Imagine, if you would, a maiden in a hooded red cape. Looking strong and confident as she takes on a fierce creature in a defiant paso doble.

If you can, you were probably watching Dancing with the Stars last night.

Talk show host and actress Ricki Lake and her professional partner Derek Hough were put back at the top of the leader board with 27 points for their near-perfect dance. They did this despite Lake’s injury earlier in the week. As she put it:

I did something to my ribs sometime in rehearsal last week, so I just want to get it checked out, to make sure it isn’t broken or displaced or something.

Lake was taken to see Dr. Bradley Frederick, D.C. X-rays did not reveal any fractures, and he diagnosed Lake as having intercostal neuritis, an irritation of the nerves that run along the ribs:

This is a severe condition. It needs time to heal and it needs rest … It will get worse and most athletes, we would take them out of the activity for at least a week or two. Since we can’t do that with you, we’re gonna just try and bandage you up and keep you going through the next three weeks.

Anatomy of a Rib

The human rib cage, also known as the thoracic cage, is a structure made up of cartilage and bone. A typical human rib cage consists of 12 pairs of ribs, the sternum (or breastbone), costal (rib) cartilages, and the 12 thoracic vertebrae of the spine.

All ribs are attached in the back to the thoracic vertebrae.

The upper seven true ribs are attached to the breast bone by means of costal cartilage. Their elasticity allows movement of the ribs when inhaling and exhaling.

The 8th, 9th, and 10th ribs are called false ribs because, instead of joining to the breastbone, they join with the costal cartilages of the ribs above.

The 11th and 12th ribs are known as floating ribs, and they do not have any connection to the breastbone .

The spaces between the ribs are known as intercostal spaces; they contain the intercostal muscles, nerves, and arteries.

Intercostal muscles are muscles that run between the ribs, and help form and move the chest wall. They are mainly involved in the mechanical aspect of breathing and help expand and shrink the size of the chest cavity.

What is Intercostal Neuritis?

Intercostal neuritis (IN) is an inflammation of the nerve that runs along a groove at the bottom of each rib. It can also be referred to as intercostal neuralgia.

Costochondritis is an inflammation of the rib cartilages and may have similar symptoms as intercostal neuralgia.

Intercostal neuralgia may be caused by an injury that damages the nerves or as a result of a degenerative disease that pinches or otherwise damages the nerves. Conditions associated with IN include pregnancy, surgical trauma, tumors of the chest, and shingles.

The pain of IN can be constant or intermittent.  It can be described as stabbing, tearing, sharp, spasm-like, tender, aching or gnawing. You may experience pain while breathing, coughing, and laughing or during exertion. Intercostal neuralgia can also be manifest as tingling, numbness, or itchiness. It can feel like the pain wraps like a band around your upper chest.
You may also feel the pain under your arm or  around to the back of your shoulder blade. Even if the pain is intermittent, it can makes the touch of cloth, skin pressure and normal daily activities such as sitting or lying difficult and painful.

Treatment of intercostal neuralgia includes the use of analgesic medication to manage pain, along with anti-inflammatory drugs to reduce inflammation, such as ibuprofen or naproxen, around the nerves. A doctor can administer an injection of local anesthetic for a patient experiencing extreme pain. Resting the area as much as possible is also important. Heating pads can also lessen the pain. Other options can include physical and/or massage therapy.

Have any of you experienced intercostal neuritis? What have you done to help with the pain?

For more information, click here to go the Resounding Health Casebook on the topic.

What did we tell you about Dancing with the Stars being one of the most dangerous shows in Reality TV?

The latest injury on DWTS was sustained by dancing pro Derek Hough. He dislocated his shoulder during rehearsal Tuesday.

However, being the professional he is, this did not stop him from dancing live last night.

Derek danced with his sister, Julianne Hough, also a former DWTS pro. Julianne was on the show to promote her new film, a remake of the 1984 dance movie Footloose.

A source told People magazine: “He popped it back in, but he is still in a lot of pain.”

What is a Dislocated Shoulder?

The shoulder is a complex of four separate joints (see diagram), together called the shoulder girdle, which gives it its amazing ability to move in so many directions.

It is easily injured because the ball of the upper arm is larger than the socket that holds it (sort of like a golf ball on a tee). To remain stable, it must be anchored by its muscles, tendons, and ligaments.

The shoulder joint is the most frequently dislocated major joint of the body. It can become dislocated when either:

• a strong force pulls the shoulder outward, or
• extreme rotation of the joint pops the ball of the humerus out of the shoulder socket

Dislocation commonly occurs when there is a backward pull on the arm that either catches the muscles unprepared to resist or overwhelms the muscles.

