exists on a spectrum. Some people have changes in the shape of the hip and never develop symptoms. Others develop pain that begins to affect exercise, work or everyday activities.

The hip is a ball-and-socket joint. In some people, the socket may develop differently, or extra bone may form where the ball and neck of the femur meet. That extra bone on the femur is often called a cam lesion. These shape changes can cause the bones to come into contact earlier than they should during movement, especially when the hip is bent deeply during sitting, squatting or sports. This can lead to pain and reduced range of motion.

Hip impingement is much more recognized today. The condition became better understood in the early 2000s, when specialists began linking some cases of hip pain and early arthritis to structural differences in the hip joint. Young adults also may be active longer, which can make symptoms more noticeable. However, not everyone with hip impingement has symptoms.

The most common symptom is groin pain. Some people also describe pain that wraps around the side of the hip in a C-shaped pattern. Symptoms often become worse with prolonged sitting, long car rides or activities that involve deep hip flexion, such as deep squats or stepping onto a high surface.

Occasional pain that goes away may not need immediate evaluation. However, you should seek medical care if hip pain persists for weeks or months, begins to affect daily life, or prevents participation in activities you enjoy.

Sports and activities that involve deep hip bending, agility and pivoting can make symptoms more likely. This includes hockey, rowing, soccer, hurdles and some forms of dance, especially ballet.

Typically, hip impingement isn't something people are born with; the shape of the hip develops over time. The socket reaches its final shape relatively early in life. Changes on the femur side of the joint, including cam lesions, are thought to develop during adolescence, especially in active teens.

Diagnosis often starts with the symptoms a person describes. Groin pain, pain with sitting, and a pinching sensation during activity can all point toward hip impingement. A physical exam also is important, since many people have reduced motion when the knee is brought up toward the chest. X-rays help evaluate the shape of the hip. In some cases, an MRI is used to examine the cushioning cartilage, such as the labrum, more closely, especially if surgery is being considered.

The first line of treatment often is physical therapy to strengthen the core, lower back and muscles around the hip. Activity changes and anti-inflammatory medications also may help. It’s important that therapy specifically targets hip impingement, since some exercises may worsen symptoms.

If symptoms continue and begin to affect quality of life, surgery may be considered. The most common procedure is hip arthroscopy, which uses small instruments and a camera to repair the labrum and reshape areas of bone. Recovery takes time, with crutches often needed for four to six weeks, followed by a gradual return to activity. Most people improve within three to four months, although returning to higher-level sports may take closer to six months.

If left untreated, outcomes for hip impingement depend on the severity of the condition.  In some people, it may raise the risk of arthritis later in life. In others, symptoms may stay mild or manageable. Not every person with hip impingement will need surgery, and treatment decisions should be based on symptoms and how much the condition affects daily life.

Hip impingement can be an overlooked cause of ongoing hip pain in young adults, especially in people who are active. It’s often manageable with the right treatment and activity changes. If hip pain keeps coming back or begins to interfere with daily life, it’s worth getting checked rather than assuming it’s just a strain.

Mason Uvodich, M.D., Orthopedics & Orthopedic Surgery, Mayo Clinic Health System, La Crosse and Onalaska, Wisconsin

The post Mayo Clinic Q&A: How is hip impingement affecting young adults? appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I'm in my 50s and have begun experiencing nagging back pain. Recently, I saw an orthopedic doctor and was diagnosed with scoliosis. Does this mean I have to have surgery? 

ANSWER: Not necessarily. Scoliosis in adults may require no treatment or be able to be managed without surgery. It all comes down to the severity of symptoms and whether there are accompanying problems, like arthritis or osteoporosis. 

Scoliosis is a change in the normal shape of the spine that leads to sideways or forward curving or twisting. It most often develops in children during their growth spurt just before puberty. Affected children who don't respond to nonoperative measures may undergo surgery to straighten and properly balance the spine. 

In adults, scoliosis may be a remnant of a curvature that began in childhood. More commonly, scoliosis is the result of wear and tear on the spine that comes with aging, usually in combination with another condition that affects the spine, such as arthritis or osteoporosis. Usually, it's these conditions that are causing discomfort. 

Symptoms 

Symptoms of adult scoliosis include low back pain and a stooped posture. Some older adults, despite having significant curves in their spines, may have no symptoms. In other cases, they have symptoms that respond to nonoperative measures such as weight loss, physical therapy, stretching, or maintaining an active, low-impact lifestyle. Both of these scenarios are unlikely to require surgical treatment.   

Many adults seek medical care when symptoms become bothersome or limiting. 

Typically, physical therapy is the first step in treatment. Recommended exercises, along with stretching and walking, may be all that's needed to relieve pain, improve mobility and keep you active.  

If osteoporosis or arthritis is contributing to scoliosis, your healthcare professional will want to address how best to manage your bone health and prevent the curve from getting worse as your bones get softer. 

Treatment options

Treatment may include bone scans to determine the degree of bone loss, weight-bearing exercises to strengthen your bones and medications or infusions that help your body repair and build bone. 

If your pain continues despite nonsurgical treatments or if your scoliosis symptoms become so severe that they limit your mobility or produce a disfiguring deformity, then it's time for you and your healthcare team to discuss surgery. 

For a good surgical outcome, it's not necessary to completely correct the abnormal curves. The goal for adults is a balanced spine — that means your head is positioned directly over your pelvis from front-to-back and side-to-side. This alignment can achieve a high degree of satisfaction and pain relief after surgery. Many patients' symptoms arise from arthritis or pressure on the nerves and can be effectively relieved by removing the pressure, not necessarily by fully correcting any deformity. 

