Common Causes of Shoulder Pain
Posted on July 4, 2024 by Jodie Chan
What is Shoulder Pain?
Shoulder pain encompasses discomfort felt in the shoulder region. The shoulder is characterized as a ball-and-socket joint, notable for its extensive range of motion, which makes it the most mobile joint in the body. However, due to this mobility, the shoulder is also inherently unstable. Moreover, the ball of the upper arm (humerus) being larger than the shoulder socket increases its vulnerability to injury. Soft tissues muscles, tendons, ligaments and bursa are also essential to support the shoulder joint, and they are also subject to injury, overuse and under use.
Given the complexity of its components, shoulder pain can arise from various causes. Injuries from falls or accidents, repetitive activities such as painting, and conditions like arthritis are common triggers.
Some Common Causes of Shoulder Pain
Overuse Injuries/Repetitive Strain Injuries
Repetitive use of shoulder like swimming or playing tennis or gardening can cause overuse injuries.
One common overuse injury is bursitis, which occurs when the bursa—a sac filled with fluid that cushions the shoulder joint—becomes swollen and inflamed due to repetitive motions. The pain associated with bursitis becomes particularly noticeable during shoulder movement.
Cartilage tear, also known as SLAP tear can also happen with overuse. This tear typically occurs at the front of the upper arm where the biceps tendon attaches to the shoulder. Athletes at highest risk for this injury include baseball pitchers, volleyball players, and lacrosse players who perform rapid, high-energy movements that stress the shoulder structures.
Rotator cuff tear is the tearing of the group of muscles and tendons in the shoulder that hold our arms in place and let us lift our arms overhead. It can be damaged through overuse and can also begin to show wear and tear as we age.
Tendinosis can develop when the rotator cuff and/or biceps tendon wear down and sometimes become inflamed, typically as a result of being pinched by surrounding structures. The severity of the injury can range from mild inflammation to extensive damage involving most of the rotator cuff. In cases where the rotator cuff tendon thickens and becomes inflamed, it may become trapped beneath the acromion, leading to impingement syndrome.
Frozen Shoulder/ Adhesive Capsulitis
Frozen shoulder is a highly restrictive condition often resulting from injury, which limits movement due to pain. Infrequent use exacerbates the issue by promoting inflammation and the development of adhesions between joint surfaces, further restricting motion. Additionally, reduced synovial fluid fails to lubricate the gap between the arm bone and socket, necessary for normal shoulder joint movement. The main symptoms of a frozen shoulder are pain and stiffness that make it difficult or impossible to move. Frozen shoulder occurs more frequently in individuals assigned female at birth. It is more prevalent between the ages of 40 and 60. Another significant risk factor is prolonged immobility of the shoulder, such as during recovery from conditions like stroke or surgeries like mastectomy, which restrict arm movement.
Arthritis
The predominant form of arthritis affecting the shoulder is osteoarthritis, commonly referred to as wear-and-tear arthritis. Symptoms such as pain and stiffness generally commence in middle age. Osteoarthritis progresses gradually, with the associated pain intensifying over time. This condition can be linked to sports or work-related injuries, as well as chronic wear and tear. People often refrain from moving their shoulder to alleviate arthritis discomfort, which can lead to tightening or stiffening of the soft tissues around the joint, ultimately causing painful limitations in motion.
Bone Spurs/Osteophytes
Bone spurs formation on the joints is often a result of arthritis due to aging and one of the most common areas a bone spur develops is under the acromion of the shoulder. Those whose sports or jobs require repetitive overhead movement are at risk for this condition. These small pieces of bone rub up against and wear on the rotator cuff and keep the shoulder from moving the way it should. This can lead to tendinitis or a rotator cuff tear.
Shoulder Pain Diagnosis
Alongside a thorough medical history and physical examination to assess range-of-motion, pain location, and joint stability, diagnostic procedures for shoulder issues may encompass the following:
- X-rays. They are useful for identifying bone spurs, arthritis, and other bone-related causes contributing to shoulder pain.
- MRI scan. This utilizes radio waves and a strong magnet to produce detailed images of the shoulder.
- CT scan. This involves a series of X-rays taken from various angles, providing a comprehensive view of shoulder conditions.
