Elbow Pain – Tendonitis

Tendonitis is one of the most common reasons for elbow pain. Sometimes called tennis elbow, this painful condition can occur when a tendon that attaches to the elbow joint becomes irritated or inflamed, either from injury or from overuse. Other common elbow problems include arthritis and problems from the wrist or shoulder, which cause referred pain to the elbow.

Diagnosis of Elbow Pain

The elbow joint works best when the arm motion is straight up-and-down. Rotation and side-to-side movements are less tolerated. Too much stress in these directions can irritate the elbow tendons and cause a tendonitis condition. It can also be caused by repeated vibration forces under weight bearing. Some sports that may cause this include tennis, other racket sports, and, to a lesser degree, golf. Continued irritation of the elbow tendons can lead to calcific tendonitis, which is a type of arthritis.

Elbow injuries or chronic elbow problems from overuse can affect more than just the elbow joint. Elbow problems can adversely affect grip strength, as well, even causing shaking hands to become painful. Elbow pain can extend up to the shoulder and down to the wrist. Many elbow problems caused by inflammation to the tendons will also worsen with turning forces. A common way to acquire or to worsen tennis elbow (also known as lateral epicondylitis) is to perform repetitive screwdriver-like activities with the sore arm.

Frequent application of ice packs will usually reduce inflammation around the elbow joint. Exercise caution  when using ice, since the lack of tissue makes the elbow vulnerable to frostbite (cold damage). For this reason, it is best to limit use to 10 minutes or less and not to reapply the ice until 10-15 minutes after removal. It is important to be especially careful and protect the sides of the elbow.

Treatment For Elbow Tendonitis

Your chiropractor can also examine your elbow to help determine the nature of the condition. Diagnostic tools, such as x-rays, may reveal early calcification of the tendons around the joint, which may be one reason why the problem keeps recurring. With proper therapy, such as joint manipulation, ultrasound (which can help reduce inflammation and breakdown calcified deposits), and other therapeutic measures, your condition may be markedly improved.

Other treatments for elbow problems include protective bracing and nutritional supplements such as bromelain (an enzyme helpful in reducing inflammation, found in pineapples). At Mountain View Pain Center, our chiropractors can help you get a correctly sized and fitted elbow support, as well as recommend the correct nutritional supplements to help your elbow condition. If you have any questions please feel free to contact us.

Shoulder Pain

The shoulder joint is supported by more muscles than any other joint in the body. However, because of the lack of bony structure and the shallowness of the shoulder joint, it is also the most commonly dislocated joint in the body. Likewise, patients with shoulder complaints often have issues with subluxations (small dislocations) and tendonitis. These shoulder conditions, while less severe (but still painful), are often the result of repetitive activity or excessive use of the muscles and the ligaments that surround the shoulder joint. For instance, bursitis (a condition of inflammation surrounding a joint) is commonly found here. Shoulder injuries, arthritis, and other conditions (such as cancer) may also cause shoulder pain.

The shoulder is also a common source of referred pain, which is when pain is transmitted to the shoulder from another area. People with neck pain may experience this due to the irritated nerves that travel from the neck into the shoulder. Referred pain can also come from diseased or distressed organs, such as the pancreas, liver, or heart. Certain other structures or disorders in the digestive tract can refer pain to the shoulder as well, such as a hiatal hernia or the ileocecal valve (between the small and large intestine, near the appendix).

Diagnosis & Shoulder Conditions

You need a proper shoulder diagnosis in order to help determine the nature (where the pain is coming from) and the degree of involvement of a shoulder condition. An examination and history aid the doctor in determining a proper diagnosis. In addition, x-rays of the shoulder could help to determine alignment, check for fractures, visualize bone damage (arthritic changes or bone loss), or find other osseous (bony) abnormalities.

How your shoulder moves with and without pain can help determine the type of shoulder problem you have. For instance, when the muscle that attaches to the tendon is forcibly contracted, it generally will exacerbate the tendonitis (hurt more, in other words). On the other hand, bursitis conditions generally hurt more at rest after a period of shoulder use. Additionally, the ability to have your arm passively moved (moved by someone else) through a motion you cannot duplicate actively (move by yourself) generally indicates a muscle weakness. If you are not able to move your shoulder or have your shoulder moved, this usually indicates a bony obstruction or soft tissue swelling.