The shoulder can dislocate either forward, backward, or downward. When the shoulder dislocates, the arm appears out of position.
Other symptoms include pain, which may be worsened by muscle spasms, swelling, numbness, weakness, and bruising.

Doctors usually diagnose a dislocation by a physical examination; x rays may be taken to confirm the diagnosis and to rule out a related fracture.

A dislocation is treated by putting the ball of the humerus back into the joint socket, a procedure called a reduction. The arm is then stabilized for several weeks in a sling or a device called a shoulder immobilizer.

After pain and swelling have been controlled, the patient enters a rehabilitation program that includes exercises. The goal is to restore the range of motion of the shoulder, strengthen the muscles, and prevent future dislocations.

After treatment and recovery, a previously dislocated shoulder may remain more susceptible to re-injury, especially in young, active individuals. Ligaments may have been stretched or torn, and the shoulder may tend to dislocate again. A shoulder that dislocates severely or often, injuring surrounding tissues or nerves, usually requires surgical repair to tighten stretched ligaments or reattach torn ones.

How is this Different from a Separated Shoulder?

Shoulder dislocation is often confused with shoulder separation, but these are two very different injuries!
A shoulder dislocation occurs when there is an injury to the joint between the humerus and scapula. A shoulder separation occurs when there is an injury to the joint between the scapula and clavicle–this is called an acromioclavicular (or A-C) separation.

For more information about shoulder injuries, click here to go to the Resounding Health Casebook on the topic.

Imagine yourself in the following scenario:

You are born with blond hair and blue eyes. Everyone tells you how nice you look, how that shirt brings out your eyes, how your hair just glistens in the sun!

But when you look in the mirror, that’s not who you expect to see looking back at you.
You see yourself with brown hair, and dark eyes.
It’s confusing, but you figure they must know better than me.

You grow older, and with each day that feeling of unease deepens, until eventually you can’t stand being in your own skin. You talk to people about it, but they look at you like you are crazy.

Until one day, you see a movie about a child with brown hair and eyes who believes he has blond hair and blue eyes. He gets beat up, ridiculed, and tormented and at that moment, you realize…

You are not alone.

Meet Chaz

Chaz Bono, born Chastity Sun Bono, is the biological daughter of pop icons Cher and Sonny Bono.

After several years of being outed as a lesbian by the tabloid press, Bono publicly self-identified as such in a cover story in a leading American gay monthly magazine, The Advocate in 1995.

She since went on to be the author of two books Family Outing: A Guide to the Coming Out Process for Gays, Lesbians, and Their Families in 1998 and The End of Innocence, a memoir in which she discusses her outing, music career, and partner Joan’s death from non-Hodgkin’s lymphoma.

In 2008, at 39, Chastity realized something very important, she wasn’t just a lesbian, she was in the wrong body entirely.

Bono began a series of surgeries in 2009 to become male.

He has been quite open about the process, documenting his journey in a film on OWN (The Oprah Winfrey Network). In Becoming Chaz, Bono reveals that:

[He] was a male trapped in a female shell for as long as he can remember. Growing up as Sonny and Cher’s adorable golden-haired daughter in a body he felt wasn’t his own was a crucible it took years to transcend. Now, as he undertakes gender reassignment, he’s bravely decided to share the process on camera.
Becoming Chaz invites us along on Chaz’s remarkable journey of transformation. As hormone shots give way to top surgery, down-to-earth, unflappable Chaz beams with a sense of liberation and goes public with his story to put a face on a misunderstood issue.

Chaz says there are still many people who disagree with his controversial decision. “I guess it’s been a little more of an issue than I expected, but part of that is that the media loves a controversy, so it gets perpetuated,” he told reporters.

Most recently, Chaz has written a New York Times Bestseller memoir entitled Transition: The Story of How I Became a Man.

The Long and Winding Road

The process of gender reassignment surgery,  more commonly referred to as a “sex change operation,” is highly complex and lengthy. The process usually has five steps:

• Diagnostic assessment
• Psychotherapy
• Hormone therapy
• Real-life experience
• Surgery to change genitalia and other sex characteristics

A transgender person begins by consulting a mental health professional who performs sessions of psychotherapy and formulates a diagnosis.

To become a candidate for gender reassignment surgery, an individual must first be diagnosed with Gender Identity Disorder (GID).  This is defined as a conflict between a person’s actual physical gender and the gender that person identifies himself or herself as.

