NECK AND BACK PAIN

Degenerative Disc Disease

Degeneration of one or more intervertebral disc(s) of the spine, often called “degenerative disc disease” (DDD) or “degenerative disc disorder,” is a pathologic process of uncertain etiology that may cause acute or chronic low back pain.

Symptoms

With symptomatic degenerative disc disease, chronic low back pain sometimes radiates to the hips, or there is pain in the buttocks or thighs while walking; sporadic tingling or weakness through the knees, hands, and fingers may also be evident. Similar pain may be felt or may increase while sitting, bending, lifting, and twisting.

Chronic neck pain can also come from the cervical spine, with pain radiating to the head, shoulders, arms and hands. After an injury, some discs become painful because of inflammation and the pain comes and goes. Some people have nerve endings that penetrate more deeply into the anulus fibrosus (outer layer of the disc) than others, making discs more susceptible to becoming a source of pain. Degenerative disc disease can lead to a chronic debilitating condition and can have a serious negative impact on a person’s quality of life.


Osteoarthritis

Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone. The most common symptoms are joint pain and stiffness. Initially, symptoms may occur only following exercise, but over time may become constant. Other symptoms may include joint swelling, decreased range of motion, and when the back is affected weakness or numbness of the arms and legs.

The most commonly involved joints are those near the ends of the fingers, at the base of the thumb, neck, lower back, knees, and hips. Joints on one side of the body are often more affected than those on the other. Usually the problems come on over years. It can affect work and normal daily activities. Unlike other types of arthritis, only the joints are typically affected.

Causes

Causes include previous joint injury, abnormal joint or limb development, and inherited factors. Risk is greater in those who are overweight, have one leg of a different length, and have jobs that result in high levels of joint stress. Osteoarthritis is believed to be caused by mechanical stress on the joint and low grade inflammatory processes. It develops as cartilage is lost, eventually the underlying bone becomes effected. As pain may make it difficult to exercise, muscle loss may occur. Diagnosis is typically based on signs and symptoms, with medical imaging and other tests occasionally used to either support or rule out other problems. Unlike in rheumatoid arthritis, which is primarily an inflammatory condition, the joints do not typically become hot or red.

Symptoms

The main symptom is pain, causing loss of ability and often stiffness. “Pain” is generally described as a sharp ache or a burning sensation in the associated muscles and tendons. OA can cause a crackling noise (called “crepitus”) when the affected joint is moved or touched and people may experience muscle spasms and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Some people report increased pain associated with cold temperature, high humidity, and/or a drop in barometric pressure, but studies have had mixed results.

OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff, painful and may swell, but usually feel better with gentle use but worse with excessive or prolonged use, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden’s nodes (on the distal interphalangeal joints) and/or Bouchard’s nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain.


ELBOW PAIN

Tennis / Golfer’s Elbow

Tennis elbow or lateral epicondylitis is a condition in which the outer part of the elbow becomes sore and tender. The forearm muscles and tendons become damaged from overuse — repeating the same strenuous motions again and again. This leads to pain and tenderness on the outside of the elbow.

Any activity, including playing tennis, which involves the repetitive use of the extensor muscles of the forearm can cause acute or chronic tendonitis of the tendinous insertion of these muscles at the lateral epicondyle of the elbow. The condition is common in carpenters and other laborers who swing a hammer or other tool with the forearm.

Causes

Tennis elbow is a type of repetitive strain injury, resulting from tendon overuse and failed healing of the tendon.

Symptoms

Symptoms associated with tennis elbow include, but are not limited to: radiating pain from the outside of the elbow to the forearm and wrist, pain during extension of wrist, weakness of the forearm, a painful grip while shaking hands or torquing a doorknob, and not being able to hold relatively heavy items in the hand. The pain is similar to the condition known as golfer’s elbow, but the latter occurs at the medial side of the elbow.

