Extremity Pain
What Kind of Extremity Pain are You Experiencing?
Elbow Pain – Tendonitis
One of the most common reasons to have elbow pain is tendonitis. This condition is due to inflammation. Sometimes called tennis elbow, this painful condition can occur when a tendon that attaches to the elbow joint becomes irritated, either from injury or from overuse. Other common elbow problems include arthritis and problems from the wrist or the 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. Repeated vibration forces under weight bearing can also cause joint irritation. Commonly played sports that can cause this condition are 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 too. Even shaking hands can be 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; In fact, 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 usually works well to reduce inflammation around the elbow joint. Care must be taken when using ice, since the lack of tissue makes the elbow vulnerable to frostbite (cold damage.) For this reason, it is best to limit the time an ice bag is on 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 like Bromelain (an enzyme helpful in reducing inflammation and 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, the shoulder is also the most commonly dislocated joint in the body. Likewise, subluxations (small dislocations) and tendonitis problems are also frequently found in patients with shoulder complaints. These less severe but painful shoulder conditions 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 pathologies (such as cancer) may also cause shoulder pain.
The shoulder is also a common source of referred pain (pain being transmitted to the shoulder from another source.) People with neck pain may experience this type of referred pain due to the irritated nerves that travel from the neck into the shoulder. Referred pain can also come from diseased or distressed organs. Organs such as the pancreas, liver, or heart can refer pain to the shoulder. Certain other structures in the and disorders in the digestive tract can refer pain to the shoulder as well such as a hiatal hernia or the ileocecal valve (a valve in the digestive tract between the small and large intestine, near the appendix.)
Diagnosis & Shoulder Conditions
A proper shoulder diagnosis is needed to help determine the nature (where the pain is coming from) and the degree of involvement of the shoulder condition. An examination and history aid the doctor in determining a proper diagnosis. In addition, x- rays of the shoulder may be helpful to determine alignment, check for fractures, visualize bone damage (arthritic changes or bone loss), or find other osseous (bony) abnormalities.
The way your shoulder moves with and without pain can play a key role in determining the type of shoulder problem you have. For instance, tendonitis conditions generally are exacerbated (hurt more) when the muscle that attaches to the tendon is forcibly contracted. 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. Whereas an inability to move your shoulder or have your shoulder moved usually indicates a bony obstruction or soft tissue swelling.
Chronic Shoulder Pain
In some cases of chronic shoulder dislocation, chiropractic treatment care can be 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 a 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, too. Often improvement can be made gradually in the shoulder joint through careful and patient stretching, relaxation, and passive motion therapy. Although many older patients will suffer from bursitis or arthritic shoulder conditions, there is one complaint about the inability to raise the arms out to the side above the level of the shoulders. In many of these complaints, the problem really isn,t in the shoulder at all. The reason why the arms cannot be raised above the level of the shoulders is because the spine has become kyphotic (bent over forward.) Even a child cannot raise his arms above his shoulders if his back is bent over.
At Mountain View Pain Center we treat thousand of shoulder problems each year. Once your shoulder problem has been diagnosed by your chiropractor, a course of treatment can be discussed. 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 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.
Acute sprains of the lateral ligaments about the ankle are the most common injury in sports and also occur commonly in the general population. Most commonly a partial tear or complete rupture of the ATFL occurs.
More severe injuries include the CFL.
Lateral ankle sprain results from an inversion mechanism.
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
Ankle sprains or low-grade trauma can be treated with the RICE protocol and gradual weight bearing as tolerated. Patients with ankle fractures should be splinted, instructed to remain non-weight bearing, and referred to an orthopedist for definitive care. Hot, swollen, erythematous ankles may warrant arthrocentesis to rule out a gouty attack or septic arthritis.
Physical Therapy
May be indicated in certain cases once diagnosis and specific treatments are performed such as 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 return to athletics may help prevent recurrence.
FAQ About Ankle Sprains
Which ligaments are involved and in what sequence in a lateral ankle sprain?
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 7 possible causes of ankle pain?
Fracture, sprain, tendon injury, tendinitis, arthritis, infection, or neoplasm.
What type of condition is suggested by morning stiffness and ankle pain?
Rheumatoid or inflammatory arthritis.
What conditions likely require referral to an orthopedist?