The person experiences significant discomfort with the biological sex they were born.

Getting Ready

Male hormones, androgens, are given to biological females transitioning to male. Estrogen, progesterone, and testosterone-blocking agents are given to biological males transitioning to female.

This causes the development of many of the desired secondary sexual characteristics, such as breast or beard growth. Hormones can be taken orally, by injection or transdermally (a patch).

The “real-life” phase of the process immerses the individual into life as his or her preferred gender.

The individual must maintain full or part-time employment (or attend school full or part-time). They must also legally change their name to a gender appropriate one and clearly and openly state as to which gender they would prefer to be associated.

If, after 12 months of continuous and successful hormone therapy and Real-Life Experience, the individual successfully completes all the steps, are they then eligible for genital surgery, but there’s still one more requirement.

In order to actually undergo the surgery, they still require two letters of recommendation (such as one from their mental health professional and one from the hormone-prescribing physician).

Surgical options

The series of surgeries for trans men (female becoming a male) is different than trans women (male becoming female).

Phalloplasty is the construction or modification of a penis. An erectile prosthesis is needed to achieve erection and there is significant risk of loss of erogenous sensation.

The surgery is long and can take 8-10 hours.

Metoidioplasty is the less risky alternative to phalloplasty. Taking testosterone, the clitoris enlarges, over time, to an average of 4–5 cm.

This is because the clitoris and penis are developmentally similar organs. The enlarged clitoral tissue is  moved forward to more closely approximate the position of a penis. The surgery itself is also considerably shorter, taking only 2–3 hours. It is also usually less expensive.

Chaz had undergone a hysterectomy (removal of the uterus/womb) in 2005, but this was done because of endometriosis. In September 2009, he underwent “top surgery”- surgery to remove his breasts.

At the present time, he is still undecided as to whether to have bottom surgery. “To me the options of bottom surgery aren’t that great, considering the time, money, and pain you have to go though”.

In May 2010, Bono legally changed his gender and name.

Dancing with the Stars

Two weeks ago, the new cast of Dancing with the Stars was announced, and Chaz Bono was among them. Being the show’s first transgender contestant, Chaz, and his partner, dancing pro Lacey Schwimmer, have been one of the most buzzed-about couples in the show’s history.

Conservative groups began to call for a boycott of the show.

The American Family Association says Chaz and ABC are pushing a political agenda, and it could harm families.

Spokesperson Monica Cole  stated: “We will not be able to watch the show with Chaz on there. This is going to be very confusing for children. And should not be included in their cast.”

Mama Cher quickly came to her son’s defense on Twitter:

Chaz is Being Viciously Attacked on Blogs & Message boards about being on DWTS! This is Still America right ? It took guts 2 do it

Chaz Bono’s inclusion on DWTS is a courageous move on his part. Despite what he has been through, he is not going to spend the rest of his life hiding under a rock.

Chaz proves that being different, doesn’t have to mean being afraid.
That standing up for what you believe in, no matter what the odds or obstacles, is the only way to live.
That being true to yourself, regardless of who may doubt you, is not only necessary, it’s your right.

And who knows, maybe he’ll turn out to be a really good dancer….

If you, or anyone you know may be struggling with Gender Identity Disorder, there are a number of resources available to you, but here’s a place where you can start:

Resounding Health Casebook on Gender Identity Disorder

Did you watch the season premier of Bravo’s Real Housewives of Beverly Hills?

Unless you’ve been living under a rock, you’ve been bombarded with the news about Russell Armstrong’s suicide (Russell was the estranged husband of one of those housewives).

Why Did He Do It?

Because he hated being on the show and/or because his marriage was on the rocks, or was it his deteriorating finances?

How are the other Housewives dealing with this? How did Bravo  handle the situation?

The answer to the last question was answered Monday night with a 10 minute intro to the premier where the cast members met at Adrienne Maloof’s mansion home to “address the suicide”.

IMHO, the other cast members came off as self-absorbed prima donne who blamed the victim, Russell.  They seemed more concerned about themselves than about the guy who actually died. WTF?

Where was the honest appraisal of the difficulties of being on a reality show? Is being on a reality show hazardous to your health?

Let’s Get Physical

Out of the top 5 most dangerous reality TV shows, let’s ignore Deadliest Catch and Ice Road Truckers. Those kinds of shows depict occupations that are inherently dangerous, whether or not cameras are rolling.

Consider Dancing With The Stars! We’ve done at least 9 stories over the past 2 years about injuries on DWTS. These include Gilles Marino’s shoulder separation,  the stress fracture in Tom Delay’s foot and Jennifer Grey’s  ruptured neck disc which required surgery.

