How Carpal Tunnel Affects People’s Quality of Life

Most people have heard of carpal tunnel syndrome because tens of millions of people are experiencing its symptoms each year. The painful disorder exists when the carpal tunnel in the wrist that protects the median nerve is compressed. The compression is due to inflammation causing swelling in the tendons and ligaments in the carpal tunnel, creating pressure on the median nerve.

The symptoms of carpal tunnel syndrome may disappear when swelling goes down and relieves the pressure. However, millions of people live with the condition on a daily basis. The carpal tunnel syndrome is painful and leads to hand and wrist weakness, making it difficult to accomplish certain activities in personal and work lives.

Symptoms and Signs of Carpal Tunnel Syndrome

Living with carpal tunnel syndrome is not easy because the hand and wrist are involved in most activities. It is often thought of as a repetitive motion condition, but can develop due to:

  • repetitive movements;
  • injury to the wrist, like a fracture;
  • aging;
  • arthritic diseases (rheumatoid arthritis, gout);
  • wrist or hand deformity.

The symptoms develop slowly and include:

  • numbness in hands;
  • finger pain or tingling;
  • pain that spreads from the palm and into the finger;
  • decreased feeling in the fingertips;
  • swollen hand;
  • weakness in the hand;
  • inability to perform certain tasks requiring dexterity;
  • frequent dropping of items because of lack of feeling and weakness in the hand.

In severe cases, the muscles at the base of the thumb may shrink. The fingers affected are the ones served by the nerve running through the carpal tunnel: thumb, middle finger, ring finger and index finger.

Daily Activities Impacted by Carpal Tunnel

For the activities of daily living carpal tunnel syndrome can have a measurable impact. Carpal tunnel syndrome can make it difficult to complete even simple tasks, like buttoning a shirt or twisting a jar lid. The disease also makes it difficult for people who do repetitive tasks on a regular basis. What type of jobs can trigger carpal tunnel syndrome? They include:

  • office jobs requiring a lot of typing;
  • technology jobs requiring a lot of keyboarding or data entry;
  • sewers;
  • manufacturing plant assembly line workers doing repetitive work;
  • cleaning professionals;
  • painters;
  • construction workers using hand hammers and other tools that jar the wrist.
The job requiring a lot of typing may trigger carpal tunnel syndrome

Some of the simplest daily and work activities become difficult and painful. It can prevent people from being able to pick up small objects, maintain the rate of task completion at work, force a person to choose a different occupation, affect the ability to enjoy hobbies and prevent someone from participating in recreational activities.

The carpal tunnel disease is not a life threatening condition but it can significantly lower the quality of life. When people cannot enjoy life because of pain, numbness or weakness in the hands and wrists, they are exhausted mentally and emotionally, as well as physically.

Self-Care for Pain Relief

A lot of people choose to avoid surgery for the carpal tunnel condition, so it is important to adopt a self-treatment plan. Carpal tunnel that is left untreated can lead to permanent muscle (atrophy) and nerve damage in the hand and wrist.

Carpal tunnel syndrome daily exercises to help pain management

  1. Wear a wrist splint or brace at night (many people sleep with their wrist flexed and wake up with numbness) and at times throughout the day.
  2. Shake and then hang the hand over the side of the bed at night.
  3. Take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs).
  4. Take changes at the workstation that ensure the arm, keep wrists and hands aligned and in a neutral position, i.e. raise the desk chair or adjust the keyboard’s height.
How to maintain wrist alignment when doing a lot of typing
  1. Maintain awareness of wrist and alignment while performing any repetitive task, making corrections as necessary.
  2. Take frequent breaks from any task that causes discomfort in the wrist and hand.
  3. Do stretching hand and wrist exercises each day that increase grip strength and reduce tightness in the wrist.
Carpal tunnel syndrome exercises for wrists
  1. Ice the wrist twice a day.
  2. Immerse the hand in warm water twice a day and flex the wrist.
  3. Carefully follow the pain treatments recommended by your physician.

Until the symptoms improve, stop doing activities that may be contributing to carpal tunnel symptoms. If the self-care treatment plan does not bring enough relief, physical therapy sessions often help. Surgery is always an option; it brings relief in 90 % of the cases.

Trigger Point Injection Therapy for Chronic Pain

Trigger point injection therapy is used for pain relief caused by trigger points. These points represent dense knots of muscles that are sensitive to pressure, touch and irritate surrounding nerves.

Understanding Trigger Points

Referred pain radiates to another area of the body. The trigger points are very tight muscle areas and form for a variety of reasons:

  • traumatic injury,
  • muscle tension,
  • pinched spinal nerves,
  • muscle over-exertion,
  • muscle spasms,
  • muscle inflammation,
  • past surgery,
  • inflamed or injured tendons or ligaments or muscle fascia,
  • poor posture,
  • muscle overuse involving repetitive movements.

Weakened, inflamed or overstretched muscles heal in a way that leads to tight, twisted or knotted ones. The knotted fibers restrict blood flow to the muscles, and it keeps them tight and stiff, causing pain and a restricted range of motion. Trigger points impact the muscle’s willingness to stretch or contract, making movement painful.