  • Pain on the outer part of the elbow (lateral epicondyle)
  • Point tenderness over the lateral epicondyle—a prominent part of the bone on the outside of the elbow
  • Pain from gripping and movements of the wrist, especially wrist extension and lifting movements
  • Pain from activities that use the muscles that extend[citation needed] the wrist (e.g. pouring a container of liquid, lifting with the palm down, sweeping, especially where wrist movement is required)

Stress Fractures

A stress fracture, also known as a hairline fracture, is a fatigue-induced fracture of the bone caused by repeated stress over time, and are common overuse injuries in both athletes and sedentary people.

Stress fractures can be described as a very small sliver or crack in the bone; and are sometimes referred to as “hairline fractures”. Stress fractures most frequently occur in weight-bearing bones, such as the tibia (bone of the lower leg), metatarsals, and navicular bones (bones of the foot). Less common are fractures to the femur, pelvis, and sacrum.

Causes

Stress fractures are the result of accumulated trauma from repeated submaximal loading, and often occur in athletes completing high volume, high impact training, such as running or jumping sports. Stress fractures also commonly occur in sedentary people who suddenly undertake a burst of exercise (whose bones are not used to the task).

Symptoms

Stress fractures most commonly present as pain with weight bearing that increases with exercise or activity. The pain usually subsides with rest but may be constantly present with a more serious bone injury. There is usually an area of localized tenderness on or near the bone and generalized swelling to the area.


Tendinitis and Tendinosis

Tendinitis is a tendon injury caused by acute injury and is accompanied by inflammation.

Tendinosis (chronic tendinitis, chronic tendinopathy, or chronic tendon injury) is chronic degeneration to a tendon at a cellular level without inflammation.

Causes

Tendinitis can be caused by the type, frequency and severity of use of a tendon.

Tendinosis is thought to be caused by microtears in the connective tissue in and around the tendon, leading to an increase in tendon repair cells. This may lead to reduced tensile strength, thus increasing the chance of tendon rupture.

Symptoms

Tendinitis symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms.

Tendinosis symptoms can vary from an ache or pain and stiffness to the local area of the tendon, or a burning that surrounds the whole joint around the affected tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day as swelling impinges on the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain, which may contribute to the symptoms. Swelling in a region of micro damage or partial tear may be detected visually or by touch.


FOOT AND ANKLE PAIN

Stress Fractures

A stress fracture, also known as a hairline fracture, is a fatigue-induced fracture of the bone caused by repeated stress over time, and are common overuse injuries in both athletes and sedentary people. Stress fractures can be described as a very small sliver or crack in the bone and are sometimes referred to as “hairline fractures”. Stress fractures most frequently occur in weight-bearing bones, such as the tibia (bone of the lower leg), metatarsals, and navicular bones (bones of the foot). Less common are fractures to the femur, pelvis, and sacrum.

Causes

Stress fractures are the result of accumulated trauma from repeated submaximal loading, and often occur in athletes completing high volume, high impact training, such as running or jumping sports. Stress fractures also commonly occur in sedentary people who suddenly undertake a burst of exercise (whose bones are not used to the task).

Symptoms

Stress fractures most commonly present as pain with weight bearing that increases with exercise or activity. The pain usually subsides with rest but may be constantly present with a more serious bone injury. There is usually an area of localized tenderness on or near the bone and generalized swelling to the area.


Tendinitis and Tendinosis

Tendinitis is a tendon injury caused by acute injury and is accompanied by inflammation. Tendinosis (chronic tendinitis, chronic tendinopathy, or chronic tendon injury) is chronic degeneration to a tendon at a cellular level without inflammation.

Causes

Tendinitis can be caused by the type, frequency and severity of use of a tendon. Tendinosis is thought to be caused by microtears in the connective tissue in and around the tendon, leading to an increase in tendon repair cells. This may lead to reduced tensile strength, thus increasing the chance of tendon rupture.

Symptoms

Tendinitis symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms.

Tendinosis symptoms can vary from an ache or pain and stiffness to the local area of the tendon, or a burning that surrounds the whole joint around the affected tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day as swelling impinges on the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain, which may contribute to the symptoms. Swelling in a region of micro damage or partial tear may be detected visually or by touch.