Then there’s the Survivor franchise. Just name an injury and someone on the show has probably had it. Two stand out in my mind…

Survivor: Micronesia contestant Chet Welch, a 49 year old pageant coach, cut his foot on some coral. This lead to a heel infection requiring antibiotics and caused Welch’s departure from the show.  Outback Australia contestant Michael Skupin suffered third degree burns to his hands when he blacked out and fell into a fire pit. He had to be rushed off the set.

Semi-starvation, Infectious Disease & Exposure, Oh My

Weight loss is a good thing and indeed a goal for contestants on Biggest Loser. On other shows, such as Survivor, weight loss comes as a result of semi-starvation diets, eating bizarre foods like insect larvae, grueling physical exertion and exposure to the elements. Most seasons of Survivor are in hot climates probably so contestants have to prance around semi-nude (good for ratings) but this can lead to sunburn, heat exhaustion and dehydration.

On I’m a Celebrity…Get me out of Here! actor Stephen Baldwin got 125 bug bites in the 8 days he was there. An allergic reaction caused him to lose 22 pounds. On the same show, Heidi Montag left complaining of abdominal pain due to gastritis.

Contestants who have preexisting conditions can be made worse by their participation in the show.  American Idol contestant Casey Abrahms, who had to be hospitalized and given a blood transfusion when his ulcerative colitis flared up.

Does This Make My Head Look Fat?

Perhaps some of most insidious aspects of Reality TV is what it does to the mental and emotional health of the participants. Although being in the public eye can be exciting for cast members this exposure can come at a high cost.

The loss of privacy exposes details of participants’ lives to the world. Every aspect of their life is now available for comment and possibly public condemnation. This can lead to feelings of humiliation, inadequacy and self-doubt.

Reality TV thrives on drama and conflict. Shows specifically recruit the kind of unstable personality who will keep things unpredictable. According to the Dallas Heralds’ Elaine Liner:

Someone in each cast is pegged as the nasty one, either through editing or subtle scripting (what reality TV insiders call “cooking” the interaction among cast members).

Even more troubling is what can happen to these contestants once the show, and their 15 minutes of fame, is over. Many of these folks will have trouble readjusting to real life. For those predisposed to depression, the loss of celebrity can accelerate the process. According to Dr. Jamie Huysman, a therapist who specializes in reality show contestants:

Being on TV helps give damaged people the illusion that they matter, that they’re noticed:  “Hey! I’m on TV so I must be important. People want to hear what I have to say.” So people will tell the camera what they’d never tell a friend or family member or clergyman…[or] a therapist. Appearing on TV is a validation that you matter, that you’re being noticed. It’s like shooting up a fix of self-esteem. Problem is, just like shooting heroin, the “fix” doesn’t fix anything. When the red light on the camera goes off, you’re left with yourself and all your problems still intact.

Tales of suicide among former reality show contestants abound. Here’s just a few:

• Paula Goodspeed- American Idol, 2008. Drug overdose in front of Paula Abdul’s home after being bounced from auditions
• Najai Turpin- The Contender, 2005.  Gun shot wound
• Joe Cerniglia- Kitchen Nightmares, 2010. Jumped into the Hudson River
• Julien Hug- The Bachelorette, 2009. Gun shot wound

Lastly, shows like the Real Housewives of Beverly Hills, where cast members belong a privileged class, often put additional financial stress on the families to keep up to the show’s high standards even when their own financial situation may change. Russell Armstrong’s crumbling financial status being aired for all to see could be a contributing factor to his suicide.

What Do You Think?

• Have you ever been on a Reality TV show or known anyone who was?
• Would you want to be a cast member, even though it could risk your physical or psychological health?
• What kind of legal waivers are contestants required to sign?
• What responsibilities do producers and advertisers have if cast members do get injured or sick?
• Should the U.S. Surgeon General or the Centers for Disease Control and Prevention (CDC) get involved?

Please share your thoughts and stories with us and other readers. For more information on suicide and non-suicidal self-injury (NSSI, e.g. cutting) see our story on Why Did Sadie Frost Hurt Herself?

The celebrity cast of Season 13 of Dancing with the Stars was announced this week with much fanfare. But for one of the new contestants, Los Angeles Lakers star Ron Artest, this competition is personal. Artest says he’s on the show to raise money for cancer research. He was inspired by his 8-year old daughter Diamond‘s battle with a kidney cancer called Wilms’ Tumor. According to People magazine:

“At first it was not appealing,” Artest confesses. “I did not want to do it. I don’t dance and all of the dressing up and everything, but my daughter Diamond was like, Daddy, you should do it.” “She asked me to do it, and I thought I could dance and raise some money for cancer research. I’m going to donate the profits.”