The Trigger Point Injection

Trigger point injections can be used to treat:

Tension headaches

Understanding the Injection Process

Trigger point injections are usually not used as a treatment until other treatments, like medications and exercises, have been tried for four to six weeks. If the pain does not improve, trigger point injections may provide the pain relief sought.

The trigger point injection does not take long to complete. Who gives trigger point injections? Injections are made by a physician in the Spine and pain clinic. Typically, it is general practitioners, neurologists, rheumatologists, pain-management specialists and rehabilitation doctors who give the injections.
How is the procedure performed?

  1. Patient sits or lies down.
  2. Physician locates the trigger point targeted for injection via manual palpitation.
  3. A numbing solution may or may not be applied before the injection.
  4. A small needle is inserted into the trigger point.
  5. An injection of an anesthetic or mixture of anesthetics, with a corticosteroid added sometimes, is made directly into the trigger point via the needle.
  6. Sometimes a needle is inserted without medication, or only a saline solution is administered, with the goal to make the trigger point inactive.
  7. More than one trigger point can be injected
An injection with the anesthetic

The anesthetic and steroid medicine provide fast relief, relaxing the tight muscles. People who experience chronic pain may have trigger point recurrence. In this case, the patient will get the trigger point injections regularly, but no more than three times to the same trigger point to avoid scarring and muscle damage.

If only the anesthetic is applied, the injection can be administered once a month. If the corticosteroid is used, the trigger point injection cannot be given so often. Steroids used over the long term can cause tissue damage.

What to Expect after Trigger Point Injections

Do trigger point injections hurt? Usually, the only complication is swelling or soreness at the injection site. Application of heat or ice, and taking over-the-counter NSAIDs, may be helpful. Infrequently, patients experience muscle spasms or balance problems due to changes in the muscles.

Woman experiences muscle spasms

If the patients got the trigger point injections into the leg or arm, they are not allowed to drive.
For the first 24 hours after the procedure, patients should do mild stretching exercises to help stretch tissues in the treated area. The physician will give the patient all necessary instructions.

Possible Benefits and Risks of Provocative Discography (Discogram) Test

Back pain can be a significant hindrance to a high quality of life. It can leave patients unable to sit or walk comfortably and may keep them from their work, family events or hobbies. The back is one of the most frequent locations for chronic pain because of the long line of vertebral bones and intervertebral discs that must be in perfect condition for a pain-free existence.

Chronic back pain

What Is the Discography Procedure?

The discography medical test is one option for diagnosing the cause of back pain. During this test, the doctor will inject a special dye into each intervertebral disc. Pain with injection indicates that a particular disc may be to blame for the chronic pain. Once the dye is injected, the doctor will take a special X-ray, called a discogram, to look for tears or other issues within the discs. The dye allows for clear X-rays.

How to Prepare for Discography

Patients may need to have several pre-procedure tests performed to ensure that their bodies can handle the discography. For example, the doctor may order a blood test to check for clotting speed and kidney health.

The doctor will also give each patient specific instructions, such as which medications to take in the morning and when the patient should stop eating and drinking. Usually, blood thinners will need to be stopped several days in advance to reduce the risk of dangerous bleeding issues.

Patients should be sure to discuss concerns with their doctors before the procedure. They should discuss possible allergies to anesthetics or contrast dyes as well as the possibility of pregnancy for female patients.

When to Call the Doctor after Discography

Most discograms are done as outpatient procedures, meaning that patients will mainly recover at home. It is normal to have some pain for several hours and up to a day or two at the injection sites. However, patients should immediately call their doctors if they experience severe, debilitating back pain, back pain that worsens or a high fever within the next couple of weeks.

Benefits, Risks and Alternatives to Discography

Discography offers several distinct benefits for patients suffering from chronic back pain.

  • Specific diagnosis of the intervertebral disc causing the pain
  • Quick outpatient procedure
  • High-quality X-ray images with the contrast dye
  • Improved ability to choose the correct treatment.
X-ray images with the contrast dye

However, patients should consider discogram risks to determine if risks outweigh the benefits for their circumstances.

  • Risk of infection from intervertebral injections
  • Possible allergic reaction to dye
  • Risk of bleeding
  • Possible long-term side effects from radiation

For some, the risk of complication from cervical discography or any other area of discography may make them look for an alternative. Some options include the following:

  • Noninvasive physical examination
  • Traditional X-rays
  • CT scans or MRIs
  • Surgery

In most cases, the results from the discography procedure are looked at along with the results from other tests or during physical assessments to determine the correct treatment for the patient. However, discography is often the best procedure to guide the treatment for intervertebral disc pain.

Carpal Tunnel Syndrome

A common condition people experience is carpal tunnel syndrome. It is called a syndrome because it presents itself with a consistent group of symptoms in the wrist and hand, including pain and weakness. It is not a life threatening condition, but it can interfere with the ability to work and limit other activities.

Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

A median nerve runs from the forearm through the wrist and into the palm. The nerve is contained in a rigid, narrow passageway made of bones and ligament at the base of the hand that is called the carpal tunnel. On the palm side of each hand, the median nerve:

  • Enables feeling of the thumb,
  • Enables feeling to the index finger, middle finger and part of the ring finger,
  • Controls some of the small muscles located at the base of the thumb.
What is Carpal Tunnel Syndrome

Any medical condition involving the hand can create serious difficulties with completing a variety of tasks at home and work, or while enjoying athletic or recreational activities.

