Osteonecrosis

Osteonecrosis

Osteonecrosis literally means "death of bone" (osteo = bone, necrosis = death). This condition is often called avascular necrosis. It leads to tiny breaks, and often eventual collapse from within the bone. Osteonecrosis frequently appears in relation to another disease or conditions such as rheumatoid arthritis or alcoholism. The underlying problem of osteonecrosis is a decrease in the blood supply to the affected area. The most common areas affected are the hips, knees, and shoulders, but the elbows, hands and feet also may become involved.

The following groups of people are most at risk for developing this condition:

  • People who have a rheumatic disease such as rheumatoid arthritis or systemic lupus erythematosis
  • People who are taking high doses of steroids (cortisone-like drugs)
  • Alcoholics
  • Professional scuba divers who have the bends (a condition brought on by the rapid reduction of air pressure)
  • People who have connective tissue disorders, such as Gaucher's disease.

Osteonecrosis of the hip occurs most often between the ages of 30 and 50, and is slightly more frequent in men than in women. Osteonecrosis of the knee occurs most often between the ages of 50 and 60, or much earlier if other risk factors are present. Osteonecrosis of the knee occurs three to four times more often in women than in men. Osteonecrosis often involves more than one joint at a time.

The primary symptom of osteonecrosis is pain. Other symptoms of osteonecrosis include limitation of motion, joint stiffness and muscle spasms.

Symptoms usually begin slowly. In fact, in the earliest stage, there are usually no symptoms at all. Other people may notice that you are limping before you feel any pain. Once symptoms begin, they come and go. If the condition is left untreated, progressive bone damage will often occur. Surgery is usually required to correct the bone damage.

Early diagnosis of osteonecrosis is important in order to lessen the damage to bone. As the condition progresses, the death of bone often leads to changes within the bone and nearby joints so that a routine x-ray shows these changes. All too often, permanent damage has already developed by this point.

Aspirin and the newer nonsteroidal anti-inflammatory medications can help relieve the pain of osteonecrosis. Heating pads, warm baths, and an electric blanket can relieve muscle spasms and pain. Activity modifications and the use of crutches or canes can unload painful joints, and physical therapy can help maintain flexibility. These measures may provide some relief, but do not change the underlying process.

Keep in mind that it is up to you to keep your doctor informed of any increase in pain or decrease in mobility. This way, he or she can work with you to keep you as comfortable and functional as possible.

In later stages, if the area of bone has been severely damaged, joint replacement surgery called arthroplasty is needed to replace the damaged bone.

Rheumatoid arthritis

Rheumatoid arthritis

Rheumatoid arthritis (RA) primarily affects the synovium, the membrane that lines and lubricates a joint. It is the most common form of inflammatory arthritis.

There is no cure for rheumatoid arthritis at present. Until the cause of RA is known, it will not be possible to eliminate the disease entirely. The goals of current treatment methods, therefore, are to relieve pain, reduce inflammation, stop or slow down joint damage, and improve function and patient well-being.

Rheumatoid Arthritis Symptoms

Initial symptoms of rheumatoid arthritis are generally pain and stiffness in the morning and few symptoms with activity. The pain and swelling will usually progress on to obvious joint swelling and the level of stiffness in the morning increases. Other symptoms include fatigue and difficulty sleeping due to joint stiffness.

Rheumatoid arthritis can be distinguished from other forms of arthritis by the location and number of joints involved. The areas affected include the neck, shoulders, elbows, wrists, and hands, especially the joints at the base and middle of the fingers but not the joints at the end of the fingers. In the lower extremities, RA can affect the hips, knees, ankles, and the joints at the base of the toes. RA tends to spare the low back. The joints affected tend to be involved in a symmetrical pattern. That is, if knuckles on the right hand are inflamed, it is likely that knuckles on the left hand will be inflamed as well. This symmetry is not found as often in most other types of arthritis.

Inflamed joints will be warm, swollen, tender, often red, and painful or difficult to move. These physical signs of arthritis are due to inflammation of the lining of joints and tendons in a layer of tissue that is called synovium. The cells of the immune system within the synovium appear active and capable of causing tissue damage. If this inflammation persists or does not respond well to treatment, destruction of nearby cartilage, bone, tendons, and ligaments can follow. This leads to deformity and disability that can be permanent.