- Electromyography (EMG). This measures muscle electrical activity to detect any nerve-related issues.
- Ultrasound. A diagnostic technique that uses high-frequency sound waves to create an image of the body.
Shoulder Pain Treatment
For dislocations, separations, and fractures, medical assistance is required to relocate your shoulder to its correct position, followed by the use of a sling to support it during the healing process.
For many other conditions, your doctor may advise rest, application of heat or ice, and medications such as aspirin or ibuprofen to alleviate pain and reduce swelling.
In cases where conditions like cartilage tears, rotator cuff tears, or frozen shoulder do not respond to rest and medication, surgical intervention may be recommended by your doctor.
Regardless of the specific shoulder problem, your treatment plan will likely incorporate exercises designed to stretch and strengthen the joint, aiming to enhance your range of motion.
References
Shoulder pain and problems. Johns Hopkins Medicine. (2021a, August 8). https://www.hopkinsmedicine.org/health/conditions-and-diseases/shoulder-pain-and-problems
WebMD. Frozen shoulder: Symptoms, causes, diagnosis, treatment. WebMD. https://www.webmd.com/a-to-z-guides/what-is-a-frozen-shoulder
WebMD. Shoulder pain: Causes, symptoms, and treatments. WebMD. https://www.webmd.com/pain-management/why-does-my-shoulder-hurt
Benefits of Regular Physical Activity
Posted on July 3, 2024 by Tina Huynh
Regular exercise is an important component of living well. Adults who lead a more active lifestyle are more likely to live longer while decreasing the chances of becoming susceptible to serious illnesses and other health conditions.
What are some risk factors that are associated with not exercising regularly?
Adults who embrace a more sedentary and inactive lifestyle are more prone towards serious health problems. Overtime, the body’s metabolism would slow down, affecting the process of blood sugar and blood pressure regulation. If this continues, some health conditions that could developed includes diabetes, high blood pressure, heart disease and obesity.
What are some health benefits to exercising regularly?
Weight Management
Through staying active, the body starts to metabolize at an increasing rate which in turn would decreases the overall number of calories consumed. A higher metabolism when combined with a healthy diet could significantly improved the process of managing weight, thereby placing such individual at a healthy weight range.
Improved Cognitive Function
Both thinking skills and memory can be improved with regular exercise, as different studies have found that the parts of the brain which control thinking and memory are larger in volume for people who demonstrate a more active lifestyle.
Managing Other Health Risks
Regular physical activity can help reduce the risk of cardiovascular disease, such as heart disease and stroke. When exercising regularly, the blood pressure is lower while improving the cholesterol levels. For people with type 2 diabetes, regular physical activity would be beneficial in that it would help control blood sugar levels while managing their conditions.
Strengthen Bones and Muscles
Bones, joints and muscles support the body movements and various daily activities. Hence it is important to keep the bones, joints and muscles healthy to prevent falls and injuries. Muscle strengthening activities such as weight liftings can help increase muscles mass and maintain strength.
References
Benefits of exercise. NHS Health Scotland. 30 Nov. 2022, https://www.nhsinform.scot/healthy-living/keeping-active/benefits-of-exercise/
Benefits of Physical Activity. Centers for Disease Control and Prevention, 1August. 2023, https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm#:~:text=Regular%20physical%20activity%20is%20one,ability%20to%20do%20everyday%20activities.
Exercise can boost your memory and thinking skills. Harvard Health Publishing, 20October. 2023, https://www.health.harvard.edu/mind-and-mood/exercise-can-boost-your-memory-and-thinking-skills
Gout
Posted on September 29, 2023 by Tina Huynh
What is gout?
Gout is a form of arthritis that is characterized by sudden and severe pain attacks, tenderness of joints, redness and swelling. It mostly affects and target the joints under the big toe. Gout is more common among men and people of older age; however, it could also affect anyone.
What is the cause?
The main cause of gout is a build-up of a substance called uric acid in the blood. If this substance is not filter out of the system through the kidneys, it will result in an excess of uric acid, causing crystals to form in and around joints. These crystals inherently cause the joint to become inflame and painful.