Causes

The carpal tunnel is quite narrow to accommodate the wrist size. Sometimes, the nerve gets compressed and inflamed, leading to the carpal tunnel condition. Nerve compression develops for a variety of reasons that include:

  • Repetitive motions that lead to thickening or swelling of tendons,
  • Medical condition that causes the wrist to swell,
  • Medical condition that obstructs blood flow,
  • Medications causing swelling in the wrist,
  • Wrist injury,
  • Pregnancy causing fluid retention,
  • Menopause causing fluid retention,
  • Obesity.

Repetitive motions are one of the most frequent carpal tunnel syndrome causes, often occurring in people who do a lot of typing, perform the same repetitive task at work and/or regularly use vibrating hand tools. The nerve compression is more likely to develop when the repetitive activity involves holding the hand lower than the wrist.

Some of the medical conditions leading to the carpal tunnel condition include rheumatoid arthritis, hypothyroidism and diabetes. In rare cases, a tumor or cyst in the carpal tunnel causes nerve compression.

Symptoms

Carpal tunnel syndrome symptoms usually develop gradually, beginning with an odd tingling or burning sensation in the palm. It can occur in one or both hands. There may be numbness in the palm, and the palm itches for no apparent reason. Other symptoms include:

  • Fingers served by the median nerve feel swollen when no outward swelling is present.
  • Fingers served by the median nerve become difficult to use and sometimes are useless.
  • Tingling in the wrist or hand.
  • Loss of grip strength.
  • Reduced ability to experience hot and cold through touch.
  • Pain in the hand.
  • Pain that begins in the wrist and moves up the arm.
  • Ache or discomfort in the hand or wrist.
  • Chronic condition that leads to wasted muscles located at the base of the thumb.
Carpal Tunnel Syndrome Symptoms

Since the symptoms appear gradually, it can take some time before a person realizes the condition is developing. One of the early symptoms for some people is waking up with a tingling feeling or numbness in the hand due to sleeping with a bent wrist.

Each person experiences different symptoms. However, once it develops, the condition often gets worse over time.

Diagnosis

The sooner the carpal tunnel condition is treated, the better. Without treatment, the median nerve could be permanently damaged. A physician performs a number of steps that lead to a carpal tunnel syndrome diagnosis. Typically, the diagnosis process includes:

  • Getting a medical history to determine if the patient does repetitive activities or other activities frequently involving the wrist and hand, or has a medical condition that could lead to carpal tunnel narrowing.
  • Physical examination of the arms, shoulders, neck, arms, hand and wrist to identify potential points of weakness or tenderness, swelling or warmth; fingers are tested for grip strength and feeling; wrist muscles are assessed for strength or indications of muscle atrophy (some medical conditions like inflammatory myopathies cause muscle inflammation in the wrist).
  • Taking X-rays to rule out conditions like bone fractures or arthritis that have distorted bones.
  • Completing routine laboratory tests to identify and/or rule out medical conditions like diabetes that can cause the carpal tunnel condition.
  • Performing specific manual and medical tests that include:
    • Tinel test – tapping or pressing on the median nerve to determine if the patient experiences tingling in the fingers,
    • Phalen’s maneuver – flexing the wrist as far as possible to determine whether it causes numbness or tingling in the fingers,
    • Electrodiagnostic tests – measures the electrical activity in the median nerve and wrist muscles,
    • Ultrasound imaging – detects abnormal median nerve size,
    • Magnetic resonance imaging (MRI) – shows the anatomy of all structures in the wrist.

Treatments

Early detection of carpal tunnel can often mean avoiding surgery. The sooner carpal tunnel syndrome treatment is initiated, the more likely non-surgical treatments will work. A carpal tunnel syndrome cure is possible.

Typical treatments include non-surgical and surgical options. Non-surgical treatments are always preferred because they are non-invasive. The earlier carpal tunnel syndrome is suspected, the more likelihood it can be successfully treated through options like the following:

  • Splinting the wrist to hold it still and straight while sleeping is one of the first treatments tried.
  • Corticosteroid injection – corticosteroids are medications that can relieve pain.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – over the counter or prescription strength NSAIDs can reduce inflammation and pain.
  • Treat other medical conditions – treating conditions like rheumatoid arthritis may lessen the symptoms of carpal tunnel.
  • Starting a regimen of carpal tunnel exercises – specific wrist and hand exercises can be done at home to relieve symptoms and stretch tight tendons.

There are a number of carpal tunnel syndrome exercises a patient can do at home that may prevent the condition from getting worse. They include flexing or stretching the wrist, fanning the fingers and doing tendon or nerve gliding.

Surgery is always a last option, but if needed, there are two types of surgeries currently used. Both involve cutting the ligament to relieve pressure on the nerve. The two current surgical options are:

  • Endoscopic surgery – surgeon makes two incisions in the wrist and palm, inserts a tiny camera, observes the wrist structures, and cuts the carpal ligament that holds the joint together.
  • Open release surgery – surgeon makes an incision in the wrist and cuts the carpal ligament to widen the carpal tunnel.