Osteoarthritis

Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone.

The most common symptoms are joint pain and stiffness. Initially, symptoms may occur only following exercise, but over time may become constant. Other symptoms may include joint swelling, decreased range of motion, and when the back is affected weakness or numbness of the arms and legs. The most commonly involved joints are those near the ends of the fingers, at the base of the thumb, neck, lower back, knees, and hips. Joints on one side of the body are often more affected than those on the other. Usually the problems come on over years. It can affect work and normal daily activities. Unlike other types of arthritis, only the joints are typically affected.

Causes

Causes include previous joint injury, abnormal joint or limb development, and inherited factors. Risk is greater in those who are overweight, have one leg of a different length, and have jobs that result in high levels of joint stress. Osteoarthritis is believed to be caused by mechanical stress on the joint and low grade inflammatory processes. It develops as cartilage is lost with eventually the underlying bone becoming affected. As pain may make it difficult to exercise, muscle loss may occur. Diagnosis is typically based on signs and symptoms with medical imaging and other tests occasionally used to either support or rule out other problems. Unlike in rheumatoid arthritis, which is primarily an inflammatory condition, the joints do not typically become hot or red.

Symptoms

The main symptom is pain, causing loss of ability and often stiffness. “Pain” is generally described as a sharp ache or a burning sensation in the associated muscles and tendons. OA can cause a crackling noise (called “crepitus”) when the affected joint is moved or touched and people may experience muscle spasms and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Some people report increased pain associated with cold temperature, high humidity, and/or a drop in barometric pressure, but studies have had mixed results.

OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff, painful and may swell, but usually feel better with gentle use but worse with excessive or prolonged use, thus distinguishing it from rheumatoid arthritis.In smaller joints, such as at the fingers, hard bony enlargements, called Heberden’s nodes (on the distal interphalangeal joints) and/or Bouchard’s nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain.


Turf Toe

A metatarsophalangeal joint sprain is an injury to the connective tissue between the foot and one of the toes. When the big toe is involved, it is known as “turf toe”, but it can occur on the lesser toes as well.

Causes

Turf toe is named from the injury being associated with playing sports on rigid surfaces such as artificial turf and is a fairly common injury among professional athletes. Often, the injury occurs when someone or something falls on the back of the calf while that leg’s knee and tips of the toes are touching the ground, or from athletic shoes with very flexible soles combined with cleats that “grab” the turf. The toe is hyperextended and thus the joint is injured.

Symptoms

The injury can be debilitating for athletes who need to accelerate, quickly change direction, or jump. Use of the toes is not possible during the healing process. Since the toes are necessary for proper push-off when accelerating, those sorts of athletic activities should be almost completely curtailed. An extended healing period of one or more months is often required.

Because of the anatomy and the unique use of the foot, it is often impossible to properly tape or brace the joint. Turf toe can often progress into a chronic problem, in which the joint(s) never really heals or heals too slowly to return to usual physical activities. It may cause serious problems if left untreated.


HAND AND WRIST PAIN

Hand Osteoarthritis

The main symptom is pain, causing loss of ability and often stiffness. “Pain” is generally described as a sharp ache or a burning sensation in the associated muscles and tendons. Occasionally, the joints may also be filled with fluid.

Causes

Damage from mechanical stress with insufficient self repair by joints is believed to be the primary cause of osteoarthritis. Sources of this stress may include misalignments of bones caused by congenital or pathogenic causes; mechanical injury; excess body weight; loss of strength in the muscles supporting a joint; and impairment of peripheral nerves, leading to sudden or uncoordinated movements.

Symptoms

As OA progresses, the affected joints appear larger, are stiff, painful and may swell, but usually feel better with gentle use but worse with excessive or prolonged use, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden’s nodes (on the distal interphalangeal joints) and/or Bouchard’s nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly.