Anyone can get rheumatoid arthritis, including children and the elderly. However, the disease usually begins in the young to middle adult years. Among people with RA, women outnumber men by 3 to 1. In the United States, approximately one percent of the population, or 2.5 million people, have rheumatoid arthritis. It occurs in all ethnic groups and in all parts of the world.

Rheumatoid Arthritis Treatments

The goals of current RA treatment methods are to relieve pain, reduce inflammation, stop or slow down joint damage, and improve function and patient well-being. There is no single standard treatment that applies to all people with RA. The disease may be very different from person to person. Instead, a treatment program should be designed to best meet each person's needs, taking into account how severe the arthritis is, other medical problems, and individual lifestyle and preferences. Often the use of two or more medications at a time, each serving a distinct purpose, is necessary. Some of these medications affect the immune system, making careful monitoring a requirement for treatment.

Treating rheumatoid arthritis usually involves a teamwork approach, using health professionals from different disciplines to help an individual deal with the disease. Treatment most often is directed and coordinated by an arthritis specialist, who is a physician with special training in arthritis and other diseases of the bones, muscles, and joints. Other health professionals, such as physical therapists, occupational therapists, nurses, psychologists, orthopaedic surgeons, and social workers, often play other roles in implementing the treatment plan.

It often is difficult to be patient when suffering from rheumatoid arthritis. People with rheumatoid arthritis might be tempted to try unproven treatments. A treatment that promises "a quick cure" or "miraculous relief" can sound wonderful. But remember, these unproven treatments usually are expensive and will do nothing. The sensational successes advertised are usually illusions. They even may be harmful and often keep people from getting the medical care they really need. For example, magnet therapy has not been proven to work for rheumatoid arthritis. New or alternative treatments should be discussed with your doctor.

Medical management may include the use of non-steroidal antiinflammatory medication, corticosteroids, injectable gold salts (Myochrysine, Solganal), methotrexate (Rheumatrex), hydroxychloroquine (Plaquinil) and antimalarial drugs, Sulfasalazine (Azulfidine), D-Penicillamine (Depend, Cuprimine), and various other immunosuppressive agents.

Physical therapy treatments are helpful for most individuals with rheumatoid arthritis. Physical therapists can teach you how to exercise appropriately for your physical capabilities. They will give you valuable instruction on how best to use heat and cold treatments to reduce joint stiffness and swelling and make movement easier. At times, therapists may use special machines to apply deep heat or electrical stimulation to reduce pain or improve joint mobility.

Therapists construct splints for the hand and wrist and teach people how to best protect and use their joints when they are affected by arthritis. They also show people how to better cope with day-to-day tasks at work and at home, despite limitations that may be caused by RA. Sometimes this includes the use of practical tools and items that help individuals perform their day-to-day activities. It is important to remember that people with RA can and should be able to do most of the normal or usual things everyone else can, except that it takes them a little bit longer to do it.

For individuals with severe joint damage, surgery such as total joint replacement can mean the difference between being dependent on others and independent life at home or in the community. Such procedures are performed by orthopaedic surgeons with special training in joint replacement. The damaged parts of the joints are replaced with metal or plastic components. Some people with RA will benefit from replacement of other joints and from other types of surgery for hand and foot problems caused by the disease. Patients with early rheumatoid arthritis, however, should be placed on a program of medications and therapy before surgery is considered.

Osteoarthritis

Osteoarthritis

Osteoarthritis (OA), or degenerative joint disease (DJD), is a form of arthritis characterized by the loss of joint smoothness and range of motion without major joint inflammation. Post-traumatic arthritis is similar to osteoarthritis, but the cause is clearly evident (usually the result of a trauma to the joint sometime in the past).

Osteoarthritis is the most common type of arthritis, affecting over 20 million people in the United States. It probably affects almost every person over age 60 to some degree, but symptoms are often mild.

Osteoarthritis Symptoms

  • Joint pain and aching
  • Limited range of motion and instability
  • Erosion of the joint's cartilage and formation of bone spurs
  • Stiffness and roughness on motion

If degenerative joint disease is related to abnormalities of cartilage surrounding joints (articular cartilage), it may involve many of the joints of the body. On the other hand, if the degenerative joint disease is caused by an injury, only one joint may be involved. The hips, knees, spine, and shoulders are most commonly involved. This condition may also affect some finger joints, the joint at the base of the thumb, and the joint at the base of the big toe.