Chronic Shoulder Pain

In some cases of chronic shoulder dislocation, chiropractic treatment care are a welcome non-surgical alternative. Shoulder joint manipulation, localized therapy, and muscle strengthening exercises may reduce the chances of future dislocations. A chiropractor can also order an MRI (Magnetic Resonance Imaging – a way to see soft tissue on an x-ray-like film) to help determine the integrity of the shoulder joint. Your chiropractor may also work with an orthopedist if needed.

Older patients that have loss of motion due to degenerative arthritis may benefit from chiropractic care, as well. Often, the shoulder joint function can improve through careful stretching, relaxation, and passive motion therapy. Although many older patients will suffer from bursitis or arthritic shoulder conditions, there is a common complaint about the inability to raise the arms out to the side, above shoulder level. The problem in many of these cases isn’t with the shoulder at all, but actually because the spine has become kyphotic (bent-over forward). Even a child cannot raise their arms above their shoulders if their back is bent-over.

At Mountain View Pain Center, we treat thousand of shoulder problems each year. Once you receive a diagnosis from your chiropractor for your shoulder problem, they will help you decide on a course of treatment. Most shoulder problems respond well to manipulation. In addition, other therapies can be applied, if needed. The goal is always to reduce pain and swelling while also improving the shoulder joint motion. In addition to restoring motion, strengthening the muscles that support the shoulder joint will also help to prevent future re-injury. If you have questions please contact one of our offices.

Ankle Pain

Ankle pain can result from a variety of underlying causes, including trauma, arthritis, sports-related conditions, infection, systemic disorders, and neoplastic processes. Successful treatment requires a full understanding of ankle anatomy, a proper history, and a thorough physical examination to yield an appropriate differential diagnosis.

A very common injury in sports, as well as the general population, is acute sprains of the lateral ligaments about the ankle. Most commonly, a partial tear or complete rupture of the anterior talo-fibular ligament (or ATFL) occurs. More severe injuries include the calcaneofibular ligament (or CFL). An inversion mechanism can cause a lateral ankle sprain.

Classification of Ankle Sprains:

Grade I: Partial tear of the ligaments
Grade II: Partial to complete tear of the ATFL, partial tear of the CFL
Grade III: Complete rupture of the ATFL and CFL

Treatments For Ankle Pain & Sprains

General Measures
Treatment for ankle sprains or low-grade trauma include the R.I.C.E. protocol and gradual weight bearing as tolerated. A provider would typically splint a patient with ankle fractures, request they remain non-weight bearing, and a refer them to an orthopedist for definitive care. Hot, swollen, bright-red ankles may warrant arthrocentesis (collection of joint fluid) to rule out a gouty attack or septic arthritis.

Physical Therapy
The provider may recommend physical therapy in certain cases once they determine the diagnosis and perform specific treatments. Exercises include ROM, strengthening exercises, and proprioceptive retraining if indicated.

Patient Monitoring
Patients should show full strength and ROM before returning to sports. Functional bracing or taping during their return to athletics may help prevent recurrence.

FAQ About Ankle Sprains

Which ligaments are involved in a lateral ankle sprain and in what sequence do they occur?

A lateral ankle sprain injures the following, in order: anterolateral joint capsule, ATFL, and occasionally the CFL.

What are appropriate initial treatments for acute ankle sprain?

RICE protocol, stirrup brace, early ambulation, and ROM exercises.

What are some possible causes of ankle pain?

Fracture, sprain, tendon injury, tendonitis, arthritis, infection, or neoplasm.

What type of condition is suggested by morning stiffness and ankle pain?

Rheumatoid or inflammatory arthritis.

What conditions likely require a referral to an orthopedist?

Acute fracture, neoplasm, and a chronic condition unresponsive to initial non-surgical treatment.

Rheumatoid Arthritis

Stiffness in the joints is a common ailment that increases with aging. When the stiffness worsens to the point of being painful, arthritis may be the diagnosis. Arthritis is breakdown of normal cartilage caused by either excessive joint wear-and-tear or from an autoimmune disease called Rheumatoid Arthritis (RA). Rheumatoid arthritis is a disease where the body is actually fighting itself, which is what the term autoimmune means. It selectively attacks the synovial joints, especially the small joints of the hands or feet, and usually occurs on both sides of the body, meaning  in both hands, both knees, etc.