Stress Fractures

A stress fracture, also known as a hairline fracture, is a fatigue-induced fracture of the bone caused by repeated stress over time, and are common overuse injuries in both athletes and sedentary people. Stress fractures can be described as a very small sliver or crack in the bone and are sometimes referred to as “hairline fractures”.

Causes

Stress fractures are the result of accumulated trauma from repeated submaximal loading, and often result from high volume, high impact activity. Stress fractures also commonly occur in sedentary people who suddenly undertake a burst of exercise (whose bones are not used to the task).

Symptoms

Stress fractures most commonly present as pain with weight bearing that increases with exercise or activity. The pain usually subsides with rest but may be constantly present with a more serious bone injury. There is usually an area of localized tenderness on or near the bone and generalized swelling to the area.


Tendinitis and Tendinosis

Tendinitis is a tendon injury caused by acute injury and is accompanied by inflammation.
Tendinosis (chronic tendinitis, chronic tendinopathy, or chronic tendon injury) is chronic degeneration to a tendon at a cellular level without inflammation.

Causes

Tendinitis can be caused by the type, frequency and severity of use of a tendon.

Tendinosis is thought to be caused by microtears in the connective tissue in and around the tendon, leading to an increase in tendon repair cells. This may lead to reduced tensile strength, thus increasing the chance of tendon rupture.

Symptoms

Tendinitis symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms.

Tendinosis symptoms can vary from an ache or pain and stiffness to the local area of the tendon, or a burning that surrounds the whole joint around the affected tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day as swelling impinges on the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain, which may contribute to the symptoms. Swelling in a region of micro damage or partial tear may be detected visually or by touch.


HIP PAIN

Hip Strains

A muscle strain or hip flexor strain is an injury to a muscle in which the muscle fibers tear as a result of overstretching. A strain is also known as a pulled muscle or torn muscle. The equivalent injury to a ligament is a sprain.

Causes

Strains are a result of muscular fiber tears due to over-stretching; they can range from mild annoyance to very painful. Although strains are not restricted to athletes and can happen while doing everyday tasks, people who play sports are more at risk of developing a strain.

Symptoms

Typical symptoms of a strain include localized stiffness, discoloration and bruising around the strained muscle.


Tendinitis and Tendinosis

Tendinitis is a tendon injury caused by acute injury and is accompanied by inflammation.

Tendinosis (chronic tendinitis, chronic tendinopathy, or chronic tendon injury) is chronic degeneration to a tendon at a cellular level without inflammation.

Causes

Tendinitis can be caused by the type, frequency and severity of use of a tendon.

Tendinosis is thought to be caused by microtears in the connective tissue in and around the tendon, leading to an increase in tendon repair cells. This may lead to reduced tensile strength, thus increasing the chance of tendon rupture.

Symptoms

Tendinitis symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms.

Tendinosis symptoms can vary from an ache or pain and stiffness to the local area of the tendon, or a burning that surrounds the whole joint around the affected tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day as swelling impinges on the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain, which may contribute to the symptoms. Swelling in a region of micro damage or partial tear may be detected visually or by touch.


Inflammatory Arthritis of the Hip

Cause

The exact cause of inflammatory arthritis is not known, but genetics may play a role in its development.

Symptoms

Symptoms of inflammatory arthritis include stiffness, pain, and swelling of the joints, restricted motions, and reduced physical strength. Other symptoms may include systemic complaints including fatigue.


Osteoarthritis

Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone. The most common symptoms are joint pain and stiffness. Initially, symptoms may occur only following exercise, but over time may become constant. Other symptoms may include joint swelling, decreased range of motion, and when the back is affected weakness or numbness of the arms and legs. The most commonly involved joints are those near the ends of the fingers, at the base of the thumb, neck, lower back, knees, and hips. Joints on one side of the body are often more affected than those on the other. Usually the problems come on over years. It can affect work and normal daily activities. Unlike other types of arthritis, only the joints are typically affected.