Acute fracture, neoplasm, and a chronic condition unresponsive to initial nonsurgical
Rheumatoid Arthritis
Stiffness in the joints is a common disease 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. This is what the term autoimmune means. Rheumatoid arthritis usually occurs on both sides of the body. This means it occurs in both hands, both knees, etc. Rheumatoid Arthritis or RA, is an autoimmune disease that selectively attacks the synovial joints, especially the small joints of the hands or feet.
Early detection of arthritis is essential. Once damage to a joint surface begins, little can be done to restore it back to the 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 with proper care and supervised rehabilitative exercises, the surrounding support tissues can be strengthened to compensate for many of these joint disorders.
As cartilage continues to be worn 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 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 is morning stiffness, pain on motion or joint effusion in at least one joint, soft tissue swelling or joint effusion in at least one joint. As well as swelling of at least one joint; bilateral, symmetrical, and simultaneous joint swelling, and also subcutaneous nodules.
Other symptoms of RA include:
- Fatigue,
- Malaise,
- Generalized muscle weakness, and
- A fever.
In fact many people think of rheumatoid arthritis as a condition of the hands and wrists, however 80% of pts will develop cervical spine changes as well.
It is important to use arthritic joints as disuse also leads to more arthritic changes; however, it is vital 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 but just have not noticed the symptoms yet. Simple palpation (feeling) of the vertebrae while the spine is slowly being moved can discover joints that do not move as freely as other joints do. Another more revealing and diagnostic procedure is a simple x-ray. An x-ray film can reveal the bony changes associated with either rheumatic arthritis.
The 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. Moist heat is also needed 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 to 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. The application of spinal and or extremity manipulation may also be used to help you gain control over your arthritic condition. Nutritional counseling, exercise instruction, and lifestyle changes may additional considerations during your course of care.
Knee Osteoarthritis
A common and debilitating form of degenerative or osteoarthritis is that of the knee joint. Most common reasons people do develop osteoarthritis are repetitive trauma, such as having a history of playing sports with repetitive un-treated injuries to the knee. Patients suffering from this ailment have a lower walking speed, shorter stride, and reduced ankle propulsion. Not only this but they suffering from a basic lack of motion causing difficulty in our basic daily activities such as shopping, walking the dog, or even getting in and out of your car. The pain starts gradually over a period of many years and changes with weather conditions. Do to the pain patients report that after frequent use they have to rest to help ease the pain or are prescribed NSIDS (nonsteroidal anti-inflammatory drugs).
Poor balance has been found in individuals with bilateral knee osteoarthritis. Another problem those with knee degeneration suffering from are 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 can lead to 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 and aid in your care 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 form a tunnel for three nerves and various blood vessels to pass from the arm into the hand. This tunnel is called the carpal tunnel. Irritation to the ligaments and bones that comprise this structure can result in the common known as carpal tunnel syndrome.
The pain, numbness, and tingling associated with Carpal Tunnel Syndrome are caused from 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. Symptoms include pain, numbness, and tingling and usually occur at night or in the early hours of the morning.
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. Temporary relief from symptoms is often obtained by shaking the affected hand in the air, elevating the wrist, or placing the hand in hot water. Placing the wrist in an extended or flexed position, especially for a prolonged period of time, aggravates the symptoms and the condition.
Since decreasing blood flow to the area increases symptoms, it is believed 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, the general area of involvement is felt in the index and middle finger. There may be slight difficulty or clumsiness associated with this condition. This is due to the lack of proper nerve function. Grip strength is usually only slightly decreased; however, 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 we can help diagnose this condition. A careful examination and history can help your chiropractor 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 are manipulation of the wrist bones to improve circulation through the tunnel, proper stretching, conditioning, bracing (thumb loop night brace), 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. It is the bursa that helps lubricate these sliding motions to prevent damage to the underlying bony structures. When this action is compromised, the inflammation that results is called Bursitis. The most common areas where bursitis occurs are the shoulder, elbow, hip, and the kneecap. Bursitis tends to get worse the more these joints are moved.
A common cause of bursitis is from the overuse of a joint, especially when the joint 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.
Another cause of bursitis is traumatic injury. Trauma such as a fall on the shoulder, elbow, hip, or the knee could create this condition. As the bursa swells, the normal function to decrease friction is decreased. This causes any movement of the joint to be painful. If too much swelling remains in the bursa for an extended period of time, 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 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 can easily be visualized 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. Chiropracticmanipulation to the involved joint, therapies like alternating hot and cold packs, ultrasound, passive range of motion, and massage may be considered as part of your course of treatment. Even the more difficult form of calcific bursitis can be treated 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.