Early detection of arthritis is essential. Once damage to a joint surface begins, little can be done to restore it back to its original condition. This is because cartilage, the material that makes up the surfaces of the joint, has a poor blood supply. Although cartilage will heal to a degree, it simply will not heal as well as muscle or skin. The good news is that proper care and supervised rehabilitative exercises can help strengthen the surrounding support tissues to compensate for many of these joint disorders.

As cartilage continues to wear down, the joint will have more difficulty functioning or moving correctly. A simple analogy to this is to go loosen the hinges on a door and see how poorly it opens and closes. Even if the swelling could be entirely removed from a very arthritic joint, the lack of proper joint motion would cause so much additional stress to the joint that the swelling would quickly return.

It is important to reduce and control the swelling of arthritis, as the swelling itself contributes to the destruction of the cartilage. People with rheumatoid arthritis usually see swelling in the affected joint after rest, especially upon awakening.

Symptoms of Rheumatoid Arthritis

Common diagnostic criteria for those affected with rheumatoid arthritis include morning stiffness, pain with motion, soft tissue swelling, joint effusion in at least one joint, swelling of at least one joint, bilateral, symmetrical, and simultaneous joint swelling, and subcutaneous nodules.

Other symptoms of RA include:

• Fatigue
• Malaise
• Generalized muscle weakness
• Fever

Many people think of rheumatoid arthritis as a condition of the hands and wrists. However, 80% of patients will develop cervical spine changes, as well.

It is important to use arthritic joints, as disuse also leads to more arthritic changes. It is vital, though, to not over stress an arthritic joint. Otherwise, the swelling may significantly worsen. Here at Mountain View Pain Center, your chiropractor will help guide you before you begin any exercise program or commit to any significant physically-related lifestyle changes.

Treatment of Rheumatoid Arthritis

At Mountain View Pain Center, we see many patients with rheumatoid arthritis. The spine is especially susceptible to this disorder. In fact, you may have the early signs of spinal rheumatoid arthritis and have not noticed the symptoms yet. You can palpate (feel) the vertebrae while the spine is slowly moving to see if you have joints that do not move as freely as others. Another more revealing diagnostic procedure is a simple x-ray. An x-ray film can reveal the bony changes associated with either rheumatic arthritis.

Treatment for the two types of arthritis is similar. Both require ice, passive motion (the practitioner moves the joint while the patient remains relaxed), and/or the use of ultrasound to help control the swelling, as well as moist heat to help increase circulation. Paraffin wax baths are helpful for hands and wrists, while moist hot packs are used for the spine, shoulders, and knees. Arthritic hips may require deep heat sources like microwave or short wave diathermy. This is because the hip joints are seated too deeply in the pelvis to reach with more commonly-used therapies. At Mountain View Pain Center, we can provide, prescribe, or recommend these therapies as needed. We may also use the application of spinal and/or extremity manipulation to help you gain control over your arthritic condition, as well as recommend nutritional counseling, exercise instruction, and lifestyle changes as additional considerations during your course of care.

Knee Osteoarthritis

A common and debilitating form of degenerative arthritis, or osteoarthritis, is that of the knee joint. The most common reason people develop osteoarthritis is repetitive trauma, such as having a history of playing sports with repetitive, untreated injuries to the knee. Patients suffering from this ailment have a lower walking speed, a shorter stride, and reduced ankle propulsion. Not only this, but their suffering from a basic lack of motion causes difficulty in basic daily activities, such as shopping, walking the dog, or even getting in and out of the car. The pain starts gradually over a period of many years and changes with weather conditions. Due to the pain, patients report that after frequent use, they have to rest to help ease the pain or are prescribed NSAIDS (nonsteroidal anti-inflammatory drugs, such as ibuprofen).

Individuals with bilateral knee osteoarthritis often struggle with poor balance, which results in the reduced ability to avoid obstacles, increasing the chances to trip and fall, causing further injuries.

Symptoms of Osteoarthritis of the Knee

Patients suffering from knee osteoarthritis walk at a slower pace and have decreased muscle endurance. Osteoarthritis can lead to a sedentary life style and, thus, further health risks. However, these patients are often in too much pain to participate in exercise programs.

At Mountain View Pain Center, we will work with you to get you back on your feet. Our chiropractors will design a treatment plan that will correctly treat and aid in your progress to help ease the pain so you can accomplish your daily goals.