In osteoarthritis, the normally smooth cartilage surface softens and becomes pitted and frayed. As the cartilage breaks down, the joint may lose its normal shape. The bone ends thicken and form bony growths, or spurs, where the ligaments and capsule attach to the bone.

Stiffness and joint deformity usually progress slowly without general body symptoms. By contrast, rheumatoid arthritis (RA) usually begins earlier, often developing more suddenly. RA usually affects the same joint on both sides of body (e.g. both knees), causing redness, warmth, and swelling of many joints. RA is often accompanied by a general feeling of sickness, fatigue, weight loss, and fever.

In the hip, OA may produce pain around the groin or in the inner thigh. Some people feel referred pain to the buttocks, the knee or along the side of the thigh. Degenerative joint disease of the hip may cause a limp and may limit range of motion, for example making it difficult to spread the legs.

Degenerative joint disease of the knees may produce pain and stiffness of the knee associated with a grating or catching sensation in the joint when it is moved. It may make it difficult to walk up and down stairs and lumps may be noted particularly along the medial (inner) side of the knee. If the pain prevents you from moving or exercising your knee, the large muscles around the knee area will become weaker.

Degenerative joint disease of the fingers may produce bony lumpiness around the joints of the finger and perhaps pain and stiffness of these joints as well. In the fingers, the breakdown of joint tissue in the fingers causes bony growths (spurs) to form in these joints. If spurs occur in the end joints of the fingers, they are called Heberden's nodes. If they occur in the joints in the middle of the fingers they are called Bouchard's nodes.

Degenerative joint disease of the feet most commonly affects the large joint at the base of the big toe. Stiffness, lumpiness and pain may be associated. Wearing tight shoes and high heels can make this pain worse.

Degenerative joint disease of the spine may produce stiffness of the back and at times, symptoms of pressure on the spinal cord and nerves running through the spine. The latter are particularly important to notice and may include numbness or weakness of the arms or legs, difficulty with controlling the bowel or bladder, loss of balance and pain radiating out the arms or down the legs.

"Wear and tear" is a widely accepted explanation of the cause of OA. It should be noted that OA is the result of an interlocking pathophysiologic malfunction of cartilage and bone metabolism. Interpreting "wear and tear" of the joints in OA from a biomechanic perspective allows patients to understand how OA differs from age-associated degeneration and overuse of the joints. There are ways to reduce the OA "wear and tear" effects which include weight control, muscle strengthening exercises, and increased proprioception accuracy (the ability to feel your joint's position in space).

The effects of degenerative joint disease can often be controlled by a few basic measures, such as diet, exercise, medication, and surgery.

If you have OA, your diet should optimize your body weight so that the joints do not bear large loads which would cause them to wear more quickly. Joints in a person with OA should be protected from rough use, particularly those involving sudden impacts. Canes or walkers may help protect the hip and knee and prevent limping. Physical therapy can help maintain joint ranges of motion, strength and stability. Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) which are also effective in relieving pain.

Osteoarthritis Treatments

  • Removing joint spurs
  • Realigning the joint
  • Fusion of the joint
  • Joint replacement

In the past several years, these operations have become very effective, and many people have benefited from joint reconstruction or replacement.

Osteoporosis

Osteoporosis

Twenty-five million Americans have osteoporosis. Fifty thousand people die each year because of complications related to osteoporosis. Yet, most of us know little about protecting ourselves from this disease.

What is Osteoporosis?

Osteoporosis is a disorder of the bones characterized by decreased bone mass (generalized thinning of the bones), which also decreases bone strength. Because weakened bones are more fragile and more likely to break, people with osteoporosis are at increased risk of fractures, especially fragility fractures (broken bones that happen with little or no trauma). It is not a form of arthritis, although it may cause fractures that, in turn, lead to arthritis.

In the United States, osteoporosis causes more than 1.3 million fractures annually and is much more common in women than in men. The most common first fracture is a wrist fracture, which typically occurs at age 50 to 70 in women. Hip fractures and fractures of the spine (compression fractures) may also occur and are most common in patients who are in their 70s. Particularly when it leads to hip fracture, osteoporosis can cause a great deal of suffering, including an increased risk of institutionalization or death.

Most people with osteoporosis have no symptoms and are totally unaware that they have the problem. One early sign can be a loss of height caused by curvature of the spine (Dowager's hump), which is caused by weakened vertebrae (spine bones). The weakened vertebrae undergo compression fractures — tiny breaks that cause the spine bones to collapse vertically. When this happens, the height of the vertebrae is decreased, and the shape of each single vertebra goes from a normal rectangle to a more triangular form. Although the loss of height caused by compression fractures can sometimes be associated with back pain or aching, more typically it is asymptomatic (causes no symptoms).