Gradual Improvement

For most people, the outcome of treatment for carpal tunnel syndrome is excellent. Though recovery from surgery may be gradual, the end result is likely to be full recovery. This assumes there is not another medical condition involved. Carpal tunnel syndrome usually does not reoccur.

Best Exercises for Osteoporosis

Osteoporosis means “porous bone” and is a disease in which there is a loss of bone. Porous bones are fragile and more easily fractured. It is a silent disease, and people often find out they have it when a simple movement or light impact causes a fracture. Exercise is important to bone health and to prevent or slow the progression of osteoporosis. There is a variety of exercises that have proven to strengthen bones.

Benefits of Exercise on Osteoporosis

Exercise offers multiple benefits at any stage of osteoporosis. In fact, if a person gets regular exercise and good nutrition in her or his lifetime, osteoporosis is less likely to develop during the aging process. It is tempting to think that an osteoporosis diagnosis means that it is too late to start an exercise routine, but that is not true.

The key is to do the right kind of exercises and to not create too much impact on the bones when a person when osteoporosis is present. The benefits of exercise include:

  • Reduced risk of experiencing a bone fracture
  • Lowered rate of bone loss
  • Increased muscle strength
  • Stronger ligaments and tendons
  • Improved balance
  • Reduced pain level.
Male Osteoporosis

Sometimes people erroneously think that exercising will increase the chances of experiencing a bone fracture and avoid exercising as a result. The truth is the opposite. Appropriate exercise routines will strengthen bones and muscles, and improve balance and flexibility.

Categories of Exercises

All types of exercises are good for general health, but some categories of exercises include movements that are particularly effective for building bone strength and delivering other benefits that prevent or slow osteoporosis. The best types of exercises benefitting bone density by slowing mineral loss are:

  • Weight-bearing exercises for healthy bones and tissues,
  • Resistance exercises to build muscle health,
  • Balance and flexibility improvement exercises to keep tendons and ligaments flexible to reduce the chance of falling.

Exercises will benefit all of the bones in the body, but it is important to place special focus on the bones that have developed osteopenia or osteoporosis. Osteopenia is bone thinning that has not become osteoporosis yet. The most common fractures due to osteoporosis occur in the wrist, spine and/or hip.

Understanding the Exercises

Osteoporosis and exercise go hand-in-hand. One of the good things to know is that there are a large variety of suitable exercises that can reduce the chances of developing osteoporosis or slow the rate of progression. People can choose the ones that best fit their needs and lifestyle.

  • Weight-bearing exercises

Weight-bearing exercises for osteoporosis focus on movements that use bones to support weight while also providing aerobic benefits. The exercises require the person to be on their feet while moving. Good exercises include walking, stair climbing, hiking, dancing, jumping rope, using gym equipment like an elliptical machine or treadmill, and doing low-impact aerobatics.

  • Resistance exercises

How does resistance training prevent osteoporosis? Resistance exercises are designed to force the muscles to contract against some kind of force or weight. Muscles are strengthened which improves coordination and flexibility. Like weight-bearing exercises, resistance training also increases bone density. As a result, the person with osteoporosis is less likely to experience bone fractures due to falls and other incidents. Resistance exercises include using elastic exercise bands, lifting your own body weight and lifting light weights.

  • Balance and flexibility exercises

Pilates and yoga for osteoporosis can strengthen many of the body’s muscles, which improve balance and flexibility. These two types of exercises have several characteristics that are ideal for people with osteoporosis or trying to prevent osteoporosis. They are low impact, weight bearing, strengthen muscles and improve balance and flexibility. If the osteoporosis is advanced, it is important to get advice from a medical professional as to the appropriate exercises. These types of exercises can require significant bending which can strain the spine.

Yoga for osteoporosis

Physical Therapy

A physician may recommend a patient work with a physical therapist who will help the person get on the right track with exercising. During physical therapy for osteoporosis, the patient learns:

  • How to do specific exercises that slow bone loss and build muscle strength.
  • The osteoporosis exercises to avoid, like high-impact exercises or exercises requiring too much spine bending that can lead to fractures.
  • The appropriate amount of weights to use during weight bearing exercises for osteoporosis.
  • Proper posture to reduce the chances of a spinal fracture.
  • Specific exercises for particular bones and joints, like exercises for osteoporosis of the hip such as hip leg lifts; hip fractures are common in people with osteoporosis.
  • How to maintain body alignment while doing a variety of activities throughout the day to reduce stress on the spine and other joints.
Exercises for Osteoporosis

Sessions of physical therapy for osteoporosis will include the patient doing exercises under the watchful eye of the therapist in a clinical setting plus consultations to develop a home-based exercise treatment plan.

Millions Live with Osteoporosis

Statistically, women are four times more likely than men to develop the bone disease, but osteoporosis afflicts men and women. The National Osteoporosis Foundation statistics indicate more than 54 million men and women live with osteopenia or osteoporosis, and 55-percent are over the age of 50. The first step is to see a physician who will diagnose the condition and help the patient get on the right path for preventing more bone loss and painful fractures with a treatment plan that includes exercises.