Causes

Causes include previous joint injury, abnormal joint or limb development, and inherited factors. Risk is greater in those who are overweight, have one leg of a different length, and have jobs that result in high levels of joint stress. Osteoarthritis is believed to be caused by mechanical stress on the joint and low grade inflammatory processes. It develops as cartilage is lost with eventually the underlying bone becoming affected. As pain may make it difficult to exercise, muscle loss may occur. Diagnosis is typically based on signs and symptoms with medical imaging and other tests occasionally used to either support or rule out other problems. Unlike in rheumatoid arthritis, which is primarily an inflammatory condition, the joints do not typically become hot or red.

Symptoms

The main symptom is pain, causing loss of ability and often stiffness. “Pain” is generally described as a sharp ache or a burning sensation in the associated muscles and tendons. OA can cause a crackling noise (called “crepitus”) when the affected joint is moved or touched and people may experience muscle spasms and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Some people report increased pain associated with cold temperature, high humidity, and/or a drop in barometric pressure, but studies have had mixed results.

OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff, painful and may swell, but usually feel better with gentle use but worse with excessive or prolonged use, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden’s nodes (on the distal interphalangeal joints) and/or Bouchard’s nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain.


Bursitis

Bursitis is the inflammation of one or more bursae (small sacs) of synovial fluid in the body. They are lined with a synovial membrane that secretes a lubricating synovial fluid. There are more than 150 bursae in the human body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying on the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem. Muscle can also be stiffened.

Cause

There can be several concurrent causes. Trauma, auto-immune disorders, infection and iatrogenic (medicine-related) factors can all cause bursitis. Bursitis is commonly caused by repetitive movement and excessive pressure. Shoulders, elbows and knees are the most commonly affected. Inflammation of the bursae may also be caused by other inflammatory conditions such as rheumatoid arthritis, scleroderma, systemic lupus erythematosus and gout. Immune deficiencies, including HIV and diabetes, can also cause bursitis. Infrequently, scoliosis can cause bursitis of the shoulders; however, shoulder bursitis is more commonly caused by overuse of the shoulder joint and related muscles.

Traumatic injury is another cause of bursitis. The inflammation irritates because the bursa no longer fits in the original small area between the bone and the functionary muscle or tendon. When the bone increases pressure upon the bursa, bursitis results. Sometimes the reason is unknown. It can also be associated with various other chronic systemic diseases.

Symptoms

Bursitis commonly affects superficial bursae. These include the subacromial, prepatellar, retrocalcaneal, and pes anserinus bursae of the shoulder, knee, heel and shin, etc. Symptoms vary from localized warmth and erythema to joint pain and stiffness, to stinging pain that surrounds the joint around the inflamed bursa. In this condition, the pain usually is worse during and after activity, and then the bursa and the surrounding joint becomes stiff the next morning.


KNEE PAIN

ACL, PCL and Meniscus Tears

An ACL tear is the tearing of the Anterior Cruciate Ligament, which connects the upper leg bone (femur) and lower leg bone (shin). A PCL tear is a tear of the Posterior Cruciate Ligament, which is located within the knee joint where it stabilizes the articulating bones, particularly the femur and the tibia, during movement. A Meniscus tear is a tear of a ligament located in the front of the knee, which serves to “cushion” the joint.

Causes

ACL injuries occur when an individual stops suddenly or plants his/her foot hard into the ground (cutting). ACL failure has also been linked to heavy or stiff-legged landing; the knee rotating while landing, especially when the knee is in an unnatural position. Common causes of PCL injuries are direct blows to the flexed knee, such as the knee hitting the dashboard in a car accident or falling hard on the knee.

The two most common causes of a meniscal tear are traumatic injury (often seen in athletes) and degenerative processes, which are the most common tear seen in all ages of patients. Meniscal tears can occur in all age groups.