When taking your history, your doctor will look for factors that increase your risk of osteoporosis. 

Osteoporosis Risk Factors

  • Being female
  • Being age 40 or older
  • Being a postmenopausal woman who does not take estrogen replacement medication
  • Having a diet low in calcium or an intestinal problem that impairs absorption
  • Having an overactive thyroid
  • Leading a sedentary lifestyle, with little or no routine exercise
  • Being thin
  • Taking certain medications, such as prednisone
  • Having a certain ethnic background (white people and those of Asian descent are more at risk of osteoporosis than are African-Americans)
  • Smoking
  • Using alcohol to excess
  • Having a family history of osteoporosis
  • Having a history of at least one fragility fracture

The diagnosis of osteoporosis should be strongly suspected in any person who has a fragility fracture. It can also be established by a bone density test, or bone densitometry. There are several techniques available to measure bone density. The most complete and accurate method is DEXA (dual- energy X-ray absorptiometry), which is the best for both diagnosing osteoporosis and assessing response to treatment. DEXA is a quick (10 to 15 minutes) and painless test that uses minute amounts of radiation (less than dental X-rays) and is generally done on the spine and hip. DEXA is available at MedStar Orthopaedic Institute.

Bone densitometry can diagnose osteoporosis when the condition is asymptomatic and mild and can help lead to treatment that will prevent the condition from getting worse. In people with loss of height or suspicious fractures, bone density tests not only confirm the diagnosis of osteoporosis, they also serve as a baseline for treatment and can be used to follow the response to therapy.

Ask your physician or therapist atMedStar Orthopaedic Institute if you are at risk for osteoporosis and if bone densitometry may be indicated.

Fracture Care

Fracture Care

A broken bone is an unfortunate experience that impacts every aspect of your life.  From your first visit to our office, our goal is pain relief and return to normal life as soon as possible.  Through a collaborative effort with you the patient and your treating physician, we will formulate a treatment plan that achieves those goals. 

A fundamental aspect of our orthopaedic practice, the care and treatment of broken bones (fractures) represents a large part of what we do.  GMOI’s subspecialty practice offers the advantage of directing your care to the most knowledgeable, experienced member of our care team.    Treatment for fractures ranges from cast immobilization, splinting, and supportive care to surgical intervention.  Appropriate treatment is based upon the nature of the injury as well as your expectations and needs.   Safety, quality of life, return to work or sport all factor into the decision making process. When surgical intervention is required, our physicians are well versed in the most up-to-date, minimally invasive surgical techniques as well as the most appropriate post-operative rehabilitation protocols to get you back to living life.

If you have sustained and injury and suspect you may have broken a bone or have been told by another physician that you have a fracture, call our office today to arrange for an expedient evaluation.  To maximize the efficiency of your visit, please bring your x-rays (the pictures themselves, not the radiologist report) so we can formulate a treatment plan to your unique needs.

Joint Replacement Surgery

Joint Replacement 

When disease processes affect joints irreversibly, patients are left with significant disability due to pain and limitations of motion. Even activities of daily living, such as rising from a chair, dressing, or using a comb or brush are nearly impossible to perform. These conditions are usually managed without surgery. But occasionally the damage to the joint is so severe that the only alternative is a complete replacement of the diseased joint.

Among the more common diseases that destroy joints are:

These and many other conditions attack all joints of the body. 

The most commonly affected are the hips, knees, shoulders, hands, and spine. MedStar Orthopaedic Institute performs hundreds of joint replacement procedures each year. We have adopted the most advanced replacement techniques, including minimal-incision and computer-assisted techniques, to help relieve your pain and assist you toward a more active life.

Advances in Total Joint Replacement

We have adopted the most advanced replacement techniques, including minimal-incision and computer-assisted techniques, to help relieve your pain and assist you toward a more active life.

A growing trend in North America and Europe has been to perform traditional total knee and hip replacements through a small incision. Using a minimally invasive technique, patients have less post-operative pain, require less medication, recover much faster, and have an overall better outcome. Our surgeons perform minimal incision surgery for hip and knee replacements.