Rotator Cuff Injury

The construction of the shoulder joint includes a delicate and complex balance of muscles and tendons. The shoulder is used in a variety of activities, and it is the rotator cuff that contributes to the range of motion. The tissues making up the rotator cuff are vulnerable to a variety of conditions like tendinitis and bursitis, but they are also subject to painful injuries like tendon tears. Any injury to the rotator cuff can interfere with life activities, but fortunately there are a number of treatment options available to restore shoulder functioning.

Rotator Cuff Syndrome

What is a Rotator Cuff?

The rotator cuff consists of tendons and muscles that enable a person to rotate the arm and to raise the arm over the head. It is called a “cuff” because the muscles and tendons form a cuff over the ball of the upper arm bone in the shoulder socket. Each muscle in the rotator cuff enables certain movements.

  • Infraspinatus – primary muscle enabling the rotation and extension of the shoulder.
  • Supraspinatus – muscle that works to keep the upper arm stable and assists with lifting the arm; it also holds the humerus (long bone in the upper arm) in place.
  • Subscapularis – muscle enabling several movements that include arm rotation, the ability to hold the arm straight out and the ability to lower the arm; it also holds the upper arm bone to the shoulder blade.
  • Teres Minor – smallest rotator cuff muscle that assists with the ability to rotate the arm while the arm is stretched out from the body.

There are three more muscles in the shoulder that are not part of the rotator cuff. Tendons attach the muscles to bones. Working together, the muscles and tendons stabilize and strengthen the shoulder during the various movements.

Medical Problems Involving the Rotator Cuff

The rotator cuff is subject to a variety of problems that include the following:

  • Rotator impingement syndrome – rotator cuff tendons are trapped and compressed while moving the shoulder.
  • Rotator cuff tendonitis – tendons get irritated or inflamed.
  • Shoulder bursitis – inflammation of the small, fluid-filled sacs called bursae.
  • Calcific tendonitis – calcium deposits form bone spurs on the underside of the acromion bone, and arm movement causes the spurs to rub the tendon.
  • Tear – a rotator cuff tear is a tear in the tendons.

Common Causes of Rotator Cuff Injuries

Rotator cuff injuries are caused as a result of a single traumatic incident or through slow degeneration. Common causes include:

  • Rotator cuff impingement inflames bursae or tendons,
  • Wear and tear from repetitive movements create repeated tendon microtrauma,
  • Tendon weakens due to aging, leading to tears,
  • Fall on an outstretched arm and hand,
  • Lifting heavy objects,
  • Other shoulder injury, like a broken collar bone, causes tissue tear,
  • Infection inflames the bursa or tendons.
Rotator Cuff Injury

People tend to experience injuries due to repetitive movements when they have a job requiring the same shoulder movement, like painting, or are involved in sports. The arm is repeatedly lifted overhead, causing wear and tear on the tendons.

There are two types of tears:

  1. Partial tear or incomplete tear – the tendon is frayed but not completely torn
  2. Complete tear – the tendon is torn all the way through or is pulled off the bone

Symptoms of an Injury to the Rotator Cuff

A rotator cuff injury is not always painful, especially if an injury is forming by slow degeneration. However, people can experience a range of rotator cuff pain from mild to severe. Common rotator cuff tear symptoms include the following:

  • Pain when moving the arm – can be specific movements or when lifting and lowering the arm;
  • Pain when lying on the shoulder, like when sleeping;
  • Difficulty lifting and lowering the arm; often accompanied by pain;
  • Inability to lift the elbow;
  • Shoulder weakness;
  • Inability to lift objects that were normally lifted in the past;
  • Crepitus, an abnormal crackling or popping sound, when the shoulder or arm is moved; often accompanied by a crunching sensation that may be painful.

The reduction in shoulder function varies, depending on the size or depth of the tear. When there is a small tear, the arm can still be lifted, and it may or may not be accompanied by pain. A moderate tear makes it difficult to lift or move the arm, and movement is painful. A large tear in the rotator cuff is likely to make it impossible to lift the arm, and it is extremely painful. When there is shoulder pain rotator cuff injury is immediately suspected.

Methods for Diagnosing Injuries to the Rotator Cuff

Many life activities are curtailed when the shoulder is not functioning properly and is painful to move. It may lead to giving up the playing of sports, difficulty performing job duties and problems sleeping. Some people stop moving their arm or shoulder to ease pain, and the shoulder joint freezes up or develops arthritis, creating another medical problem. Frozen shoulder is when the rotator cuff tissue thickens and grows tight.

It is important to see a physician to determine the precise problem. Continuing to use the shoulder when there is a tear can lead to the tear getting worse or may lead to permanent loss of range of motion or weakness. It is chronic pain that often drives people to see a medical professional.

The physician will discuss the history of the injury and do a medical examination of the shoulder. The medical examination will include a rotator cuff injury test consisting of different motions to explore the current range of shoulder movement and muscle strength. For example, the patient will be asked to place a hand on the small of the back with the palm facing outward and then try to lift the hand away from the back. The physician will also rule out other medical issues that may be causing pain, like a pinched nerve.