Symptoms

ACL and PCL injuries typically result in pain, inflammation and instability. If instability is evident, particularly rotatory instability, then the menisci will get injured, sooner or later, setting the scene for progressive, degenerative, arthritis of the knee. A torn meniscus will most commonly result in knee pain and swelling. These are worse when the knee bears more weight (for example, when running). Another typical complaint is joint locking, when the affected person is unable to straighten the leg fully. This can be accompanied by a clicking feeling. Sometimes, a meniscal tear also causes a sensation that the knee gives way.


Osteoarthritis

Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone. The most common symptoms are joint pain and stiffness. Initially, symptoms may occur only following exercise, but over time may become constant. Other symptoms may include joint swelling, decreased range of motion, and when the back is affected weakness or numbness of the arms and legs.

The most commonly involved joints are those near the ends of the fingers, at the base of the thumb, neck, lower back, knees, and hips. Joints on one side of the body are often more affected than those on the other. Usually the problems come on over years. It can affect work and normal daily activities. Unlike other types of arthritis, only the joints are typically affected.

Causes

Causes include previous joint injury, abnormal joint or limb development, and inherited factors. Risk is greater in those who are overweight, have one leg of a different length, and have jobs that result in high levels of joint stress. Osteoarthritis is believed to be caused by mechanical stress on the joint and low grade inflammatory processes. It develops as cartilage is lost with eventually the underlying bone becoming affected. As pain may make it difficult to exercise, muscle loss may occur. Diagnosis is typically based on signs and symptoms with medical imaging and other tests occasionally used to either support or rule out other problems. Unlike in rheumatoid arthritis, which is primarily an inflammatory condition, the joints do not typically become hot or red.

Symptoms

The main symptom is pain, causing loss of ability and often stiffness. “Pain” is generally described as a sharp ache or a burning sensation in the associated muscles and tendons. OA can cause a crackling noise (called “crepitus”) when the affected joint is moved or touched and people may experience muscle spasms and contractions in the tendons. Occasionally, the joints may also be filled with fluid.[9] Some people report increased pain associated with cold temperature, high humidity, and/or a drop in barometric pressure, but studies have had mixed results.

OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff, painful and may swell, but usually feel better with gentle use but worse with excessive or prolonged use, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden’s nodes (on the distal interphalangeal joints) and/or Bouchard’s nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain.


Bursitis

Bursitis is the inflammation of one or more bursae (small sacs) of synovial fluid in the body. They are lined with a synovial membrane that secretes a lubricating synovial fluid. There are more than 150 bursae in the human body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying on the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem. Muscle can also be stiffened.

Cause

There can be several concurrent causes. Trauma, auto-immune disorders, infection and iatrogenic (medicine-related) factors can all cause bursitis. Bursitis is commonly caused by repetitive movement and excessive pressure. Shoulders, elbows and knees are the most commonly affected. Inflammation of the bursae may also be caused by other inflammatory conditions such as rheumatoid arthritis, scleroderma, systemic lupus erythematosus and gout. Immune deficiencies, including HIV and diabetes, can also cause bursitis. Infrequently, scoliosis can cause bursitis of the shoulders; however, shoulder bursitis is more commonly caused by overuse of the shoulder joint and related muscles.

Traumatic injury is another cause of bursitis. The inflammation irritates because the bursa no longer fits in the original small area between the bone and the functionary muscle or tendon. When the bone increases pressure upon the bursa, bursitis results. Sometimes the reason is unknown. It can also be associated with various other chronic systemic diseases.

Symptoms

Bursitis commonly affects superficial bursae. These include the subacromial, prepatellar, retrocalcaneal, and pes anserinus bursae of the shoulder, knee, heel and shin, etc. Symptoms vary from localized warmth and erythema to joint pain and stiffness, to stinging pain that surrounds the joint around the inflamed bursa. In this condition, the pain usually is worse during and after activity, and then the bursa and the surrounding joint becomes stiff the next morning.


SHOULDER PAIN

Rotator Cuff Tears

A rotator cuff tear is a tear of one or more of the tendons of the four rotator cuff muscles of the shoulder. A rotator cuff ‘injury’ can include any type of irritation or overuse of those muscles or tendons, and is among the most common conditions affecting the shoulder.