One of the most important factors in determining the lifespan of the replacement is the alignment of the replacement parts. Up until now this was accomplished manually by the surgeon. Recent technological advances allow surgeons to align the replacement parts quicker and more accurately. We are excited about this new advancement and are certain that it will prove beneficial to our patients.

Our physicians are working closely with Plus Orthopedics and Southern Maryland Hospital to offer this service to the surrounding community. This system is called the Galileo System and will be one of only four used in the country.

Infusion Therapy

Infusion Therapy

The development of a center for infusible medications is practical and paramount for 21st century physicians. The evolution of treatment options for various disease processes has not only involved newer mechanisms of action, but newer modalities of delivery. Many of the newer pharmacologic agents have taken into account the number of medications patients take, the variability of absorption of these medications and the ease of delivery of current medications. With this in mind, studies have supported the delivery of certain medications by infusion or injection to be equally efficacious, if not superior, as oral regimens.

Infusion Therapy Benefits

Injection and/or infusible medications increase patient compliance by cutting down on the number of oral medications taken and removing the variable of forgetfulness in medication regimens. This method of deliver also allows the physician to directly assess a patient’s compliance and tolerance of an agent. At MedStar Orthopaedic Institute, our infusion center allows  on-site surveillance of our patients being treated with state of the art medications for Lupus, Rheumatoid Arthritis, Osteoporosis, Vasculitis, Crohn’s and Ulcerative Colitis just to name a few. Given their preference, most patients would prefer to be treated in the presence of their physician in the company of people under treatment with “like” illness.

Orthopaedic Trauma

Our orthopaedic trauma team specializes in treating broken bones throughout the body. We provide a full array of nonoperative care for fractures. When surgery is needed, we apply advanced training in and access to leading-edge technology. We believe in a multifaceted approach to patient care in order to fully treat the problems associated with musculoskeletal injury.

Musculoskeletal injury can have long-lasting effects. For those afflicted with chronic problems from fracture or injury such as limb-length problems, deformity or the non-healing of bones, we employ the most up to date non-operative and operative techniques for treatment in order to maximize function. MedStar Washington Hospital Center also serves as a referral center for patients with chronic infection of bone, or osteomyelitis, where we work closely with our integrated team of infectious diseases specialists and plastic surgeons.

For our injured elderly patients, we have instituted the region’s only orthopaedic-geriatric trauma service, with 5 full-time geriatricians, dedicated to the total health of the acutely injured elderly patient.

Orthopaedic trauma conditions:

  • Pelvic fractures
  • Hip fractures
  • Tibial plateau fractures
  • Fractures of the distal tibia
  • Acute injuries
  • Injured elderly patients
  • Chronic problems from fracture or injury

Orthopaedic trauma treatments:

  • Bone infections
  • Geriatric fracture center that provides integrated care by our orthopaedic surgeons, geriatricians and physical and occupational therapists
  • Malunions and nonunions
  • Pelvis and acetabulum fracture management
  • Upper and lower extremity fracture management

We also specialize in correcting problems from fractures treated unsuccessfully elsewhere. These include nonhealing of the bone (nonunion) or healing of the bone in the incorrect position (malunion). Our geriatric fracture center serves the unique needs of the elderly. The center brings together our orthopaedic surgeons, geriatricians and physical and occupational therapists to provide the integrated care that elderly patients need to get back to normal function as quickly as possible.

Awards and Recognitions

  • Recognized among the Best Hospitals by U.S.News & World Report in the Washington, D.C., metropolitan area for nine specialties, including orthopaedics.
  • Regions only orthopaedic-geriatric trauma service dedicated to the wellbeing of the acutely injured elderly patient.

 

Orthopaedic Oncology

Orthopaedic cancers start in or travel to bone, muscle, or soft tissue. MedStar Health orthopaedic oncologists are leaders in the surgical advances and innovations to treat this type of cancer, including limb-sparing surgery, a modern technique that can save an affected arm or leg and avoid amputation.

At The National Center for Bone and Soft Tissue Tumors at MedStar Franklin Square Medical Center, we offer a comprehensive approach to treating these rare tumors, incorporating every resource we have to ensure our patients receive the best treatment available. Working with patients, their families, and referring physicians, our dedicated specialists provide expert guidance and support throughout the diagnosis and treatment process. Because of our experience, we frequently perform complex and revision surgeries referred from other medical centers in the country.

In addition to our advanced and compassionate clinical care, we have a highly successful, accredited fellowship training program and educate students and residents with an emphasis on our surgical services and research.