Since this is a soft tissue injury, x-rays are of little value except to detect bone spurs or a problem with the position of the arm bone, like the humeral head is intruding into the rotator cuff space or a bone deformity. X-rays will not show a tendon tear. The two diagnostic tests most often used to pinpoint the rotator cuff pain location and tissue damage are:

  • Magnetic Resonance Imaging (MRI) – radio waves produce images of all the shoulder structures.
  • Ultrasound – sound waves produce images of shoulder structures, allowing dynamic testing as the shoulder is moved.

Treatment Options

Any rotator cuff treatment the physician recommends is focused on reducing pain and restoring shoulder and arm functioning. Nonsurgical treatments are almost always tried first, making surgery a last resort. The best treatment depends on the type and extent of the injury.

  • Rest the shoulder to allow for healing but not long enough to develop frozen shoulder; may wear a sling.
  • Take over-the-counter nonsteroidal anti-inflammatory medications.
  • Apply ice first for a few days to reduce inflammation and pain, followed by applying heat to relax sore and tight muscles.
  • Follow recommended treatments for bursitis or tendinitis, i.e. resting the joint, physical therapy, anti-inflammatory medications, etc.
  • Application of electrical stimulation of nerves and muscles.
  • Steroid injection for temporary relief (limited use because overuse can weaken tendons).
  • Exercise routine, including stretches, intended to restore range of movement, flexibility and shoulder strength.
  • Physiotherapy – combination of treatments that include heat treatment, exercise and physical therapy, rather than drugs or surgery, to strengthen the muscles and improve flexibility.
  • Surgery.

Rotator cuff surgery is frequently used when the tendon is not attached to the bone; there is a large tear; or pain does not improve after trying nonsurgical treatments. There are different types of surgeries to repair rotator cuff injuries.

  • Arthroscopic tendon repair – a tiny camera is inserted through a small incision to reattach a torn tendon to the bone.
  • Tendon transfer – a different tendon than the severely damaged one is attached as a replacement.
  • Open tendon repair – a large incision is made so the surgeon can reattach the damaged tendon to the bone.
  • Shoulder replacement – a surgery of last resort, an artificial joint is installed; in reverse shoulder arthroplasty, the artificial joint’s ball is attached to the shoulder blade and the socket part is attached to the arm bone.

Early Treatment Recommended

The sooner treatment is started when problems appear in the shoulder, the more likely surgery can be avoided. Small tears are less likely to become large tears, additional damage to the rotator cuff is prevented and pain is reduced or eliminated sooner rather than later. Effective treatments enable patients to resume their work and recreational activities.

Joint Injections

Joint pain of any kind interferes with a person’s lifestyle and can become debilitating when it is chronic and intense. Inflammation can occur in any joint in the body, but some of the most common joints that become inflamed and painful are in the spine, especially the lumbar region (lower back), and in the knees, shoulders and hips. A common treatment for joint pain that offers temporary relief is an
injection of an anesthetic and steroid medication directly into the joint.

Joint Pain and Injections

Joint pain develops for several reasons:

  • Normal wear and tear of cartilage
  • Injury
  • Disease, like rheumatoid arthritis or osteoarthritis
  • Surgery
  • Physical deformity
Hip joint injection

Pain caused by a damaged joint might be felt in the joint, and sometimes the pain travels to additional places, like down the back of the legs. An injection for joint pain is given to patients for one of two reasons. First, it can serve as a diagnostic test to pinpoint the joint causing the pain. Second, it is a treatment option to relieve pain and reduce inflammation. The anesthetic numbs the tissue inside the joint, and the steroid medication reduces inflammation and blocks pain.

Virtually every joint is a candidate for an injection. They include:

  • Facet joints – These are the small joints in the spine. A physician can inject the appropriate medication into any joint in the spine in the cervical (neck and upper spine), thoracic (center) and lumbar (lower) spinal areas.
  • Sacroiliac joint – The two SI joints connect the spine to each hip. Their primary purpose is to support upper body weight while standing or walking, shifting the load to the legs. The pain can occur in the lower back, but it may also be felt in the buttocks, groin or thighs and can travel up the back.
  • Coccyx joint – This joint is often referred to as the tailbone. Consisting of three small bones, it too can get inflamed.
  • Hip joint – The pain from a hip joint issue may be felt inside or outside the hip or in the groin, buttocks or upper thigh.
  • Shoulder joint – Pain in the shoulder joint is caused by a variety of medical issues that include bursitis, tendinitis, tear in the rotator cuff, inflammatory arthritis and “frozen shoulder” (adhesive capsulitis).
  • Knee joint – Pain in the knee joint is often due to arthritis, gout (uric acid buildup), inflammation from injury or normal wear and tear, or chondromalacia patella which is when cartilage under the kneecap is damaged.
  • Other joints – Other joints frequently causing pain include the elbows, hands, ankles and feet.

How Long Does the Procedure Take?

A joint injection does not take long. Most procedures are finished within 20 minutes.

Before the procedure is done, the physician will order imaging studies to assess the best injection location. Usually, the injection is given on an outpatient basis, including in a doctor’s office. The main requirement is availability of fluoroscopic equipment that is usually used to help the physician inject the fluids into the ideal location. The patient is awake and alert during the procedure.

