Thursday, November 21, 2013

Common Overuse Injuries and How to Prevent Them

Many injuries to the joints are caused by a one-time traumatic event, such as a fall. However, more common are overuse injuries or conditions that result from too much activity, repetitive activities, poor form or a combination of those factors. Athletes often experience overuse injuries, but they can also be caused by daily activities — for example, tennis elbow is only caused by playing tennis in about five percent of all cases.

Because these injuries are so common, it’s important to understand why they occur and how to avoid them.

Tennis Elbow

Lateral epicondylitis, or tennis elbow, is an inflammation of the tendons on the outside of the elbow joining the forearm muscle to the joint. The elbow joint consists of the humerus (upper arm) and the radius and ulna (forearm) bones; the bony protrusions at the bottom of the humerus are called the epicondyle. Tennis elbow occurs when repetitive motion, such as the swinging of a racket, causes the extensor carpi radialis brevis, or the forearm tendon attached to the epicondyle, to become inflamed. The result is pain or a burning sensation on the outside of the elbow that worsens with activity. 

Although most people can recover from tennis elbow without surgery — rest, support and physical therapy usually solve the problem — it’s still important to prevent it. Avoid repetitive motions for extended periods, use proper equipment, and learn proper form and body mechanics

Shin Splints

Most common among runners, shin splints is a painful condition that can be brought on by any vigorous physical activity. The term refers to pain occurring on the outer edge of the tibia, or shinbone; the medical term is medial tibial stress syndrome and it refers to the inflammation of the muscles, tendons and tissue surrounding the tibia, typically where the tissue meets the bone. 

Getting a medical diagnosis of shin splints is important because the pain can often be confused with that of a stress fracture, tendonitis or chronic exertional compartment syndrome, a serious and painful condition requiring treatment. Shin splints, however, is treated with rest, ice, compression and flexibility exercises; you can usually prevent the condition by wearing supportive footwear and/or orthotic inserts, cross-training and gradually increasing your activity as your fitness level improves.

Runner’s Knee

The complicated structure of the knee joint renders it susceptible to several overuse injuries that cause pain to the front of the knee, collectively known as runner’s knee, or patellofemoral pain syndrome. This pain can be caused by any number of conditions, including flat feet, misalignment of the kneecap, an injury to the joint or dislocation. 

Runner’s knee is characterized by a pain in the front of the kneecap (patella) where it connects with the lower end of the thigh bone (femur). It’s aggravated by activity and by sitting or standing for long periods of time. You’ll need to see a doctor to determine the exact cause of the pain and course of treatment; for example, in many cases the pain is caused by the patella being out of alignment. This can wear on the patella’s cartilage and subsequent irritation on the lining of the joint and underlying bone. 

The specific treatment plan for runner’s knee depends on the cause, but usually involves rest, physical therapy and support. You can prevent the pain by wearing proper footwear, stretching appropriately, using good form and increasing your activity gradually.

If you are experiencing pain and believe it is due to overuse, see your doctor for diagnosis and treatment. From there, your doctor may refer you to a specialist. Follow the appropriate precautions to avoid pain in the first place.

Wednesday, September 25, 2013

Treating Frozen Shoulder

Adhesive capsulitis, also known as frozen shoulder, is a common affliction among adults, affecting approximately one in five people between the ages of 40 and 60. Often a result of not using the joint properly due to disease  (including arthritis and diabetes) or injury, frozen shoulder is marked by pain, stiffness and limited range of motion in the shoulder joint.

How the Shoulder Works

Three bones come together to form the shoulder, which is a ball-and-socket joint. The humerus, or upper arm bone, fits into a socket located in the scapula, or shoulder blade. The joint is surrounded by thick tissue, known as the shoulder capsule, which connects the joint to the clavicle, or collarbone. The entire apparatus is lubricated by synovial fluid, which keeps everything moving smoothly.

In a healthy shoulder, the shoulder capsule remains flexible, with plenty of joint fluid to ensure you have a full range of motion. However, when you don’t use the joint enough, the shoulder capsule thickens, becoming inflexible and inflamed. The amount of joint fluid then decreases. In time, you lose all range of motion in the shoulder and cannot move it at all either on your own or with help.


Because frozen shoulder is painful and limits patient activity, it’s important to treat it as soon as possible. Ideally, treatment will begin in the early stages when the shoulder begins to freeze, but even a fully frozen shoulder can be treated to restore full range of motion.

