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Thomas Cha: Role of Specialists in Accountable Care Organizations

Grand Rounds Video of Dr Tom Cha at Mass General Hospital, Boston, MARole of Specialists in Accountable Care Organizations:An Example of Spinal Stenosis
Thomas Cha, MD
Department of Orthopaedic Surgery
Massachusetts General Hospital,
Boston, MA
Grand Rounds presented on March 28, 2013 at the O’Keeffe Auditorium, Massachusetts General Hospital, Boston, MA
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Scapular Exercises for Stronger Shoulders

Exercises for Strong and Healthy Shoulders
Shoulders permit our arms to move in a wide arc and perform elaborate activities. This mobility is due to superb coordination of muscles and soft tissues around the shoulder and shoulder blades (scapula, SKA-pew-la), and is essential for performing activities in a pain- and injury-free manner. See related article on Rotator Cuff complications impairing shoulder movement.

Conventional shoulder exercises strengthen the larger muscles but tend to overlook the mid-back muscles that stabilize the scapulas. This can often result in muscle imbalance and consequently, bad posture. Even non-shoulder exercises like running on a treadmill with shoulders slouched can lead to stiffness and pain. These conditions increase injury potential and thus the need for corrective exercises.

Michael Bento, personal trainer at the Clubs at Charles River Park, Boston, demonstrates simple exercises you can do at home to develop shoulder strength and protect them from injury. As a bonus, these exercises also help tone the all important core muscles.

These exercises can be performed on a stability ball as shown, or on a work bench. Dumbbells or additional weights are not required. And as I surprisingly found out last week, you can do these scapular exercises while standing and starting with the arms in front! Yaay!

Common Starting Position for Shoulder-Scapula Exercises
scapular exercises

  • Anchor heels to a wall, toes on the floor and slowly roll out on a stability ball.
  • Rest upper abdomen on the ball and straighten body forming a line from ears to ankles.
  • Pull your shoulder blades down, tuck your chin and look at the floor.
  • Start with arms straight, hands in front of the ball (or bench), fingers lightly curled, palms facing each other and thumbs pointing forward.
  • In this position, your core muscles including abdominal and gluteus muscles are engaged in stabilizing your body.
  • For a challenging core-muscle workout, move your heels away from the wall as demonstrated above and use as starting position.

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What should I do for back pain?


Since shoveling snow two weeks ago, I have constant low back pain. What should I do for the pain?


Low back pain is one of the most common reasons for patients seeking medical advice. Most patients can find relief by using simple remedies at home.

Rest: During the initial phase, bed rest may relieve the pain, but should be limited to one or two days.

Medication: Over the counter medications such as ibuprofen (Motrin, etc) or naproxyn (Aleve, etc.) reduce the inflammation and relieve pain.

Talk to your primary care physician if the pain persists despite these measures. They may initially recommend –
Physical Therapy: A physical therapist often uses various techniques to decrease inflammation and will walk you through an exercise regimen to improve muscle strength and mobility. Patients can continue to perform these exercises as part of a home-based program to maintain these benefits over time.

Improvements in Posture: A simple tip to remember for the next time you are shoveling or lifting a heavy package is to use proper lifting techniques emphasizing the thigh and leg muscles, and not the back.

FDA Panel Approves Artificial Cervical Intervertebral Disc

A key Advisory Panel of the Food and Drug Administration (FDA) has recommend approval for an artificial cervical intervertebral disc device. The panel’s recommendations were based on results of limited clinical trials and the FDA is likely to approve the device for use in patients.

While artificial discs have been used in UK and Europe for many years, this will be the first artificial cervical disc approved for use in patients in the US. Artificial discs by other manufacturers are also at various stages of clinical trials and are in the process of seeking FDA approval.

Healthy spinal discs are soft but tough shock absorbers that separate each vertebral body making up the spine. Discs allow the spine to bend and twist. As we age, discs begin to dry out and lose their ability to absorb shocks, resulting in their bulging. This can put pressure on the spinal cord and nerves, leading to neck or arm pain.

In current surgical practice, the degenerated disc is removed and adjacent vertebrae are fused together with a metal plate, aiming to lessen the pain. But it also prevents natural movement of the spine, putting additional stresses on the adjacent (healthy) non-fused discs, quickening their breakdown and possibly leading to additional surgery.

The new artificial discs will be placed between the two vertebral bodies after the affected disc has been removed. Ideally, the artificial disc acts much like a human disk, providing flexible motion while acting as a shock absorber in the spine.

As part of the approval, the FDA panel has also insisted that the manufacturer Medtronic Sofamor Danek, Minneapolis, MN, conduct additional clinical studies to determine the long term durability of this device. This process will provide an early warning of complications and unexpected problems in a larger patient population.

“Surgeons here at the Orthopaedic Spine Center at MGH will be involved in the use and study of artificial cervical discs in the months to come,” reports Dr Kirkham Wood MD, Chief of the Orthopaedic Spine Service at MGH, and Assistant Professor of Orthopaedic Surgery at Harvard Medical School.