The patient lies on a table. A local anesthetic is applied to the skin first to minimize discomfort or pain associated with the medication injection. Using a fluoroscope (type of X-ray machine) as a visual guide, a hollow needle is inserted into the joint. The anesthetic and corticosteroid, or other types of medications, are injected into the joint through the hollow needed.

Ultrasound-guided injection

The physician may need to drain some fluid from the joint first to make room for the medications and to relieve joint pressure. This is common with a knee joint injection. In some cases, it may take more than one injection in various locations. For example, a facet joint injection might be needed in several of the spine’s joints.

How Often Should the Procedure Take Place?

In general, if the joints causing the pain were the ones injected, joint pain relief is felt within a day or two, and can last for months. If the pain continues for 2-3 weeks, or flares up again, the procedure can be repeated.

Specifically, there are many factors determining how often the procedure should be done. They include:

  • Joint or joints receiving the injection
  • Type of medication used
  • Whether pain relief is experienced
  • How long pain relief endures

Generally, injections are limited to four times a year, whether spaced out to once a quarter or given in a weekly or monthly series.

Side Effects of Injections into the Joint

There are usually few joint injection side effects, and they are temporary. The specific side effects depend on the joint receiving the injections. For example, a sacroiliac joint injection may cause some people to experience temporary weakness in the legs, making it difficult to walk for several hours.

The potential side effects are:

  • Joint remains numb from the anesthetic for several hours, after which pain may be felt for a couple of days until the medication reduces the inflammation.
  • Infection.
  • Temporary bruising at the injection sites.
  • Reaction to medical conditions, like elevated blood sugar in people with diabetes (It is critical to inform the physician of any and all chronic medical conditions and medications).
  • Physical responses to corticosteroid, i.e. weight gain, water retention, etc.

In most cases, any side effects are gone within a few days to a week. Millions of people each year find needed pain relief with joint injections. Joint pain is not something that must be endured because help is available. Consult with a physician to learn the options available.

Genicular Nerve Block and Radiofrequency Ablation (GNRFA)

Chronic knee pain, due to various reasons, plagues millions of people. Sometimes prescribed medications help, but often times they prove ineffective. An alternative treatment to surgery is the two-part genicular nerve block with radiofrequency ablation, also called a genicular nerve neurotomy. The therapeutic treatment option involves a diagnostic procedure followed by a procedure with long-term pain blocking results.

What is a Genicular Nerve Block?

The knee is innervated (supplied) by the articular (related to joints) branches of a set of nerves. The set of nerves are referred to as genicular nerves, and they are responsible for transmitting pain from the knee. A geniculate block knee treatment attempts to stop all or most of the pain by blocking the nerve supply. The procedure involves a physician injecting a local anesthetic into three genicular nerves to interrupt pain signals while using fluoroscopic (live X-ray) or ultrasound guidance. Sometimes a steroid is also injected to reduce inflammation.

Genicular Nerve Radiofrequency Ablation

The knee block procedure is primarily used as a diagnostic treatment to determine which nerves are causing the pain and if nerve blocking works. If the nerve block is successful, pain relief begins within an hour, but the relief is short-lived. The nerve block’s effects last from eight hours to a maximum of 24 hours. If the first block works, the diagnostic test is performed a second time before the next step is taken.
Generally, if pain is reduced by at least 50 percent both times, the physician knows that blocking certain nerves does work and will proceed with a longer-lasting treatment called a radiofrequency ablation of genicular nerves.

Best Candidates for the Nerve Block Procedure

The people who are most likely to be candidates for the nerve block in the knee are those who:

  • had a total or partial knee replacement, and the pain continued after the surgery,
  • want knee surgery as a last resort option,
  • have health issues that make knee replacement surgery too risky,
  • have chronic knee pain due to degenerative joint disease (osteoarthritis),
  • have a knee injury marked by chronic painful inflammation,
  • need pain relief before or after knee surgery.

What to Expect During a Typical Procedure

During the procedure, the patient lies on a procedure table, and the body, except for the knee being treated, is covered with a sheet. The physician sterilizes the injection sites and numbs them with an anesthetic. Using a fluoroscope (or some type of technology) as a guidance system, a cannula (needle with a thin tube) is inserted into the correct position near a genicular nerve. While inserted, a local anesthetic is administered to numb (block) the nerve to stop pain signaling. This procedure is repeated until several (usually three) genicular nerves are blocked.

In some cases, people are sedated, so they do not feel any pain from the injection. Once discharged, it is recommended that strenuous activity be avoided for at least 24 hours. However, it is also important to resume normal moderate activities that previously caused knee pain. This helps to determine whether the genicular nerve block for knee pain is working.

Radiofrequency Ablation of Genicular Nerves

The longer-term pain relief treatment is the radiofrequency ablation procedure. During this genicular nerve block treatment, patients that responded well to the diagnostic nerve block undergo the ablation procedure, usually done with local anesthetic on an outpatient basis. Once again, fluoroscopic or ultrasound guidance is used.

First, a local anesthetic is applied at the injection sites except when it is determined the patient should be first moderately sedated via IV. A cannula is guided as close as possible to the appropriate nerves, one at a time. Once in place, radiofrequency lesioning (ablation) involves inserting a microelectrode into the cannula so that an electrical current produced by a radio wave can heat up the tip of the needle. The hot tip of the needle then cauterizes the nerve transmitting pain signals, so it cannot transmit pain signals to the brain. The process is repeated for each nerve.