Signs/Symptoms
Some common signs and symptoms of gout include:
- Inflammation: the affected joint or joints would become swollen and tender, the skin would appear shiny and red
- Intense joint pain: even though gout commonly targets the big toe, it could also affect any joints towards the ends of the limbs, such as the knees, ankles and fingers. The pain is most likely to be more severe and debilitating within the first four to 12 hours after it begins
- Discomfort and limited range of motion: after the sudden attack subsides, joint discomforts may remain from a few days to a few weeks. Range of motion are limited as joints are not able to move normally
How is gout diagnosed?
- Blood test: to measure the level of uric acid present in the blood
- Joint fluid test: by using a needle, the doctor may draw fluid from the affected joint. When placed under microscope examination, urate crystals may be identifiable
Treatment
- Medications use to treat severe gout attacks include colchicine and NSAIDs (non-steroidal anti-inflammatory drugs). Ice packs could also be used to relieve swelling and redness
- To prevent future attacks, a lifestyle change may be necessary which includes losing weight or changing one’s diet
References
“Gout.” Mayo Clinic, 16 Nov. 2022, https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897
“Gout.” National Institute of Arthritis and Musculoskeletal and Skin Diseases, Feb. 2020, https://www.niams.nih.gov/health-topics/gout
Ramsay Hunt Syndrome
Posted on August 16, 2022 by Grace Lee
What is Ramsay Hunt Syndrome? What causes it?
Ramsay Hunt Syndrome, also known as herpes zoster oticus is characterized by the occurrence of a painful rash with fluid-filled blisters inside or around one ear and facial paralysis on one side of the face. Ramsay Hunt Syndrome is caused by varicella zoster virus (VZV) which is the same virus that causes chickenpox in children and shingles in adults. After chickenpox disappears, the virus remains in the nerves and can potentially be reactivated once you are older. When the virus is reactivated, it spreads and affects your facial nerves as well as triggering a shingles outbreak.
Symptoms
The two well known symptoms of Ramsay Hunt Syndrome include: painful fluid-filled blisters around or in one ear, and facial paralysis on the same side as the affected ear. Additional symptoms that may be present include: ear pain (otalgia), hearing loss, ringing in the ear (tinnitus), inability to close one eye, nausea, sensation of spinning (vertigo), change in taste perception, dry mouth and eyes.
Treatment
Immediate treatment of Ramsay Hunt Syndrome can alleviate pain and decrease any risk of long-term complications from arising. Medications that might be prescribed are antiviral drugs such as acyclovir or famciclovir as well as corticosteroids like prednisone to help fight against the varicella zoster virus. Other medications including pain relievers may be advised especially if pain becomes unbearable and anti-anxiety medication such as diazepam (valium) which can help individuals that are experiencing vertigo.
References
Mayo Foundation for Medical Education and Research. (2021, October 12). Ramsay Hunt syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ramsay-hunt-syndrome/symptoms-causes/syc-20351783
Ramsay Hunt Syndrome. (n.d.). NORD (National Organization for Rare Disorders). https://rarediseases.org/rare-diseases/ramsay-hunt-syndrome/#:~:text=Ramsay%20Hunt%20syndrome%20(RHS)%20is
Cauda Equina Syndrome
Posted on by Andrea Cheung
Introduction
Cauda equina is the collection of nerves at the very end of the spinal cord. When the cauda equina was damaged and compressed causing pain and numbness sensation, we call it “Cauda Equina Syndrome” (CES).
CES is very rare which only account for 1 in 2000 of lower back pain patients. However, if health practitioners failed to diagnosis CES, this will cause serious consequence to patient’s bladder, bowel, and sexual function.
Cause/Mechanism
The major cause of CES is a large lumbar disc herniation at immediate vicinity of L2 or below, which compresses the cauda equina. Infections such as meningitis can also lead to CES. Moreover, sacral fracture can also cause CES when it compresses the cauda equina.
Signs/Symptoms
The signs and symptoms of CES can be universal to other chronic disease. Common signs reported from patients are low back pain, unilateral or bilateral sciatica, motor weakness in lower extremities, and/or numbness around the buttock area. With regards to bladder and bowel dysfunction, it may not present in the early stage.