Surgery

One of the most common surgical approaches for scoliosis is spinal fusion. In many cases, spinal bones that are out of alignment account for a significant portion of the deformity. Spinal fusion helps your surgeon realign the bones, improve the curvature of the spine and make the spine more stable. This may be performed alongside a spinal decompression to remove any bone spurs or pressure on the nerves. 

During spinal fusion, your surgeon places bone or a bone-like material in the space between two spinal bones. Metal plates, screws or rods might hold them together so the bones can fuse together and heal as one bone. 

After spinal fusion, you'll be required to stay in the hospital for two to three days. Depending on the location and complexity of your surgery, you may experience some pain and discomfort, which can be controlled with pain medications. 

At some surgical centers, scoliosis surgery can be performed using minimally invasive techniques that shorten recovery times. Regardless of the surgical approach, it can take several months after surgery for the spinal bones to heal and fuse together. During that time, you may need a brace to protect and support your spine. 

In the area where the bones were fused together, spinal mobility is limited. Physical and occupational therapy can teach you ways to sit, stand, bend and walk to improve your mobility and quality of life.  

Although spinal fusion surgery for adults with scoliosis may not eliminate all symptoms, in a high percentage of cases, it can effectively balance the spine, relieve posture symptoms and allow you to get back to doing the activities you enjoy. 

Paul Huddleston, M.D., Orthopedic Surgery/Spine Care, Mayo Clinic Health System, Red Wing, Minnesota, and Mayo Clinic, Rochester, Minnesota  

Related post:

• Tomorrow’s Cure: Shaping a new future for youth with scoliosis

The post Mayo Clinic Q&A: Scoliosis in adults appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I need to have a joint replacement, but I'm really nervous. What questions should I ask my orthopedic doctor?

ANSWER: Knee and hip replacements have changed so much due to advanced surgical techniques, making them far different from those even five years ago. From multiple-day hospital stays, total joint replacement has advanced to a one-night stay or even going home the same day as surgery.

Questions from my patients usually fall into three categories:

• How do I know it's time for surgery? 
• What will happen during surgery? 
• What will recovery be like?

Let's start with the "when" question. Patients undergoing replacement surgery have arthritis in the joint. Arthritis is the loss of the protective cartilage layer between bones, and when that cushioning is gone, you have bone-on-bone contact, pain and swelling. Physical therapy, over-the-counter medications and injections can help for a while. 

Eventually, the pain and discomfort affect your mobility and activities of daily living, whether it's walking the dog or playing with grandkids. That's when you may decide it's time.

But joint replacements aren't only for older patients. Total joint replacement in people in their 50s is no longer uncommon.

Deciding on surgery

Once you've decided on surgery, the next step is preparation, particularly making sure any chronic conditions like diabetes or high blood pressure are under control. To reduce your risk of infection, stop any steroid injections at least three months before surgery. You'll also need to address dental work, such as cleanings.

Your orthopedic care team will provide you — through classes and printed guides — with a wealth of information on how to prepare, including:

• Required preoperative tests and exams.
• Adapting your home for recovery.
• Arranging for care when you return home, such as having a support person with you through the early weeks.
• Setting up transportation to and from physical therapy and medical appointments. 
• Requesting a temporary accessible parking permit.

If you have questions or concerns, be sure to ask your care team so that you feel ready for surgery and recovery.

Your surgeon also will be preparing. This includes using X-rays or CT scans to study your bones and anatomy. 

If your surgeon is using robotics, they're able to make a 3D model of the joint to assist with planning your joint replacement. In knees, this lets them correct issues caused by arthritis, such as bow-leggedness or knock knees.  During your surgery, the surgeon will map your knee in the operating room to the 3D model on the computer built from your preoperative CT scan. Your surgeon will use the robot to collect information on ligament balance and alignment so they can determine the best position to place your implants. 

While robotics makes total joint replacement more accurate, it doesn't make it less invasive. It helps achieve a more precise balance, which can lead to less pain and wear and tear on the implant.

When it comes to hip replacement, there are multiple surgical approaches available. The two most common approaches are the posterior and the direct anterior. The direct anterior approach is a more recent surgical technique that has gained popularity over the last decade. The anterior approach is considered "muscle-sparing" because the surgeon is working between the muscles. As a result, patients tend to recover faster, and there's less risk of dislocation.

For both knee and hip replacements, don't hesitate to talk with your surgeon about the techniques they'll be using.

After surgery

After surgery, knee and hip recovery differ:

• Knees. For the first two weeks, there's pain and swelling, but also the need to regain range of motion to minimize stiffness and scar tissue. Therapy is a big focus of early recovery. At-home physical therapy is every day; in-person is typically twice a week. 
• Hips. The first few weeks are for letting the incision heal and reducing pain and swelling. That means gradually increasing activity, using a walker, then a cane. Most patients do home-based therapy but not in-person therapy.

Whether you've had a knee or hip joint replacement, you're able to return to your regular activities within three months. However, there may be some restrictions. For the hips, these may include avoiding extreme positions, such as deep squatting and certain yoga poses, to decrease dislocation risk. For knees, kneeling may be uncomfortable and often isn't recommended. Also, don't be alarmed by clicks and pops from your implants — they're normal. 

Overall, patients do well with total joint replacement. This is a long journey, so an incredibly important part of your success is the relationship with your surgeon and care team. They'll be with you from beginning to end to ensure you have the best possible outcome.

Kariline Bringe, M.D., Orthopedics and Orthopedic Surgery, Mayo Clinic Health System, La Crosse, Wisconsin

Related post:

• AI, robotics and motion-preserving implants expand spine surgery options for patients

The post Mayo Clinic Q&A: Questions to ask before joint replacement surgery appeared first on Mayo Clinic News Network.