The pain relief from the genicular nerve ablation procedure can last from six months to one year, or even longer. It is a low risk procedure that is done on an outpatient basis.

Genicular Nerve Block

Potential Complications

Though both procedures are considered low risk pain treatments, any medical procedure can lead to complications. Though rare, potential genicular nerve block complications include:

  • septic arthritis (joint inflammation caused by infection),
  • allergic reactions to the anesthetics,
  • severe pain or infection at the needle sites or elsewhere,
  • pain that becomes severe or progressive,
  • leg muscle numbness or weakness that lasts longer than 8 hours,
  • fever,
  • bladder or bowel dysfunction.

There is no reason to live with chronic knee pain when minimally invasive procedures, like the geniculate block knee treatment, are available. Speak with a physician about the medical treatment options, and together determine the best route for achieving pain reduction.

Sciatica Prevention: Recommendations from Specialists

The sciatic nerve is a large nerve that extends from the spinal cord’s lower end and branches out to each buttock and then down each thigh to the knee and calf. Sciatica refers to pain that follows the path of the sciatica nerve. It can be an intensely painful condition that makes sleeping and other activities very difficult. There are steps everyone can take to prevent sciatica.

How to Prevent Sciatica

Sciatica develops for various reasons that include a herniated disk, spinal stenosis, inflammation due to a disease like arthritis and bone spurs on the spine. The pain associated with sciatica is often severe because the sciatic nerve is the largest nerve in the body. Pain usually radiates down one buttock and into one thigh and calf. Besides pain, other symptoms include numbness or weakness in a leg muscle, knee pain, muscle tingling, muscle cramping, tingling in the toes or a combination of two or more symptoms.

How to Prevent Sciatica

A common question is: How to prevent sciatica?

Prevention is always the best course of action. According to the specialists, the best strategies for preventing sciatica include:

  • Exercise – Exercising tops the list of prevention measures because it strengthens the abdomen and back muscles that support the spine. Numerous types of exercises are beneficial, including walking, swimming, Pilates and yoga. In particular, do core exercises and lower back exercises to reduce the chances of developing a herniated disk.
  • Learn and practice proper lifting techniques – All too often, people improperly lift objects. It is not just the weight of something that leads to herniated disks. They put most of the pressure on their back during lifting when it’s the hips and legs that should be taking the brunt of the weight. It is important to keep the back straight while rising up with the hips and legs. If the item is too heavy to lift while using the right technique, find another way to move the item.
  • Maintain good posture when sitting – Many people today sit for long periods of time and have poor posture while sitting. This doubles the impact on the spine, especially the lower back. When sitting or standing, keep your back straight and shoulders back to relieve the pressure on the back. Another good practice is to stand up and move around every 30 minutes when a job requires a lot of sitting.
  • Do not smoke – The negative effects of smoking are many, and include contributing to disk degeneration.

Sciatic develops for different reasons, and one is age-related degeneration. Developing a healthy lifestyle is the best way to prevent painful conditions that makes it impossible to fully enjoy life.

Exercises to Prevent Sciatica or Reduce Pain of a Sciatica Flare Up

Sometimes, despite everything, people experience what is referred to as a sciatica flare up. It can be due to something like the piriformis, a small hip muscle, becoming tight and pressing on or pinching the sciatic nerve. Flare ups can also be treated with exercises that are specifically designed to relieve the pressure on the nerve.

Exercises to Prevent Sciatica

Good exercises for managing sciatica flare-ups that also serve as exercises to prevent sciatica are activities like stretching exercises for the hips and lower back, and walking. It may be tempting to lie in bed for hours, hoping the pain will subside. The reality is that extended bed rest can contribute to the development of sciatica when back muscles weaken or because the pain associated with sciatica to worsen due to the pressure placed on the spine.

Easing Sciatica Pain While Sleeping

Of course, everyone should get seven to eight hours of sleep each night. As noted, sciatica pain can intensify when in a prone position for an extended length of time because additional pressure is placed on the spine’s disks. People want to know how to prevent sciatica pain while sleeping.

Easing Sciatica Pain While Sleeping

One strategy is to lie flat on the back and bend the knees slightly while keeping the buttocks and heels flat against the bed. Place a pillow under the knees to provide support. Elevating the knees can take some of the pressure off the spine and thus the sciatica nerve.

Other suggestions include:

  • Doing gentle stretching exercises right before getting into bed
  • Sleeping on a firm mattress
  • Soaking in a warm bath before bedtime
  • Using over-the-counter pain medications

A medical professional can offer suggestions on how to prevent sciatica pain while sleeping that best fit the patient’s circumstances.

Managing Sciatica

Despite all efforts to prevent or self-manage sciatica, additional treatments are sometimes necessary. A doctor will assess the condition and determine the appropriate treatments to add to the self-management regimen. Treatments include prescription pain medications, physical therapy and steroid injections. Surgery is always a last resort for people with sciatica pain that worsens or pain that does not respond to non-surgical treatments.