Carpal Tunnel Syndrome

The Carpal Tunnel is made up of eight tiny bones in the wrist, which form a tunnel for three nerves and various blood vessels to pass from the arm into the hand. Irritation to the ligaments and bones that comprise this structure can result in the common condition known as carpal tunnel syndrome.

Symptoms include pain, numbness, and tingling, which usually occurs at night or in the early hours of the morning. These are caused by irritation to the median nerve, which runs through the center of the wrist. This nerve supplies feeling and motor function (the ability to move your fingers) to the first three fingers of the hand.

Women are affected with this problem more than men. This may have to do with hormonal factors that affect fluid retention in the body. In general, any build up of fluid in the tissue can further compress the area within the carpal tunnel.

The position of the hand and wrist can ease or worsen the symptoms of carpal tunnel syndrome. Shaking the affected hand in the air, elevating the wrist, or placing the hand in hot water provides temporary relief. Conversely, placing the wrist in an extended or flexed position, especially for a prolonged period of time, aggravates the symptoms and the condition.

Because decreasing blood flow to the area increases symptoms, experts believe that the median nerve irritation is a result of poor blood supply through the tunnel to the nerve. There may also be a slight amount of hand discoloration due to this suspected circulatory deficiency.

Although part of the thumb may be involved, patients generally feel it in the index and middle finger. There may be slight difficulty or clumsiness associated with this condition due to the lack of proper nerve function. Grip strength is usually only slightly decreased, though patients who have this condition regularly report periods of weakness and may have problems with dropping things.

If you think you are suffering from carpal tunnel syndrome, the doctors at Mountain View Pain Center can help diagnose this condition. We perform a careful examination and history to help outline a corrective or palliative (way of controlling and decreasing the symptoms) course of treatment for you to follow.

Treatment of Carpal Tunnel Syndrome

Chiropractic therapies that help this condition include manipulations of the wrist bones to improve circulation through the tunnel, proper stretching, conditioning, bracing (thumb loop night brace), and therapeutic and nutritional measures (extra B6, bromelain, etc.). It is important to follow the advice of your doctor, as this condition is not easily helped by exercise. Ultrasound also demonstrates disappointing results, as the swelling inside the tunnel is shielded by the wrist bones that make up the tunnel. Use of hot and cold hand soaks might, therefore, be recommended instead of ultrasound therapy to help treat this condition.

Bursitis

The bursa is a structure that is found mostly around areas where muscle and tendons slide over joints, such as the knee or shoulder. It is the bursa that helps lubricate these sliding motions to prevent damage to the underlying bony structures. When this action is compromised, the resulting inflammation is called bursitis. The most common areas where bursitis occurs are the shoulder, elbow, hip, and the kneecap. Bursitis tends to get worse as the joints move.

A common cause of bursitis is from the overuse of a joint, especially when it is under the strain of excessive and repetitive use. Placing too much continuous pressure on a bursa can also cause bursitis. For instance, the bursa that is found in the back of the elbow can become inflamed by resting on the elbows for extended periods of time.

Bursitis can also occur because of a traumatic injury. Trauma, such as a fall on the shoulder, elbow, hip, or the knee, could create this condition. As the bursa swells, it becomes less able to decrease friction. This causes any movement of the joint to be painful. If the bursa remains swollen for too long, calcium salts will invade the region and eventually create a more chronic condition known as calcific bursitis.

Bursitis can be diagnosed by a chiropractor using a history, simple examination, and by taking an x-ray of the involved joint. The calcific form of bursitis will show on the x-ray. The extent of calcium deposits within the bursa is easily visible on the film. The range of motion of the joint and the amount of palpable (feel) swelling around the joint will help determine the extent of the bursitis condition.

Treatment of Bursitis

Mountain View Pain Center can help decrease the inflammation and improve the gliding action to the muscles and tendons surrounding the joint. Our chiropractors may also utilize chiropractic manipulation to the involved joint, therapies such as alternating hot and cold packs, ultrasound, passive range of motion, and massage as part of your course of treatment. We can even treat the more difficult form of calcific bursitis by slowly breaking down the calcium deposits and applying therapies like passive motion or motion under mild traction to circulate the salts out of the joint tissue. Provided treatment is continued so that improvement can be achieved, the return of the calcium deposits should be limited.