CES can be present acutely or chronically. With acute CES, patient may present sudden back pain with dramatic sensory changes around the buttock area, and possible weakness in urination. During chronic CES, previous symptoms mentioned will build up gradually or may fluctuate over weeks, months or even years. If the patient had slow onset of bladder and bowel dysfunction, it will present with increase severity and less responsive to management.
Health practitioners and patients should monitor the red flag to CES such as bladder dysfunction and numbness tingling between legs and around the anus if the patient have continuous back pain, sciatica, and increase urinary frequency and urgency.
Treatment
When patient has diagnosis with CES, surgery is the first option to prevent further neurological damage. Study had found significantly improvement in neurological outcome if patient had surgical operation within 24 hours of onset compare to 48 hours. Some patient may also be able to regain bladder continence if they have surgery within the 24 hours to 48 hours timeframe. Therefore, surgery should be done as soon as CES was diagnosed.
The goal of the surgery is to decompress any compressed lesions to improve sensory and motor deficits. However, some patient may still experience some degrees of neurological deficit.
References
Whiplash Associated Disorder
Posted on January 14, 2022 by Andrea Cheung
What is Whiplash Associated Disorder?
Whiplash is a general termed injury that usually take place in a motor vehicle crash where the head is subject to sudden acceleration and deceleration, causing forceful bending in neck region. Since the movement is unlikely to occur in normal human range of motion, the muscles that control your neck movement do not have time to respond to the force, causing damage to the neck region.
The Quebec Task Force classifies Whiplash into five gradings, based on severity:
- Grade 0: No complaint about pain, tenderness, or stiffness of the neck. No physical signs.
- Grade I: Complaint of pain, tenderness, or stiffness of the neck without physical signs.
- Grade II: Complaint of pain, tenderness, or stiffness of the neck with musculoskeletal signs such as decrease range of motion and point tenderness.
- Grade III: Complaint of pain, tenderness, or stiffness of the neck with neurological signs such as sensory deficits.
- Grade IV: Complaint of pain, tenderness, or stiffness of the neck with signs of fracture and dislocation.
Mechanisms
During a rear-end crush, the torso the carried forward, forcing the cervical spine, located in our neck, into an abnormal “S-shaped” position. Then, the head and neck were forced backwards since the torso was pulled forward during the collision. This may cause injuries to anterior cervical ligaments. The head and neck will swing forward as the driver stop the vehicle immediately.
Signs and symptoms
Whiplash Associated Disorder comprised range of symptoms including neck pain and stiffness, headache, memory loss, dizziness, dysphagia, and temporomandibular joint pain.
Clinical Diagnosis
Patients with history of sudden or excessive neck extension, flexion, or rotation are in the risk of whiplash injury. During initial assessment, patient may report having reduced cervical spine range of motion, loss of muscle control in both cervical spine and shoulder gridle, loss or decrease in balance and deficits in neck-influenced eye movement control. For more serious cases, some patient may experience muscle degeneration in the cervical extensor muscles, lead to long lasting pain and disability.
Treatment
In the first 96 hours after injured, mobilization such as active and passive range of motion exercises can result in reduced pain levels and improve function. Active rest, such as continue daily activity with brief rest period, can help blood flowing and muscle recover. Immobilization of long period of time can delay recovery time as muscle and ligament fibers are not aligned properly which can reduce strength and energy absorption capacity. Moreover, some patients will take NSAIDs to reduce inflammation, and neck rang of motion had reported improved after two weeks with medicine. Other physical treatments that practitioners will used are heat and cold packs, ultrasound therapy, and head traction. Theses can reduce pain and enhance recovery during the acute phase of whiplash injury.
During subacute phase, the goal for the patient is to return cervical muscle function as normal as possible. Light isometric and isotonic strengthening exercises that target the neck and scapular can help restore neck active range of motion. Light stretching also play a crucial role to improve tissue healing by increasing blood flow to the injured area. Vestibular and motor control exercises can improve neuro deficits and retraining muscle activation. Manual joint manipulation provided by chiropractors can reduce pain and initiate body’s natural healing processes. For ongoing management, continue with all the treatments stated above as well as increase the intensity of strengthen exercises.