Causes

Recurrent lifting and overhead motions are at risk for rotator cuff tears. People who have jobs that involve overhead work, such as carpenters, painters, custodians and servers are at risk of also experiencing a rotator cuff tear. People who play sports that involve overhead motions, such as swimming, volleyball, baseball, tennis, and american football quarterbacks, are at a greater risk of experiencing a rotator cuff tear.

Symptoms

Many rotator cuff tears are asymptomatic. They are known to increase in frequency with age and the most common cause is age-related degeneration and, less frequently, sports injuries or trauma. The most common presentation is shoulder pain or discomfort. This may occur with activity, particularly shoulder activity above the horizontal position, but may also be present at rest in bed. Pain-restricted movement above the horizontal position may be present, as well as weakness with shoulder flexion and abduction.


Tendinitis and Tendinosis

Tendinitis is a tendon injury caused by acute injury and is accompanied by inflammation.

Tendinosis (chronic tendinitis, chronic tendinopathy, or chronic tendon injury) is chronic degeneration to a tendon at a cellular level without inflammation.

Causes

Tendinitis can be caused by the type, frequency and severity of use of a tendon.

Tendinosis is thought to be caused by microtears in the connective tissue in and around the tendon, leading to an increase in tendon repair cells. This may lead to reduced tensile strength, thus increasing the chance of tendon rupture.

Symptoms

Tendinitis symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms.

Tendinosis symptoms can vary from an ache or pain and stiffness to the local area of the tendon, or a burning that surrounds the whole joint around the affected tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day as swelling impinges on the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain, which may contribute to the symptoms. Swelling in a region of micro damage or partial tear may be detected visually or by touch.


Osteoarthritis

Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone. The most common symptoms are joint pain and stiffness. Initially, symptoms may occur only following exercise, but over time may become constant. Other symptoms may include joint swelling, decreased range of motion, and when the back is affected weakness or numbness of the arms and legs.

The most commonly involved joints are those near the ends of the fingers, at the base of the thumb, neck, lower back, knees, and hips. Joints on one side of the body are often more affected than those on the other. Usually the problems come on over years. It can affect work and normal daily activities. Unlike other types of arthritis, only the joints are typically affected.

Causes

Causes include previous joint injury, abnormal joint or limb development, and inherited factors. Risk is greater in those who are overweight, have one leg of a different length, and have jobs that result in high levels of joint stress. Osteoarthritis is believed to be caused by mechanical stress on the joint and low grade inflammatory processes. It develops as cartilage is lost, eventually the underlying bone becomes effected.

As pain may make it difficult to exercise, muscle loss may occur. Diagnosis is typically based on signs and symptoms with medical imaging and other tests occasionally used to either support or rule out other problems. Unlike in rheumatoid arthritis, which is primarily an inflammatory condition, the joints do not typically become hot or red.

Symptoms

The main symptom is pain, causing loss of ability and often stiffness. “Pain” is generally described as a sharp ache or a burning sensation in the associated muscles and tendons. OA can cause a crackling noise (called “crepitus”) when the affected joint is moved or touched and people may experience muscle spasms and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Some people report increased pain associated with cold temperature, high humidity, and/or a drop in barometric pressure, but studies have had mixed results.

OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff, painful and may swell, but usually feel better with gentle use but worse with excessive or prolonged use, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden’s nodes (on the distal interphalangeal joints) and/or Bouchard’s nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain.


Bursitis

Bursitis is the inflammation of one or more bursae (small sacs) of synovial fluid in the body. They are lined with a synovial membrane that secretes a lubricating synovial fluid. There are more than 150 bursae in the human body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying on the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem. Muscle can also be stiffened.