Diamond was diagnosed with Wilms’ Tumor at the age of 4. When the stomach pains she of which she complained wouldn’t go away, she was taken to her family doctor. A large lump in her abdomen was found, and she was eventually diagnosed with Stage 3 Wilms’ Tumor.  Stage 3 means that the cancer has spread to tissues, and possibly the lymph nodes near the kidney and cannot be completely removed by surgery. Diamond had to undergo chemotherapy to shrink the tumor before it could be removed. Typically the whole kidney is removed with the tumor, but this wasn’t possible for Diamond, since she was born with only one kidney. Fortunately, Diamond is doing great now, and will surely serve as an inspiration to her father during the competition.

Wilms’ tumor is a rare type of kidney cancer that affects children. It causes a tumor on one or both kidneys. According to the American Cancer Society, about 500 new cases of Wilms tumors are diagnosed in the United States each year. About 5% of all cancers in children are Wilms tumors.

Wilms tumors tend to occur in young children. The average age at diagnosis is about 3 years. It becomes less common as children grow older and is uncommon after age 6.  Wilms tumors are slightly more common among African Americans and among girls. It is a very treatable cancer- about 90% of patients are still cancer-free five years after treatment.

Possible signs of a kidney tumor include a lump in the abdomen and blood in the urine. Because the kidneys are located in the back of the abdomen (on either side of the spine), the tumors often grow quite large before they are detected.  Other signs can include fever, constipation, decreased appetite, abdominal pain and weight loss.

The tumor is usually diagnosed and removed in surgery. Other treatments include chemotherapy, radiation, biologic therapy or a combination. Biologic therapy, or immunotherapy, boosts your body’s own ability to fight cancer.

I’ll be rooting for Ron during the competition, since he will be competing for a very worthy cause.

Any of you have any experience with Wilms’ Tumor?

Parents, have you had a child with cancer? Tell us about that experience?

For more information about Wilms’ Tumor, click here to go to the Resounding Health Casebook on the topic.

Photo Credit: American Society of Clinical Oncology

Another dancer has been injured on Dancing with the Stars. This time, it’s professional dancer Kym Johnson, who is partnered with NFL Pittsburgh Steeler Hines Ward. Johnson was injured during a fall at rehearsal last night and was taken by ambulance to a local hospital. She apparently injured her neck, but was released from the hospital wearing a neck brace. The show released a statement saying:

“After several tests, she was cleared by the medical staff, though she is bruised, sore and currently wearing a neck brace. Kym plans to continue with Hines Ward in the competition and resume rehearsals as soon as possible.”

The neck (medically called the cervical spine) supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In addition, the neck is highly flexible and allows the head to turn and flex in all directions. The cervical portion of the spine consists of seven vertibrae, typically referred to as C-1 to C-7, with cartilaginous discs between each vertebral body. From top to bottom the cervical spine is gently curved in convex-forward fashion. It is the least marked of all the curves of the column.

There are also many muscles and ligaments which help move the head and  support the spinal column.

Neck pain can come from any part of your neck: muscles, bones, joints, tendons, ligaments or nerves  can cause it. Pain may also come from your shoulder, jaw, head or upper arms.

Muscle strain or tension often causes neck pain. The problem is usually overuse, such as from sitting at a computer for too long. Sometimes you can strain your neck muscles from sleeping in an awkward position or overdoing it during exercise. Falls or accidents, including car accidents, are another common cause of neck pain. Whiplash, a soft tissue injury to the neck, is also called neck sprain or strain.

(Remember: A sprain is an injury to the ligaments and tendons, a strain is a muscle injury.)

According tot the American Association of Orthopedic Surgeons, the symptoms of a neck sprain can include:

• Pain, especially in the back of the neck, that worsens with movement
• Pain that peaks a day or so after the injury, instead of immediately
• Muscle spasms and pain in the upper shoulder
• Headache in the back of the head
• Sore throat
• Increased irritability, fatigue, difficulty sleeping, and difficulty concentrating
• Numbness in the arm or hand
• Neck stiffness or decreased range of motion (side to side, up and down, circular)
• Tingling or weakness in the arms

Treatment depends on the cause, but may include applying ice, taking pain relievers, getting physical therapy or wearing a cervical collar. Surgery is rarely needed.