References
Bannister, G., Amirfeyz, R., Kelley, S., & Gargan, M. (2009). Whiplash injury. The Journal of Bone and Joint Surgery. British Volume, 91-B(7), 845–850. https://doi.org/10.1302/0301-620x.91b7.22639
Barnsley, L., Lord, S., & Bogduk, N. (1994). Whiplash injury. Pain, 58(3), 283–307. https://doi.org/10.1016/0304-3959(94)90123-6
Elliott, J. M., Noteboom, J. T., Flynn, T. W., & Sterling, M. (2009). Characterization of Acute and Chronic Whiplash-Associated Disorders. Journal of Orthopaedic & Sports Physical Therapy, 39(5), 312–323. https://doi.org/10.2519/jospt.2009.2826
Pastakia, & Kumar, S. (2011). Acute whiplash associated disorders (WAD). Open Access Emergency Medicine, 29. https://doi.org/10.2147/oaem.s17853
Sterling, M. (2011). Whiplash-associated disorder: musculoskeletal pain and related clinical findings. Journal of Manual & Manipulative Therapy, 19(4), 194–200. https://doi.org/10.1179/106698111×13129729551949
Tameem, A., Kapur, S., & Mutagi, H. (2014). Whiplash injury. Continuing Education in Anaesthesia Critical Care & Pain, 14(4), 167–170. https://doi.org/10.1093/bjaceaccp/mkt052
Sciatica
Posted on by Andrea Cheung
What is sciatica?
Sciatica is the symptom of an underlying medical condition, not a medical diagnosis. However, this term has been incorrectly used to describe pain in back and leg symptoms by the general population. This is a term to describe a pain symptom that radiates from the middle or lower buttock down to the back and the side of the leg along the sciatic nerve, sometime it could radiate below the knees into the foot and toes. Sensory symptoms may also be reported by the patient. Usually, the pain only affects either left or right rather than both sides. Other thing to note is that Low back pain is not a consistent feature seen in sciatica but may also present in patient.
Symptoms and examination
Research has found that 90% of the cases are due to herniated disc that compress the nerve root from L4 to S1. Different levels of compression will present slightly different clinical features. With L4 compression, the pain is front and to the side of the thigh, which may sometimes mistake as a hip disease. Vis versa, L5 compression show pain at the back and the sides. Some other causes of sciatica might be lumbar canal or foraminal stenosis and tumors or cysts.
To examine whether a patient have sciatica, Straight Leg Raising Test have shown high sensitivity of 91%. When the patient is lying down and facing up, raising the whole leg straight can stretch the nerve root of the protruding disc. This will reproduce the pain and discomfort that the patient complains. If the leg is angled between 30 to 70 degrees with pain from buttock to below knee, disc compression of nerve root might be the cause of radiated pain.
Sometimes, sciatica might be mixed up with non-specific low back pain. Some major signs to justify sciatica are radiated pain towards foot or toes, numbness and paranesthesia.
Treatment
Conservative non-surgical treatments are recommended for patient. Most common initial treatment will be pain control by medication prescribed by family doctor, which could provide relief to patient’s discomfort. The most common medication is naproxen, used to relieve pain for various conditions. Other conservative treatment such as acupuncture, steroid injections, etc. might be beneficial but studies has been inconsistent with pain relief of sciatica. However, rest and bed rest are not recommended to reduce pain as it might lead to acute low back pain although it might provide instant relief. Staying active likely to be more beneficial in improving sciatica and aid in faster recovery.
Another conservative treatment is spinal manipulation. It is widely used to provide a short-term benefit in relief pain symptoms in addition to exercise program targeting the low back and hip. Study had found that patient who has sciatica of at least six weeks, both conservative and disc surgery might improve patient’s pain and function. But we must aware of possible confounding in the study due to self reported data and patients’ preference for treatment may also affect treatment outcome.
If pain does not diminish in six to eight weeks, patient should meet a neurologist, neurosurgeon, or orthopedic surgeon to discuss other treatment methods such as surgery. It is always the last resource to treat sciatica when practitioner suspect a disc herniation or disc rupture. However, evidence has shown controversial outcomes with surgery. Studies has shown patient who did surgery has faster relief of pain compare to conservative treatment.
