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Pain Issues

Back and Neck Pain

Back pain is one of the most common human afflictions and most people experience neck pain at some point in their lives as well. These conditions can be acute or chronic. Pain is considered acute if it lasts fewer than six weeks, while a diagnosis of chronic pain is made around the three month mark. Back and neck pain may follow an injury or develop unrelated to activity. The spinal area consists of the spinal cord, bones, joints, muscles, ligaments, tendons, cartilage, and nerves, all of which can contribute to the sensation of pain. The pain message is delivered to the brain via the nerves and spinal cord. Pain that continues for a long period of time can cause anxiety and stress for the individual, which can begin an unpleasant cycle of physical pain and emotional stress.

Neck pain can radiate into the shoulder, upper back, and arm while lower back pain is often felt in the hip or leg. Spine-related pain becomes more common as one ages. Common causes include age-related degenerative disorders, improper lifting, and chronic wear and tear but there are dozens of possible causes. Often, back and neck pain resolve on their own or with minimal intervention such as rest, pain medicine, or anti-inflammatory medication. Severe or ongoing pain warrants a medical evaluation. Physical medicine can often provide back and neck pain relief.

Knee Pain

Knee pain is a common problem that can develop at any age. The actual kneecap is called the patella, but the knee is considered to be a complex combination of structures including leg bones, ligaments, tendons, nerves, bursae, and cartilage, any of which can create pain. Knee pain may be chronic or acute, and crunching, aching, throbbing, or positional. The area may become swollen, warm to the touch, or reddened. The knee may be weak or “give out” while the sufferer is attempting to walk. Causes include overuse, arthritis, gout, pseudogout, bursitis, ACL injury, Baker cyst, tendinitis, dislocation of the kneecap, or other injury or disease. Diagnosis is typically made by x-ray, CT scan, MRI, or ultrasound. Treatment varies according to the underlying cause of the pain. Typical treatments include rest, ice, elevation of the knee, anti-inflammatory medication, pain medicine, injections into the knee area, compression bandages, exercises, and physical therapy. Physical medicine plays an integral role in the treatment of knee pain.

Shoulder Pain

Shoulder pain results from an injury, overuse, or inflammation of any of the structures in the shoulder area, including bones, muscles, tendons, joints, and nerves. The pain may be constant or it may come and go depending on activity. Common causes include a fracture, arthritis, dislocation, nerve problem, tendinitis, and bursitis. Diagnosis is made by physical examination and one or more of the following: x-ray, CT scan, MRI, ultrasound, electromyography, or arthroscopy. Treatment for shoulder pain includes rest, physical therapy, anti-inflammatory medication, pain medicine, a sling, ice, heat, exercise, and injection of steroids or other medication. Physical medicine can effectively treat most shoulder pain and provide rehabilitation if surgery is required.

Hip Bursitis

Bursitis is an inflammation of the bursa, which is a fluid-filled sac present where muscles are attached to the hip bone by tendons. Trochanteric bursitis is felt at the outside of the hip, while ischial bursitis may be felt in the groin or buttock area. The pain is typically described as sharp, but the hip area may become achy over time. Pain may be felt in the hip, thigh, buttock, or groin. It may be worse when lying on the hip, overusing the hip, or standing after sitting for an extended period of time. In hip bursitis, the bursa swells with too much fluid, causing discomfort. Occasionally, a bursa becomes infected. Hip bursitis is more common in women and older adults. It can be caused by overuse of the hips, a bone spur, an injury, rheumatoid arthritis, or other condition. Conservative treatment, including physical medicine, is usually attempted at first. Treatments include rest, anti-inflammatory medication, pain medicine, steroid injections, ice, stretching exercises, and/or physical therapy. Crutches or a cane may be utilized for walking.

Ulnar Nerve Entrapment

Ulnar nerve entrapment is a common condition in which the ulnar nerve that runs from the neck down the arm to the ring and little fingers becomes compressed along its path. Often, the compression occurs behind the elbow, but it may also be found at the wrist, collarbone, or neck area. Symptoms include numbness or tingling of the ring and little fingers, a weakened grip, easy fatigue of the fingers, and aching inside the elbow. In severe cases, some of the hand muscles may experience wasting. Nerve conduction studies may be performed. Treatment typically includes anti-inflammatory medication, a splint, specific exercises, or occupational therapy. Physical medicine can treat many cases of ulnar nerve entrapment and provide rehabilitation if surgery is required.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a frequently painful wrist condition that involves the median nerve, a nerve that allows movement and relays sensation for part of the hand. A group of nine tendons can be found near the median nerve and these are protected by synovium, a soft tissue. When the synovium swells, the median nerve becomes compressed and numbness and pain in the hand and first four fingers can ensue. This condition is common among computer operators and others who use their hands continuously during their workday, including those who use vibrating hand tools or work on an assembly line. It can also be the result of repetitive sports activity, diabetes, rheumatoid arthritis, obesity, menopause, and a host of other conditions. Carpal tunnel syndrome is more common in women.

A diagnosis of carpal tunnel syndrome may be made during a physical examination or through diagnostic testing, such as ultrasound, electromyography, or MRI. In addition to pain and numbness, weakness while gripping objects, and the inability to freely move the fingers are common symptoms. Muscle damage may become evident in advanced cases. Depending on the patient’s condition, carpal tunnel syndrome may be treated with anti-inflammatory drugs, steroidal injections, pain medication, a splint to immobilize the joint, or surgery. Physical medicine allows many carpal tunnel syndrome patients to return to work by utilizing a combination of treatment and patient education.

Brain Injury

Brain injuries are classified as mild, moderate, or severe. These result from the brain violently coming into contact with the skull or the skull being penetrated. Oxygen to the brain may be compromised and the blood pressure may fall, causing the brain to be starved of nutrients. Symptoms of a mild injury, often called a concussion, include brief or no loss of consciousness, confusion, sleep problems, sensitivity to light, headache, vomiting, poor balance, fatigue, and blurry vision. Symptoms of moderate to severe brain injury include loss of consciousness for more than a few minutes, seizures, dilated pupils, restlessness, slurred speech, and severe confusion. Symptoms related to a brain injury may show up immediately or not be recognizable for days or weeks. Diagnosis is typically made based on a neurological examination, history of events, and CT scan.

Brain injury may be the result of a fall, gunshot, assault, car crash, accident, or war-time event. Surgery is often necessary to repair ruptured blood vessels or remove blood from the brain. A brain injury may result in permanent physical, mental, and psychological challenges. Rehabilitation under the supervision of a physical medicine specialist can greatly aid in recovery. Physical therapy, Speech Therapy and Occupational therapy are typically utilized in the rehabilitation process.

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