Patients experiencing shoulder pain should see a doctor, who will run several tests to determine whether adhesive capsulitis is present and, if so, how far along it is. A physical exam, testing both active and passive range of motion (in other words, the range of motion possible when you move your arm yourself and then with assistance) can often lead to a frozen shoulder diagnosis. In some cases, your doctor may perform X-rays, MRI tests or ultrasounds to rule out other causes for the pain.

Common Treatment Plans

In the majority of cases, patients can restore the range of motion in their shoulder without surgical intervention, although it may take up to three years to be completely pain-free. Treatment usually consists of physical therapy to restore range of motion combined with steroid injections and non-steroidal pain relievers to reduce pain and inflammation.

In about 10 percent of cases, when therapy and medication don’t provide relief, surgery is necessary. There are two types of surgery for this condition, and they are often used in combination to achieve full recovery: manipulation under anesthesia and arthroscopy. In the first surgery, you are put under full sedation while your doctor forces the shoulder to move, causing the tightened capsule and the scar tissue to tear or stretch, thereby loosening the shoulder. In an arthroscopic procedure, your surgeon will use small instruments to cut through the tightened tissue through a series of incisions around your shoulder. In most cases, with physical therapy, patients who undergo surgery have full or almost full range of motion in three months.

Frozen shoulder is a painful condition, but not one that you need to live with. If you are experiencing symptoms and you suspect your shoulder may be freezing, schedule an appointment with your doctor today. 

Thursday, September 5, 2013

Osteoarthritis Pain Relieved by Viscosupplementation

Aging affects everyone differently. Some people live well into their eighth and ninth decades without experiencing anything more serious than a few aches or pains, while others start to feel the impact of years of use on their joints as early as their 30s and 40s. Osteoarthritis, also known as “wear-and-tear” arthritis, is one of the most common ailments of older adults — more than 27 million people live with some form of the disease — and it’s most common in the weight-bearing joints, particularly the knees and lower spine.
While osteoarthritis is technically a breakdown of the cartilage of the joints — as the cartilage stiffens, it wears down like a tire tread and causes swelling and — it is associated with a loss of water content in the cartilage and also a loss of the hyaluronic acid lubricant in the synovial (joint) fluid surrounding the joints. This thick fluid helps to serve as a shock absorber, lubricating the joint so that the bones can move more smoothly over each other. Lacking this vital fluid, and combined with the breakdown of the cartilage, in time the cartilage wears done leading to bone on bone contact which at the end can cause debilitating pain. During the early stages of osteoarthritis, treatment often consists of over-the-counter pain relievers, anti-inflammatory medications, reduced activity and physical therapy. However, there is another treatment that can be effective for managing the symptoms of osteoarthritis: viscosupplementation.

Viscosupplementation Basics

While some osteoarthritis sufferers respond to corticosteroid treatment, those drugs are generally reserved for rheumatoid arthritis patients who need relief from the pain and inflammation caused by their immune systems attacking their joints.  While corticosteroid treatment is very effective in reducing pain and swelling early on, it may also weaken the cartilage and add to the wear of the cartilage over time, especially if given on a repetitive basis.   
As an alternative osteoarthritis patients may respond favorably to viscosupplementation (injections of the hyaluronic acid that is lost due to the disease’s progression). With this treatment, approximately every six months the patient receives an injection of the hyaluronic acid directly into the site (most commonly the knee). Within a few days to weeks of the injection, the patient typically has less pain and a greater functional range of motion.
Viscosupplementation is generally most effective with patients who are in the early stages of osteoarthritis but who aren’t responding well to the traditional treatments. While the treatment will not replace cartilage that has been lost to time, some evidence shows the injections encourage the body to produce more hyaluronic acid. This, in turn, can help reduce the symptoms of osteoarthritis.

Important Considerations

Viscosupplementation has helped thousands of osteoarthritis patients find relief from their pain, but it’s not effective for everyone. Also, the injections do not provide immediate pain relief — it can take up to a few weeks for the benefits to be noticeable — and there can be some redness, pain and swelling at the local injection site immediately after the treatment. In some cases, the injections can cause increased pain and swelling, and very rarely the complication of infection. Patients who are considering the treatment will have the opportunity to discuss with a medical professional the benefits and risks that are associated with viscosupplementation.
Osteoarthritis, when left untreated, is painful and can seriously impact a person’s quality of life. Anyone looking for relief from the pain and stiffness should talk with their doctor about viscosupplementation and how it may improve their condition.