Dancing with the Stars contestant, Ralph Macchio, has been out of rehearsals several times this week due to pain caused by a ruptured cyst (called a Baker’s cyst) behind his knee. The 49 year old, former Karate Kid, tweeted:

“Have missed days of rehearsal this week. Had a ruptured cyst on the back of my knee causing acute pain. Hoping to be able to perform tonight!”

So far, it looks like Macchio will be dancing tonight, although he will be “rough around the edges w/o rehearse time.”

A Baker’s cyst is a buildup of joint fluid (synovial fluid) that forms behind the knee. It  is noticed as a  swelling at the back of  the knee. The swelling is due to an increase in synovial fluid – the fluid that lubricates the knee joint. When pressure builds up, fluid bulges into the back of the knee.

Baker’s cyst commonly occurs with:

• A tear in the meniscal cartilage of the knee
• Knee arthritis (in older adults)
• Rheumatoid arthritis
• Other knee problems

A large cyst may cause some discomfort or stiffness, but there are often no symptoms. There may be a painless or painful swelling behind the knee. The cyst may feel like a water-filled balloon. Sometimes, the cyst may break open (rupture), causing pain, swelling, and bruising on the back of the knee and calf.

NOTE: It is important to know whether pain or swelling is caused by a Baker’s cyst or a blood clot. A blood clot (deep venous thrombosis) can also cause pain, swelling, and bruising on the back of the knee and calf. A blood clot may be dangerous and requires immediate medical attention.

During a physical exam, the doctor will look for a soft mass in the back of the knee. If the cyst is small, comparing the affected knee to the normal knee can be helpful. There may be limitation in range of motion caused by pain or by the size of the cyst. In some cases there will be signs and symptoms of a meniscal tear.

Transillumination, or shining a light through the cyst, can show that the growth is fluid filled.

Often no treatment is needed. The health care provider can watch the cyst over time. If the cyst is painful, the goal of treatment is to correct the problem, such as arthritis or a meniscus tear. The cyst is usually not removed because it can come back. The surgery may also damage nearby blood vessels and nerves. Sometimes, a cyst can be drained (aspirated) or, in rare cases, removed with surgery if it becomes very large or causes symptoms.

A Baker’s cyst will not cause any long-term harm, but it can be annoying and painful. The symptoms of Baker’s cysts usually come and go. Long-term disability is rare. Most people improve with time or arthroscopic surgery.

Source: MedlinePlus

Last night on Dancing with the Stars contestants were to tell a “personal story” with their dance.  Kirstie Alley and professional partner Maksim Chmerkovskiy were dancing to Somewhere Over the Rainbow when, shortly after starting, Maks fell, dropping Kirstie. Afterwards he seemed to be in pain, although he and Kirstie finished the dance. He said it was his fault, and that his thigh  “just gave out”.

Despite the fall, the judges praised the pair and gave them a score of 21- higher than their score for last week’s quickstep. Today Maks apologized to Kirstie on Twitter:

“To all the fans…I’m sorry! It will never happen again and I will never ‘fall’! To @kirstiealley You were..FLAWLESS! In more ways than one!”

Her reply? “I salute u… U r a gladiator …. A champion… I’m honored to be your partner.”

The thigh has three main sets of muscles: the hamstring muscles in the back of the thigh, the quadriceps muscles in the front, and the adductor muscles on the inside. The quadriceps muscles and hamstring muscles work together to straighten (extend) and bend (flex) the leg. The adductor muscles pull the legs together.

The quadriceps femoris, or quads, is a large muscle group that includes the four prevailing muscles on the front of the thigh.It is the strongest and leanest muscle in the human body.
It is subdivided into four separate portions or ‘heads’, which have received distinctive names:
Rectus femoris occupies the middle of the thigh, covering most of the other three quadriceps muscles. It originates on the ileum- the main part of the pelvic. It is named from its straight course.

The other three lie deep to the  rectus femoris and originate from the body of the femur, or thigh bone, and run the entire length of the bone:
Vastus lateralis is on the lateral side of the femur (i.e. on the outer side of the thigh).
Vastus medialis is on the medial side of the femur (i.e. on the inner part thigh).
Vastus intermedius lies between vastus lateralis and vastus medialis on the front of the femur (i.e. on the top or front of the thigh), but deep to the rectus femoris. Typically, it cannot be seen without dissection of the rectus femoris.

All four parts of the quadriceps muscle attach to the knee cap (patella) via the quadriceps tendon.