Cause

There can be several concurrent causes. Trauma, auto-immune disorders, infection and iatrogenic (medicine-related) factors can all cause bursitis. Bursitis is commonly caused by repetitive movement and excessive pressure. Shoulders, elbows and knees are the most commonly affected. Inflammation of the bursae may also be caused by other inflammatory conditions such as rheumatoid arthritis, scleroderma, systemic lupus erythematosus and gout. Immune deficiencies, including HIV and diabetes, can also cause bursitis. Infrequently, scoliosis can cause bursitis of the shoulders; however, shoulder bursitis is more commonly caused by overuse of the shoulder joint and related muscles.

Traumatic injury is another cause of bursitis. The inflammation irritates because the bursa no longer fits in the original small area between the bone and the functionary muscle or tendon. When the bone increases pressure upon the bursa, bursitis results. Sometimes the reason is unknown. It can also be associated with various other chronic systemic diseases.

Symptoms

Bursitis commonly affects superficial bursae. These include the subacromial, prepatellar, retrocalcaneal, and pes anserinus bursae of the shoulder, knee, heel and shin, etc. Symptoms vary from localized warmth and erythema to joint pain and stiffness, to stinging pain that surrounds the joint around the inflamed bursa. In this condition, the pain usually is worse during and after activity, and then the bursa and the surrounding joint becomes stiff the next morning.


SLAP Tears (Labral Tears)

A SLAP tear or SLAP lesion is an injury to the glenoid labrum (fibrocartilaginous rim attached around the margin of the glenoid cavity). SLAP is an acronym for “superior labral tear from anterior to posterior”.

Causes

A SLAP tear or lesion occurs when there is damage to the superior (uppermost) area of the labrum. These lesions have come into public awareness because of their frequency in athletes involved in overhead and throwing activities in turn relating to relatively recent description of labral injuries in throwing athletes, and initial definitions of the 4 (major) SLAP sub-types, all happening since the 1990s. The identification and treatment of these injuries continues to evolve.

Symptoms

Several symptoms are common but not specific:

  • Dull, throbbing, ache in the joint which can be brought on by very strenuous exertion or simple household chores.
  • Difficulty sleeping due to shoulder discomfort. The SLAP lesion decreases the stability of the joint which, when combined with lying in bed, causes the shoulder to drop.
  • For an athlete involved in a throwing sport such as baseball, pain and a catching feeling are prevalent. Throwing athletes may also complain of a loss of strength or significant decreased velocity in throwing.
  • Any applied force overhead or pushing directly into the shoulder can result in impingement and catching sensations.

Frozen Shoulder

Adhesive capsulitis (also known as Frozen shoulder) is a painful and disabling disorder of unclear cause in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain. Pain is usually constant, worse at night, and with cold weather. Certain movements or bumps can provoke episodes of tremendous pain and cramping.

Causes

The condition is thought to be caused by injury or trauma to the area and may have an autoimmune component. People who suffer from adhesive capsulitis usually experience severe pain and sleep deprivation for prolonged periods due to pain that gets worse when lying still and restricted movement/positions.

Symptoms

Movement of the shoulder is severely restricted, with progressive loss of both active and passive range of motion. The condition is sometimes caused by injury, leading to lack of use due to pain, but also often arises spontaneously with no obvious preceding trigger factor (idiopathic frozen shoulder). Rheumatic disease progression and recent shoulder surgery can also cause a pattern of pain and limitation similar to frozen shoulder. Intermittent periods of use may cause inflammation.

In frozen shoulder, there is a lack of synovial fluid, which normally helps the shoulder joint, a ball and socket joint, move by lubricating the gap between the humerus(upper arm bone) and the socket in the shoulder blade. The shoulder capsule thickens, swells, and tightens due to bands of scar tissue (adhesions) that have formed inside the capsule. As a result, there is less room in the joint for the humerus, making movement of the shoulder stiff and painful. This restricted space between the capsule and ball of the humerus distinguishes adhesive capsulitis from a less complicated, painful, stiff shoulder.


SPORTS MEDICINE

Sports medicine, also known as sport and exercise medicine (SEM), is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise.

Common sports injuries include:

  • Torn ACL and MCL ligaments
  • Fractures
  • Meniscus tears
  • Shin splints
  • Rotator cuff tears