Learn more about orthopaedic cancer, including: 

 

Types of Orthopaedic Cancer

Benign Orthopaedic Tumors

Benign orthopaedic tumors put pressure on healthy tissue but do not spread. They pose minimal risks and are considered non-cancerous. Some childhood benign tumors, such as bone cysts, may fully resolve over time as the bone matures with age.

Other benign bone tumors are considered more aggressive and require additional care. These include:

  • Giant cell tumors occur around the knee or the ends of long bones and can quickly damage the bone. These tumors tend to affect young adults.
  • Chondroblastomas occur at the very ends of the long bones in the arms or legs and can damage the growth plate or joint surfaces. These tend to occur in children.
  • Aneurysmal bone cysts cause the bones in the arms, legs, trunk, or skull to expand dramatically. These tumors tend to affect children and younger adults and can damage bone and often grow back.
  • Osteoid osteomas may occur anywhere in any bone and are typically extremely painful, due to chemicals released by the tumor into the the surrounding nerves.

Treatment

Giant cell tumors, chondroblastomas and aneurismal bone cysts are often treated with the same therapy, including a combination of:

  • Curettage, where the tumor or cyst is scraped out during a surgical procedure
  • Cryosurgery, where the tumor or cyst is frozen with liquid nitrogen and destroyed
  • Reconstruction, where the remaining bone is repaired with metal rods, cement and bone graft

Osteoid osteoma is often treated with:

  • Surgery
  • Radiofrequency ablation

Sarcomas

Sarcomas are tumors that occur in bones or soft tissue such as muscles, fat, and nervous tissue, and are distinguished by the type of tissue from which they originate.

Bone Sarcomas

  • Primary tumors originate in the bones (less common than many other cancers that spread, or metastasize, to bone)
  • Secondary tumors begin in a different part of the body and spread to the bones. Primary bone tumors are.

Common bone sarcomas include:

  • Osteosarcoma, which forms osteoid or hard bone tissue, is the most common form of bone sarcoma, found in about 35 percent of cases. While it may occur at any age, it tends to affect children in late adolescence and appears most commonly around the knee.
  • Chondrosarcoma, which forms cartilage tissue, is found in about 30 percent of cases. It tends to affect adults older than 40, and appears in the hip, pelvic, and shoulder areas.
  • Ewing's Sarcoma, which develops in the lungs, bone or the pelvis, arises from cells of unknown origin. It tends to affect children younger than age 19, and appears in the legs and arms. It is more common in boys than girls.

Risk Factors

Certain conditions, as well as exposure to certain chemicals, put people at higher risk for developing bone sarcomas, particularly osteosarcoma. These include:

  • Hereditary conditions, including a rare childhood eye cancer called hereditary retinoblastoma, and hereditary bone diseases, such as enchondromatosis and osteochondromatosis
  • Prior radiation exposure
  • Treatment with anti-cancer medications

Symptoms

As a sarcoma begins to develop, there may be no noticeable symptoms. However, over time, patients may feel:

  • Persistent pain
  • Swelling
  • A bump or mass where the tumor is located

Diagnosis and Treatment

Your doctor can detect the presence of a bone sarcoma in the following ways:

  • History and physical examination: This includes feeling and looking at the area of pain, as well as gathering information about family medical history.
  • Imaging tests help to determine a tumor's size, shape, location and whether a tumor is benign or malignant. Imaging tests include:
    • X-rays, CT and PET scans, and MRI
    • Angiogram: creates a picture of the interior of the blood vessels
    • Bone scan: a doctor injects and then tracks a radioactive substance through the blood. A scanner can detect the substance's route once it settles in the bones.
  • Blood work: tests for levels of alkaline phosphatase. This chemical in the blood may be higher than normal because of tumor growth in the bone tissue.
  • Biopsy: your doctor collects a tissue sample from the affected area to identify the exact type of tumor

After examining the results of one or more of these tests, your doctor will tell you if you have a bone sarcoma and will always answer any questions you have. MedStar Health also has compassionate patient support services for newly diagnosed patients.

Many patients will have success from a combination of treatment types. Each patient undergoes a thorough evaluation to determine the most effective course of treatment, which include

Soft Tissue Sarcomas

Soft tissue sarcomas are rare cancerous tumors that can grow in muscle, fat, nerves, and blood vessels, and they are distinguished by where in the body they originate. About half of all soft tissue sarcomas affect the arms and legs, while the rest appear in the head, neck, or trunk. Regardless of where they begin to grow, soft tissue sarcomas tend to present with similar characteristics and symptoms, and are treated the same way.