A strain comes from an injury to a muscle or tendon (the thick fibrous band that attaches a muscle to a bone). It comes after a quick tear, twist or pull of a muscle caused by over contraction or stretching. Pain, weakness, or muscle twitching are frequent symptoms of strains.  A sprain is an injury to the ligaments ( thick bands of cartilage that connects bone to bone) caused by a fall or outside force that pulls the surrounding joint beyond its normal range of movement. The degree of sprain can range from a stretched ligament to a completely torn ligament.  Symptoms include pain with movement,  swelling, bruising, and joint instability. Mild injuries of either type are treated with RICE therapy- rest, ice, compression, and elevation. More severe injuries may require immobilization or possibly surgery to restore function.

Actress Jennifer Grey posted this season of Dancing with the Stars’ first “perfect score” for her rumba with dance partner Derek Hough last night. At the end of the show, the 52 year old actress was tied at the top of the Leader Board with singer Brandi. This was done despite the fact that Grey has been dancing with pain in her knee caused by a patella tendinitis. Rehearsal clips from earlier in the week showed Grey being barely able to dance, then being examined by orthopedic surgeon, Dr. Gary Brazina. According to Brazina: “You’ve got this partial tearing of the tendon constantly…She has a fairly significant patella tendinitis. It’s inflamed, it’s badly inflamed.”  When Grey had to decide whether to continue in the DWTS competition, she called in her father, Caberet actor, Joel Grey to talk it over with him. “My dad reminded me of who I am… My knee hurts but I’m going to push through, because my dad always told me ‘The show must go on’.” And so she did…

Tendinitis is a common condition that involve inflammation of the soft tissue around muscles and bones, most often in the shoulder, elbow, wrist, hip, knee, or ankle. A tendon is a flexible band of fibrous tissue that connects muscles to bones. Tendons transmit the pull of the muscle to the bone to cause movement. They are found throughout the body, including the hands, wrists, elbows, shoulders, hips, knees, ankles, and feet. Tendons can be small, like those found in the hand, or large, like the Achilles tendon in the heel. Tendinitis is an inflammation of a tendon.

What Causes Tendinitis?

Tendinitis is most often the result of a repetitive injury in the affected area. These conditions occur more often with age. Tendons become less flexible with age, and therefore, more prone to injury. People such as carpenters, gardeners, musicians, and athletes who perform activities that require repetitive motions or place stress on joints are at higher risk for tendinitis .

The patella tendon is the band of tissue that connects the knee cap (the patella) to the larger of the two lower leg bones called the tibia.  Along with the quadriceps muscle and the quadriceps tendon, these structures allow your knee to extend, or straighten out the leg.

Patella tendinitis is also due to overuse, especially from jumping activities. If a person overuses a tendon during activities such as dancing, cycling, or running, it may elongate or undergo microscopic tears and become inflamed. Trying to break a fall may also cause the quadriceps muscles to contract and tear the quadriceps tendon above the knee cap (patella) or the patellar tendon below it. This type of injury is most likely to happen in older people whose tendons tend to be weaker and less flexible. Tendinitis of the patellar tendon is sometimes called jumper’s knee because in sports that require jumping, such as basketball, the muscle contraction and force of hitting the ground after a jump strain the tendon. After repeated stress, the tendon may become inflamed or tear.

People with tendinitis of the knee may feel pain during running, hurried walking, or jumping. Knee tendinitis can increase risk for ruptures or large tears to the tendon. A complete rupture of the quadriceps or patellar tendon is not only painful, but also makes it difficult for a person to bend, extend, or lift the leg; or to bear weight on the involved leg.

How is Tendinitis treated?

Treatment focuses on healing the injured tendon. The first step in treating this condition is to reduce pain and inflammation with rest, compression, elevation, and anti-inflammatory medicines such as aspirin, naproxen (Naprosyn1, Aleve), or ibuprofen (Advil, Motrin, or Nuprin).

Activity involving the affected joint is also restricted to encourage healing and prevent further injury. In some cases a physician may recommend a support strap (called an infrapatellar strap or a Chopat strap), a knee brace, or custom orthotics to provide some pain relief, limiting the pull of the tendon on the bone.

The doctor or therapist may use ultrasound (gentle sound-wave vibrations) to warm deep tissues and improve blood flow. Iontophoresis may also be used. This involves using an electrical current to push a corticosteroid medication through the skin directly over the inflamed tendon.

Gentle stretching and strengthening exercises are added gradually. Massage of the soft tissue may be helpful. These may be preceded or followed by use of an ice pack. The type of exercises recommended may vary depending on the location of the affected tendon.

If there is no improvement, the doctor may inject a corticosteroid medicine into the area surrounding the inflamed  tendon. While corticosteroid injections are a common treatment, they must be used with caution because they may lead to weakening or rupture of the tendon (especially weight-bearing tendons such as the Achilles [ankle], posterior tibial [arch of the foot], and patellar [knee] tendons). If there is still no improvement after 6-12 months, the doctor may perform either arthroscopic or open surgery to repair damage and relieve pressure on the tendons.

For more information about patella tendinitis, click here to go to the Resounding Health Casebook on the topic.

New Kids on the Block singer (as well as former Dancing with the Stars contestant)  Joey McIntyre spoke to People magazine about his 3-month-old son Rhys’ s hearing problem. Little Rhys, after failing his newborn hearing screening test, was extensively worked-up and determined to have severe hearing loss. Although McIntyre and his wife Barrett were shocked by the diagnosis, they did not simply throw up their hands: Joey told People : “We’re being totally proactive about the situation.  That meant signing up for speech therapy and getting Rhys fitted for hearing aids in both ears when he was just a month old.” The McIntyres are now seeing things in a positive light- Rhys responds to their voice and is doing all the age-appropriate developmental things. Barrett says: “He’s really easy-going; he has that chill vibe. Rhys’ hearing loss won’t stop him from doing anything.”

According to the National Institutes of Health:

“Two to three of every 1,000 children in the United States are born deaf or hard-of-hearing, and more lose their hearing later during childhood. NIH-supported research suggests that the most intensive period of speech and language development is during the first three years of life — a period when a child’s brain is developing and maturing. If a child is not exposed to language during this period due to hearing loss, he or she will have more difficulty developing spoken or signed language, and reading skills. In addition, during the early stages of life, the brain builds the nerve pathways necessary for understanding auditory information. For these reasons, identifying hearing loss as early as possible, by the time a child reaches three months of age, enables pursuing treatment options early so that a child can learn to communicate comparably with his or her hearing peers.”

What is Universal Newborn Hearing Screening?

Most babies have a hearing screening soon after birth, usually before they leave the hospital. This is often called Universal Newborn Hearing Screening (UNHS). That means everybody is screened. UNHS is the first step in the Early Hearing Detection and Intervention (EHDI) programs. Thirty-nine states plus the District of Columbia and Puerto Rico have mandated newborn hearing screening programs. An additional 5 states have voluntary programs. Most of the screening is done in the hospital, being the newborn is discharged for home. The procedure takes less than 10 minutes and is completely painless.

How does the inner ear work?

The inner ear is made of of two parts:the semicircular canals, which are important for balance, and the cochlea, a snail shell shaped organ which is responsible for hearing sounds. The cochlea is filled with a watery liquid, which moves in response to the vibrations coming from the middle ear via the oval window. As the fluid moves, thousands of “hair cells” are set in motion, and convert that motion to electrical signals that are communicated via neurotransmitters to many thousands of nerve cells.

How is UNHS done?

There are two kinds of screening tests that can be done:

1. Otoacoustic Emissions (OAE): This test measures sound waves (like an echo) produced by the cochlea in response to sound. A tiny probe is put inside the opening of the ear canal which measures the echo which occurs when small clicks or tones are played in the baby’s ear. If cochlear hearing loss exists, the cochlea either will not generate a response or the response will fall below the level that is expected from an ear with normal hearing.

2. Auditory Brainstem Response (ABR): This test measures the auditory nerve’s response to sound. Small clicks or tones are, once again, played in the baby’s ear. This time, small surface electrodes are place at three places on the baby’s head. These sensitive devices are able to measure the small electric current which is the nerve’s response to the sounds.

What happens if my baby fails the screening test?

First of all, don’t panic! Screening tests are just that- screens for the possibility of hearing problems.  Factors such as fluid in the middle ear, hearing loss at some but not all frequencies, and other factors can give false results.  Formal hearing tests by a trained audiologist will need to be done to confirm whether hearing loss actually exists.

If the hearing loss is permanent, referrals for hearing aids and speech and language services will be offered.

The Individuals with Disabilities Education Act (IDEA) requires that free early intervention programs be offered to babies and children with hearing loss, beginning at the time the child’s hearing loss is identified.

According to the American Academy of Pediatrics, “The outlook is good for children with hearing loss who begin an early intervention program before the age of 6 months. Research shows these children usually develop language skills on a par with those of their hearing peers.”

For more information:

Resounding Health(tm) Newborn Hearing Screening