Prevention
Exercise is always the best prevention protocols that a patient could do during their free time. Specific strengthening exercise that targets the core and the lower back can help protect the spine and maintain good posture. Patient can also stay active by jogging around the neighborhood or swimming and the pool.
Maintaining a good sitting posture is also important to prevent disc compression. Prevent bending the lower back which could reduce pressure on the discs and ligaments. Moreover, take a small break every 30 minutes of sitting can relief the pressure in the disc.
References:
Harvard Health Publishing. (2020, September 24). 5 tips with coping sciatica. https://www.health.harvard.edu/pain/5-tips-for-coping-with-sciatica
Koes, B. W., van Tulder, M. W., & Peul, W. C. (2007). Diagnosis and treatment of sciatica. BMJ, 334(7607), 1313–1317. https://doi.org/10.1136/bmj.39223.428495.be
Ropper, A. H., & Zafonte, R. D. (2015). Sciatica. New England Journal of Medicine, 372(13), 1240–1248. https://doi.org/10.1056/nejmra1410151
Valat, J. P., Genevay, S., Marty, M., Rozenberg, S., & Koes, B. (2010). Sciatica. Best Practice & Research Clinical Rheumatology, 24(2), 241–252. https://doi.org/10.1016/j.berh.2009.11.005
Ultrasound
Posted on October 28, 2021 by Andrea Cheung
What is ultrasound?
Ultrasound has been wildly accepted as a therapeutic modality among the medical field by delivering noninvasive soundwaves causing the molecules in our body to vibrate. Depends on the frequency that practitioner prescribed, it has slightly different positive effects to the patient. However, the main goal for ultrasound therapy is to decrease plain, enhance tissue repair, and aid in muscle relaxation.
What are the theories behind it?
The theory behind ultrasound therapy is the soundwaves transmitted by the machine will cause vibrations in deep tissues, thus heat production. Heat can enhance blood flow and reduce pain symptoms.
Usually, frequency range from 0.8MHz to 3MHz are used during the therapy session. Higher frequency will be used in deep tissues treatment since ultrasound energy will be absorbed by superficial tissues.
How does the treatment looks like?
Transducer can be applied directly to patient’s skin with a layer of gel moving in a circular motion or under water. However, direct application is more common in clinical settings. For acute injury, application will be around 3-5 minutes. For chronic injury, the treatment will take 5-10 minutes. Excessive exposure to ultrasound will cause burning to the skin and damage to cell tissues.
Is it safe? What are some contraindications?
Ultrasound therapy is generally safe for most people. However, certain conditions may prohibit patients from receiving ultrasound therapy. People who are pregnant and in the presence of a pacemaker should avoid direct application over the affected area. Moreover, application will not be placed in areas with cancer, fractures, or directly over spinal cord, and epiphyseal growth center.
Conclusion
Ultrasound therapy is very useful to treat pain symptoms and enhance tissue healing. In addition, incorporating exercise therapy such as active rehabilitation can enhance one’s physical function and recover quicker than only with electrical therapy.
Stretch During Work
Posted on June 29, 2021 by Rebecca Seto-Leung
Time to step away from your desk; your work will be there when you get back. Stand with your feet hip width apart, clasp your hands behind you and bring your knuckles down to the floor. Open up the chest and take an inhale in and long exhale out. Bring your arms overhead to stretch triceps, it’s an old school stretch but a good one, hold for 30 seconds then switch to the other side. Last stretch, bring your hands to the top of your shoulders and gently twist to the right and then to the left. Should a registered massage therapy treatment for your back, shoulders, neck and arms sound good to you, you know where to find us at ruperthealth.com
Plank Pose
Posted on June 18, 2021 by Rebecca Seto-Leung
Rupert Health has taken the 2-minute plank challenge. Our office assistant, George, was able to plank for exactly 2 minutes. Our registered massage therapist, Rebecca, clocked in at 4 minutes, 11 seconds. The plank pose is well known to be helpful in strengthening the core muscles. Other benefits include strengthening the shoulders and decreasing discomfort in your lower back muscles. You can start off your plank pose slowly and gradually build up strength by adding 15-30 seconds to your plank over time. Try out the 2-minute plank challenge, let us know how you do! Visit us at ruperthealth.com