Types

  • Fibrosarcoma: Develops from the tissues keeping bones, organs, and muscles secure and appears most often in the legs, arms, and trunk.
  • Hemangiosarcoma: Develops from the blood vessels in the arms, legs, head and trunk.
  • Leiomyosarcoma: Develops from smooth muscles used to control the movement of internal organs and blood vessels. These tumors tend to affect adults.
  • Liposarcoma: Develops from fatty tissues, and appears most often in the legs and trunk.
  • Lymphangiosarcoma: Develops from the lymph vessels, and appears in the arms. It tends to affect tissues that may have been exposed to radiation.
  • Malignant fibrous histiocytoma: Develops within muscle or fat, most often in the thighs and trunk. It tends to affect older adults.
  • Neurofibrosarcoma: Develops from nerves, and appears most often in the legs, arms and trunk.
  • Rhabdomyosarcoma: Develops from skeletal muscles used to move bones. It tends to affect young children, and appears most often in the arms and legs.
  • Synovial sarcoma: Develops from tissues that cushion the joints, such as knees and elbows. It tends to affect children and adolescents.

Risk Factors

Certain conditions, as well as exposure to certain chemicals, put people at higher risk for developing soft tissue sarcomas. These include:

  • Hereditary conditions, including a rare childhood eye cancer called inherited retinoblastoma, Li-Fraumeni syndrome, Gardner's syndrome, and a nerve tissue disorder called neurofibromatosis.
  • Radiation exposure, specifically when used to treat other cancer types.
  • High dose chemical exposure to
    • Vinyl chloride, an ingredient in plastic
    • Phenoxyacetic acid, an ingredient in certain herbicides
    • Chlorophenols, an ingredient in wood preservatives
    • Arsenic

Symptoms

As the soft tissue sarcoma develops, patients may feel a lump. These sarcomas often do not cause pain or swelling, so it is important to have a doctor examine any lump that lasts a long time.

Diagnosis and Treatment

Your doctor can detect the presence of a soft tissue sarcoma in the following ways:

  • History and physical examination: This includes palpating (feeling) the tumor mass. as well as gathering information about family medical history.
  • Imaging tests help to determine a tumor's size, shape, location and whether a tumor is benign or malignant. Imaging tests include X-rays, CT and PET scans, and MRI

After examining the results of one or more of these tests, your doctor will tell you if you have a bone sarcoma and will always answer any questions you have. MedStar Health also has compassionate patient support services for newly diagnosed patients.

Many patients will have success from a combination of treatment types. Each patient undergoes a thorough evaluation to determine the most effective course of treatment, which include

Learn more about orthopaedic cancer treatment.

Physiatry/Pain Management

Physiatry

Physiatrists, i.e. Pain Management and Rehabilitation physicians, are medical doctors who are:

  • Non-surgical spine specialists who use targeted spinal injections to diagnose and treat “sciatica,” back, buttocks, leg, neck, shoulder, and arm pain
  • EMG (electromyographers) who perform specialized nerve tests to determine if numbness or tingling is from diseases such as carpal tunnel syndrome, radiculopathy(bulging discs), or peripheral neuropathy
  • Experts at diagnosing and treating pain
  • Restore maximum function lost through injury, illness or disabling conditions
  • Treat the whole person, not just the problem area
  • Lead a team of medical professionals
  • Provide non-surgical treatments
  • Explain your medical problems and treatment plan
  • Work not only on treatment but also prevention

Rehabilitation physicians are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. Rehabilitation physicians have completed training in the medical specialty physical medicine and rehabilitation (PM&R).

Rehabilitation physicians treat a wide range of problems from sore shoulders to spinal cord injuries. Their goal is to decrease pain and enhance performance without surgery. Rehabilitation physicians take the time needed to accurately pinpoint the source of an ailment. They then design a treatment plan that can be carried out by the patients themselves or with the help of the rehabilitation physician’s medical team. This medical team might include other physicians and health professionals, such as neurologists, orthopedic surgeons, and physical therapists. By providing an appropriate treatment plan, rehabilitation physicians help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions throughout a person’s lifetime. 

Physiatry Specialists and Rehabilitation Physicians may treat the following conditions: