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How to Modify Your Road Training Regimen for Winter

August 16th, 2019

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Shape Up For Summer General Diet and Exercise Tips for Getting Back in Shape

August 1st, 2019

Shape Up For Summer - General diet and exercise tips for getting back in shape

Now that it's Summer and the weather is warming up, lots of people are thinking about changing their routine: shaking up their wellness, setting new well-being objectives, or perhaps simply shaping up for shorts-and-bathing-suit weather. In fact, any time is a good time to consider positive changes in diet, healthy habits and exercise. Shedding pounds, reducing your cholesterol, choosing healthy habits of rest, stress management, activity and diet – call it Summer Cleaning for the mind and body!

General diet advice

  1. Avoid liquid calories
    Most people fail to appreciate that they consume thousands of low-nutrition calories by drinking sweetened soda, bottled coffee and tea drinks, and super sugary fruit juices. Plain water is a much better beverage choice if your aim is to improve your diet and general health. Besides water, you can also try fresh lemon, orange and other citrus juices without extra sweeteners, and vegetable juices.
  2. Turn off the TV and head outdoors
    This one may sound self-evident, but for some people the most difficult distance to cover is the steps from the couch to the front door. And it’s way worse when we add a snacking habit – before you open that bag of chips or buttered popcorn, have a close look at the calories and the sodium content. Watching dancers, dieters or ninja warriors on TV is no substitute for getting up and getting active.
  3. Start dinner with a vegetable
    According to research, it’s smart to begin your evening meal with a salad, green vegetables, non-creamy vegetable soup, or broth. This is because the water and fiber in the vegetables will help satisfy feelings of hunger. Accordingly, you'll be less inclined to overeat when you get to the main dish.
  4. Love your grill
    One surprising benefit of grilling is that it can make a cook out of practically anybody. It’s a pretty simple matter to toss fish or chicken and veggies on the barbecue. The result is usually plenty flavorful without high-calorie sauces, gravies or side dishes.
  5. Close the kitchen after dinner
    To prevent yourself from backsliding as the days get longer and the time between supper and sleep time lengthens, put a decisive end to your meal by drinking some home brewed tea, and then brushing and flossing your teeth.
  6. Eliminate the extras
    Try to eliminate extra helpings of food and beverages, snack foods, and between-meal eating too. If you can cut out the "in between" eating, it will pay off.

Exercises

A daily 30 to 45-minute session of exercise is a great way to improve and maintain your body shape. Try adding some of these exercises to your new healthful routine.

Triceps Exercise

  • Triceps extension exercises help to strengthen and shape up your upper arms.
  • Pushups help tone and strengthen arm muscles, as well as muscles in the chest, upper and lower back and abdomen.
  • Try 3 daily sets of 12 bicep curls.

Abdominal exercises

  • Plank – Hold for 60 seconds and repeat after 60 seconds of rest, five or more times per session.
  • Crunches – Work up to12 left, 12 right and 12 center crunches. Repeat 5 times.

Leg exercises

  • Squats – 10 squats. Repeat 5 times.
  • Forward lunges – take 12 forward lunges on each leg. Repeat 5 times.
  • Wall sits – Sit on a wall or bench with legs extended in front at a 90-degree angle for 30 seconds; add more time as your muscles grow stronger. Repeat 5 times.

These exercises can burn as much as 300 Kcal daily or about 1,500 Kcal a week.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.


Cervical Foraminotomy

July 26th, 2019
Cervical Foraminotomy

What is a Cervical Foraminotomy?

A foraminotomy is a surgical procedure performed to relieve pressure on spinal nerves as they exit the spine through an opening known as the foramen. When this surgery is performed in the neck region, it is known as cervical foraminotomy. This is a minimally invasive procedure for widening the area where the spinal nerve roots exit the spinal column.

Who needs a Cervical Foraminotomy?

Cervical Foraminotomy is suggested for patients who have bone spurs or herniated discs that are causing cervical nerve root compression. Symptoms of cervical nerve root compression include pain in neck and shoulders. Pins and needles, numbness, tingling, or weakness in the hands and arms are also symptoms.

This surgery is suggested only if the conservative treatments have failed to relieve the pain.

Cervical Foraminotomy is Suggested:

  • If there is evidence of severe weakness
  • If the pain in the arm is so severe that narcotic analgesia fail to control the pain
  • If there is a suggestion of spinal cord compression and myelopathy

What are the steps involved in Cervical Foraminotomy?

Following are the steps involved in the procedure of Cervical Foraminotomy.

Incision

Cervical Foraminotomy Step 1 Incision

The patient is given general anesthesia. The surgeon makes an incision down the middle of the rear of the neck. The skin and soft tissues are retracted to expose the bony roof of the spine.

Removal of Spinal Bone

Cervical Foraminotomy Step 2 Removal of Spinal Bone

The surgeon removes and clears away the bone from posterior arch of the spine. This helps the surgeon to have access to the pinched nerve root and herniated disc in the spinal canal.

Removal of Herniated Disc

Cervical Foraminotomy Step 3 Removal of Herniated Disc

The surgeon checks the freedom of the nerve with the help of a small instrument. The surgeon then removes the thickened ligament, bone spurs and herniated discs. This helps to take the tension and pressure off the nerve root.

Closure

Cervical Foraminotomy Step 4 Closure

The surgery ends when the surgeon puts the muscles and soft tissues back in place. The wound is then closed with the help of stitches or medical glue.

What Happens After the Surgery?

Usually the patient is able to get out of his or her bed within an hour or two after the surgery. The surgeon may advise you to wear a soft neck collar. You will be instructed to move your neck very carefully and comfortably.

In most cases, patients can leave the hospital the day after surgery. Patients are usually safe to drive within a week or two. They can generally get back to light work by four weeks. They can take part in heavier work and sports within two to three months after the surgery.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.


Sciatica

July 21st, 2019
Sciatica

What is Sciatica?

Sciatica is a condition that occurs when nerve roots are compressed or irritated in the area of the spine located in the lower back. This condition is also called lumbar radiculopathy. Lumbar refers to the area of the spine in which it occurs, while radiculopathy is the word used to describe pain, weakness, tingling and numbness caused by irritation of the nerve roots.

What causes Sciatica?

Nerve roots are the area of nerves where they branch off from the spinal cord to connect to different parts of the body. The nerves send signals to the brain to create sensations, like texture or pain. Irritation or compression of the nerve roots is usually caused by disc herniation or degenerative changes to the spine that put pressure on nerve roots.

Conditions that may causes compression in the lumber area of the spine vary, but can include herniated disc, degenerative disc disease, and spinal stenosis. When the roots of the nerves are compressed, it causes muscle weakness, pain and numbness in the area connected to the affected nerves.

Symptoms and Diagnosis

When the roots of the nerves are compressed anywhere along the spine, it causes muscle weakness, pain and numbness in the area connected to the affected nerves. The nerve roots in the lumbar area of the spine branch off the spinal cord and through the boney structure that protects them out to the feet, legs, hips, and buttocks. This means that compression of those nerve roots may cause pain or other sensations in the feet, legs, hips, and buttocks.

Symptoms vary depending on where the nerve roots are being compressed, but commonly include pain, weakness, tingling, or numbness. The area where these symptoms are felt may depend on where in the spine the nerve roots are compressed. Each vertebrae in the spine is assigned a numbered level. The 5 vertebrae in the lumbar section are L1 through L5, while the sacrum is S1. The locations of symptoms can vary depending on where the nerve roots are compressed, as the nerve roots in each level correspond to different places. Below is a list of symptoms you may experience depending on the level at which your sciatica is occurring:

  • L2: hip weakness and pain in your thigh
  • L3: weakness in your knee, as well as pain and weakness in your thigh.
  • L4: foot weakness and pain that travels from the lower back down to the knee or foot.
  • L5: pain down the outside of your leg to the top of your foot or big toe, as well as foot weakness
  • S1: weakness in your foot and pain down the back of your calf to the outside of your foot and little toe

To diagnose sciatica, a physician will review a patient's medical history, asking about the location and type of the symptoms to help determine if a nerve root is being affected. A physical exam will follow, focusing on range of motion and flexibility, as well as muscle strength, sensation, and reflexes to determine what nerve root is being compressed.

To verify the diagnosis, several tests may be needed. An X-ray will be performed first, which can help identify the presence of trauma or osteoarthritis, as well as early signs of infection or tumor growth. A CT scan or an MRI may follow. A CT scan can show the amount of space nerve roots are allotted by the foramen, or openings in the vertebrae of the spine. An MRI scan can best reveal the location and extent of nerve compression because it is designed to show the soft tissues around the spine, including discs, ligaments and nerves.

How is Sciatica treated?

Symptoms of sciatica can often be relieved by conservative treatments like anti-inflammatory medication, physical therapy, and rest. Bracing may be prescribed. Most patients respond well to this treatment, with symptoms improving from six weeks to three months. However, if there is evidence of nerve damage or if symptoms fail to improve over time, surgery may be needed to remove pressure from the spinal roots. The procedure needed varies according to the source of the nerve root compression and its location in the spine.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.


Mustard Rubbed Roast Pork Loin

July 16th, 2019

Mustard-Rubbed Roast Pork Loin

Prep Time: 10 Minutes
Total Time: 80-100 Minutes
Serves 6

Rub mixture

2 tablespoons Creole-style mustard
1 teaspoon Creole seasoning
1 teaspoon crumbled thyme leaves
1/2 teaspoon crumbled rosemary leaves
1/2 teaspoon granulated garlic
1 tablespoon olive oil

1 boneless pork loin, about 4 pounds
Salt and pepper to taste

A great way to welcome hot Summer weather, this savory pork roast goes great with mashed potatoes or baked sweet potatoes, and snap beans or asparagus. Choose a Creole mustard - coarse, stone ground and spicy but not too hot - plus Creole seasoning, or substitute your own favorite gourmet mustard.

Directions:

  1. Line a 13x9-inch baking pan with foil. Heat oven to 325°.
  2. Combine mustard, Creole seasoning, thyme, rosemary, garlic powder, and olive oil in a small bowl.
  3. Wash and pat dry the pork loin. Trim and discard excess fat, sprinkle lightly with salt and pepper. Rub the meat thoroughly with the mustard mixture. Lay the pork loin, fat side up, in the prepared baking pan.
  4. Bake for 80 to 100 minutes, until the pork registers 145° to 150° on a meat thermometer inserted into the middle.
  5. Let stand for 15 minutes before slicing.
  6. Serve and enjoy!

All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.


Throwing Injuries

July 11th, 2019
Throwing Injuries of the Elbow

What are Throwing Injuries of the Elbow?

The elbow joint undergoes a lot of stress when throwing motions are repeated without alloting the proper time for healing and rest. If the tendons and ligaments on the inner side of the elbow are stretched repeatedly while the outer side of the elbow's structures are compressed, this can lead to damaged bone and tissues. This damage is especially likely to occur if the bones have not finished developing, as would be the case in a young athlete.

Medial Epicondylitis

Medial Epicondylitis, known also as golfer's elbow, is a condition caused by overuse of the forearm's tendons and muscles. This overuse gradually deteriorates the common flexor tendon, which attaches to the media epicondyle on the inner side of the elbow. Often conservative treatments can benefit this condition.

Medial Ulnar Collateral Ligament Injury

The Medial Ulnar Collateral Ligament, or MUCL, can be found between the ulna and the the humerus on the inner side of the elbow. Symptoms of this injury generally include pain in this area. This ligament can be sprained or torn from repetitive throwing. A type of reconstructive surgery called Tommy John surgery may be required if the ligament is completely torn.

Medial Apophysitis

Commonly called Little League elbow, this is a condition that usually occurs before puberty. Growth plates are material on the ends of bones in children that allow the bones to expand while the child finishes growing. Damage from repetitive throwing can affect not only ligaments, but also the the growth plates. This can cause painful inflammation on the elbow's inner side. Surgery may be required if the condition is very severe.

Osteochondritis Dissecans

The blood supply to the cartilage in the elbow can be disrupted by repetitive throwing. This can force areas of cartilage and bone to pull away or apart. Symptoms of this condition can include pain on the outer side of the elbow, as well as clicking or locking of the joint. Loose fragments may need to be removed surgically.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.


Does Cracking My Back Cause Permanent Harm?

July 6th, 2019

Are you wondering if you’re doing more harm than good when you crack your back? If so, you’re not alone. Thousands, if not millions, of people routinely ask themselves or their health care providers the same question. There’s just something about cracking your back that feels so good but also so wrong. In today’s post, we’ll give you all the information you need to know about exactly what happens when you crack your back. To start things off, let’s go over some related anatomy.

Spine Anatomy

The spine is divided into cervical (neck), thoracic (middle back), and lumbar (lower back) regions. Each region is composed of uniquely shaped bones known as vertebrae. There are a total of twenty-four vertebrae in the mentioned regions. The breakdown of vertebrae per region is as follows:

  • 7 cervical
  • 12 thoracic
  • 5 lumbar

An anatomical spine is one in which the vertebrae of each region perfectly align to form a channel that allows the spinal cord to pass from the brain to the lower back. This channel is called the spinal canal. In addition to forming the spinal canal, the vertebrae have the important job of facilitating movement by serving as the sites for ligament and tendon attachments. The joints that are responsible for moving the spine are called the facet joints.

Facet Joint Anatomy

The facet joints are formed by the joining of adjacent vertebrae. Like all joints of the body, the facet joints consist of two bony surfaces covered in cartilage facing one another. A fluid-filled capsule surrounds each facet joint. A healthy facet joint is one that moves freely and smoothly. An unhealthy facet joint is one in which the bone, cartilage, or capsule is diseased or damaged.

Cracking Your Back

When you crack your back, you’re cracking your facet joints. The process that causes the “cracking” noise is really not that complicated.

The fluid found in the capsule that surrounds facet joints contains nitrogen and carbon dioxide gases. When you twist, turn, or maneuver your back in such a manner that stresses the facet joints, pressure is placed on the fluid and the gases inside it escape and a “crack” is heard.

Cracking your back can temporarily relieve tension and feel good; however, it is not a reliable short or long-term treatment option for back pain. Cracking your back every once and a while will not cause damage. Frequently cracking your back or manipulating your spine can lead to back problems. If you feel the need to constantly crack your back, you probably have an underlying problem with your spine. Some frequently seen problems include the following:

  • Poor posture
  • Muscle imbalances
  • Osteoarthritis
  • Ligament sprains
  • Tendon strains

These and other problems are best diagnosed and treated by an orthopedic spine specialist. Once a formal diagnosis is made, an effective treatment plan can be prescribed and the urge to constantly crack your back will go away.

Conclusion

The main thing to look out for when cracking your back is the frequency in which you do it. Cracking your back on a daily basis should be avoided. If you’re in pain that won’t go away until you crack your back, you should make an appointment with an orthopedic spine specialist.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.


Where Back Pain Begins

July 1st, 2019
Where Back Pain Begins

What are the Vertebral Discs?

Vertebral discs separate the vertebrae in your spine, acting as shock absorbers for the spinal column by providing a cushion between the vertebrae. These discs are made of tough, elastic material that allows the spine to bend and twist naturally. The tough outer wall of the disc is called the annulus fibrosis, while the soft material contained inside the disc wall is called the nucleus pulposis.

Vertebral Disc Wall Weakness

Despite their strength and elasticity, vertebral discs can be damaged by injury or everyday wear-and-tear from aging. Often, this damage starts with cracking and weakening of fibers in the disc's annulus fibrosis. Radial tears can form in the disc wall, in or near sensitive nerve fibers.

Nucleus Pushing Through The Vertebral Disc Wall

As the outer wall weakens, the nucleus pulposis will push through the wall's tear to the edge of the disc wall. This additional pressure creates back pain at the level of the affected disc.

Pressure Against Nerve Roots

If the nucleus pulposis pushes through and out of the disc wall's outer edge, it's called a herniation or a rupture. This herniated disc material may put pressure against the nerve roots near the disc, which can cause radiating pain to travel down one or both of the legs.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.


Anterior and Posterior Scoliosis Surgery

June 26th, 2019
Anterior and Posterior Scoliosis Surgery

Overview of treatment:

Surgeons usually use one of two ways to approach the spine: from the anterior, or front, or from the posterior, or back. Surgeons use the anterior approach when the operation is performed through the chest wall. In the posterior approach, the spine is reached through the patient's back.

Anterior and Posterior Scoliosis Surgery uses both methods. First, an anterior approach is used to allow correction of problems, and then a posterior approach is used for better fusion.

Who needs this treatment?

Anterior and Posterior Scoliosis Surgery is recommended when:

  • There is extremely large curve or deformity
  • There is evidence that the curve is progressing and an abnormal curve is expected in the future
  • Previous attempts at fusion have failed
  • Non-surgical or non-operative treatments have failed

What are the steps in Anterior and Posterior Scoliosis Surgery?

The Anesthesia

First, the patients are given an anesthesia to put them to sleep. A breathing tube is then placed to assist the patients with breathing during the procedure. Different catheters are put in veins to monitor the blood pressure, fluid level, heart function and depth of the anesthesia during the operation.

Anterior approach

The surgeon will first approach the spine from the side of the chest. In order to do this, an incision is made in the chest wall, the lungs are deflated, and a rib is removed to reach the spine. The disc material is removed from between the vertebrae to make the curve more flexible and to facilitate fusion. The removed rib is then used as a bone graft. The anterior procedure is completed, and the wound is closed.

Posterior approach

The patients are then positioned for posterior surgery. The spine is exposed from behind by stripping the back muscles to the sides. Then the spinal instrumentation is put in place to correct the deformity. Metal rods are inserted alongside the spine and affixed to the vertebrae by hooks, screws, or wires. The fusion will make the spine rigid and resistant to deformity or curvature.

Final tightening and Incision closure

Once the spinal instrumentation is in place, a final tightening is done. The incision is then closed and dressed.

What happens after the surgery?

The patients usually have to stay in the Intensive Care Unit, or ICU, for one to two days. Most patients are discharged from the hospital after 7 to 10 days of the surgery. The first few days after the surgery are extremely painful, so patients are given strong painkillers, which may cause nausea and drowsiness.

Patients have to perform coughing and breathing exercises to get rid of congestion in the lungs. The patients are usually able to sit up the day after surgery and may be able to walk within a week. Patients may have trouble with activities involving arms and hands in the initial days after the procedure.

What are the potential complications and risk factors?

Following are some of the complications and risk factors that may occur after this surgery:

  • Non-union: The fusion may fail and false joints may develop at the site.
  • Bleeding: There is a risk of major blood loss during the surgery.
  • Infection: All surgeries involve a risk of infection.
  • Damage to nerves: There is a risk of damage to nerves, although it is a low risk.
  • Lung function: Some serious lung problems may occur after the surgery.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.


Congenital Scoliosis

June 21st, 2019
Scoliosis

Congenital Scoliosis

What is Congenital Scoliosis?

Scoliosis is a musculoskeletal disorder that adversely affects the shape of the spine (backbone). A scoliotic spine (when viewed from behind) will not be straight and may instead look like the letter "C" or "S", due to a side-to-side (right-to-left) curvature. Congenital means the scoliosis is present at birth. A congenital condition is present at birth because of a problem during development. For congenital scoliosis, the abnormal curvature of the spine develops before birth. This is thought to occur early in fetal development (during first 4-6 weeks). Although congenital scoliosis is present at birth, it may not be discovered until a child grows.

Compared to idiopathic scoliosis, the abnormal curves in congenital scoliosis are generally more resistant to correction. It is estimated that between 10-25% of congenital scoliotic curves will never progress (get worse). Unfortunately, the majority of congenital scoliotic curves do progress (get worse) and require active treatment. Generally, scoliotic curves tend to progress (get worse) only when a child grows.

It is unclear as to how frequently congenital scoliosis occurs (i.e., its incidence rate). However, it is much less common than idiopathic scoliosis. Finally, unlike idiopathic scoliosis, congenital scoliosis does not run in families.

Causes of Congenital Scoliosis

The main causes of congenital scoliosis include:

Formation Failure

Formation failure means that one or more bones of the spine (vertebrae) are incompletely formed during fetal development. These incompletely formed bones are abnormally shaped compared to completely formed vertebrae. These bones have the appearance of a triangle or wedge and, therefore, may cause the spine to tilt in the direction of the wedge. This is how they can cause a scoliotic curvature of the spine.

The presence of malformed bones does not necessarily result in a scoliotic curve. For example, two wedges on opposite sides of the spine may balance each other out. However, if both wedges are on the same side then the abnormal curve will be accentuated.

Segmentation Failure

This is also referred to as separation failure. Segmentation/separation failure means that some of the bones of the spine (vertebrae) incompletely separate from one another during fetal development. This causes the bones of the spine to be abnormally connected (fused) to one another on one side of the spine. This connection (called a boney bar) causes the two sides of the spine to grow at different rates—slower than normal on the connected side—and results in an abnormal curvature of the spine.

Combination of Formation and Segmentation Failure

It is possible for both wedged shaped bones (formation failure) and connected bones (segmentation failure) to be the cause of congenital scoliosis. This is referred to as a mixed deformity.

The above developmental defects of the spine can range from mild to severe and they can affect one or multiple areas of the spine. The degree to which these occur will determine the severity of the scoliotic curve, the symptoms, as well as the requirement for treatment.

Congenital Scoliosis Symptoms

Children with congenital scoliosis usually do not experience any pain. Potential signs and symptoms of scoliosis can include:

  • Uneven hips and/or shoulders (one is higher than the other)
  • One shoulder blade sticks out more than the other
  • Spine curves to one side

Often congenital scoliosis is detected during an examination at birth. However, if it is not detected at birth, it can remain undetected until there are obvious signs and symptoms, which may take years.

Children with congenital scoliosis often have other health issues. There is a fairly high rate of other spinal deformities (like lordosis and kyphosis) in children with congenital scoliosis. Other skeletal problems may coincide with or be related to congenital scoliosis. For example, rib abnormalities (missing and/or fused ribs). If the ribs are fused this can adversely affect the shape of the chest and ultimately the ability to breathe normally; this condition is known as thoracic insufficiency syndrome. Children with congenital scoliosis often have other non-skeletal health issues (e.g., bladder and kidney problems).

How is Congenital Scoliosis Diagnosed?

The following are used to evaluate children for congenital scoliosis:

Medical History

This includes an interview with a doctor and a review of any medical records. These are done in order to determine the presence any medical conditions that may be causing the spinal curvature.

Physical Examination

Items that will be looked for during the exam include:

  • Shoulders are not level (one shoulder is higher than the other)
  • If the head is centered
  • One side of the rib cage is higher than the other
  • Pelvis is tilted/uneven
  • Significant asymmetry between opposite sides of the body
  • Certain changes in the skin (e.g., café au lait spots)

A thorough examination will be performed to determine if there are other congenital abnormalities.

Imaging Studies

Children with abnormal spinal curves and/or signs of underlying medical conditions will need imaging studies. These may include X-rays, CT scans, or an MRI of the spine. Which of these imaging studies will depend on what conditions are suspected to be involved in causing the scoliosis. An abdominal ultrasound is frequently used to examine the internal organs of children with congenital scoliosis.


All information provided on this website is for information purposes only. Please see a healthcare professional for medical advice. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 VoxMD.com, All Rights Reserved.