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Common Problems 

                Do I need to see the doctor? 

This page contains general patient information for many common conditions that are seen in our office. 

Contents

  • sprains/strains
  • fractures
  • back pain
  • shoulder pain (rotator cuff tears)
  • carpal tunnel syndrome
  • arthritis (degenerative joint disease)
  • osteoporosis

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Sprains, strains and pain -Most injuries occur as a result of an unexpected force on the bones and/or soft tissues (muscles, ligaments, tendons ,etc.) as either a sudden event i.e. a fall, or a repetitive action i.e. 5 sets of tennis, for which the body is unaccustomed. Conditioning is important to prevent these injuries with regular exercise. A brisk walk every day, stretching before sports and building up slowly to a desired level of activity will decrease the frequency of these injuries. When they occur standard first aid involves R.I.C.E.-Rest (stop the activity), Ice (fill a Plastic bag with ice and wrap in towel then apply to skin 20 min on 20 min off every hour while awake for 24-48 hrs), Compression (ace bandage), Elevation (lay down with the injured part above the level of the heart). All designed to control swelling. Anti-inflammatory medicines (Advil, Motrin and many others-but not Tylenol) control swelling and decrease pain but patients with ulcers, kidney problems and taking blood pressure or blood thinner medicine should check with their doctor first. MOST PATIENTS WITH SEVERE PAIN THAT DOES NOT IMPROVE SHOULD SEE A DOCTOR.                             

                        

Fractures (BROKEN BONES) require an xray to know for sure if it is broken. Just because you can move it or walk on the injured part does NOT mean you do not have a break. X-rays are done at the hospital emergency room or your doctor's office. R.I.C.E. treatment with application of a splint (to keep the injured part at rest) usually with a soft cast or brace will decrease pain and further injury. Emergency splints before getting to the hospital/office can include rolled newspapers, pillows, or any straight stiff object taped to an arm or leg to immobilize the affected part. Just holding it still will help if a splint cannot be used. Never move an obviously bent or deformed part. Immobilize in that position. All fractures should be treated by an orthopedist. Many can be treated with a cast (especially children) but some will require surgery immediately (compound/open fractures through the skin) or when swelling decreases in 1-10 days.

    

Back pain-Most cases of low back pain do not require emergency treatment. Almost everyone will experience back pain at some point in their lives and the causes are many including work lifting injuries, home twisting injuries, car accidents/whiplash, wear and tear arthritis as we age, and sports injuries. These usually represent sprains/strains of the many small muscles and joints of the spinal column that is normally a finely balanced skeletal structure (like a skyscraper) holding our bodies erect against the pull of gravity. Most injuries can be treated with a short period(24-48 hrs) of bed rest getting up for meals and the bathroom, anti-inflammatory medicines, and after 24-48 hrs, moist heat (a hot shower or a heating pad). ANY PATIENT WITH SEVERE PAIN THAT GOES DOWN THE LEG, LEG OR FOOT WEAKNESS OR THE LOSS OF BOWEL /BLADDER CONTROL SHOULD SEE A DOCTOR. Your doctor may not even order x-rays if you have only back pain and you may be treated with pain medicine,  muscle relaxers and anti-inflammatories for many weeks. Physical therapy can be helpful for some but pain that does not improve over 4-6 weeks is uncommon and may require referral to a specialist.

Shoulder Bursitis/Tendonitis- Longstanding pain in the shoulder that worsens with overhead activity i.e. reaching up or brushing hair, can be caused by a single injury like a fall or by repetitive overuse at home or at work. Swelling and inflammation of the rotator cuff tendon causes pain as it rubs on the undersurface of the top of the shoulder blade bone and can eventually lead to tears of the tendon requiring surgery to repair. Temporarily stopping or reducing the amount of overhead use of the arm and taking anti-inflammatory medicines can allow the tendon to recover. A cortisone shot may be recommended to quickly decrease symptoms. The key to recovery is strengthening the muscle and tendon with physical therapy to allow increased overhead activity without pain. Inability to raise the arm, not just painful raising, should be evaluated by your doctor in case early surgery is necessary for a complete tear of the tendon.

Carpal Tunnel Syndrome- Numbness or pins and needles sensation in the hand (like when your foot is asleep) is a common condition caused by mild compression of the median nerve at the wrist and causes symptoms in the thumb and fingers. Causes include repetitive overuse of the wrist (i.e. factory workers and computer operators), injuries/fractures of the wrist, diabetes, pregnancy, obesity, and the continuous use of vibrating tools (i.e.jackhammers). Pain and or numbness usually comes and goes for a few minutes and may be relieved by shaking or changing the position of the hand or wrist. Many people wake up at night with a numb hand. Symptoms can worsen but usually improve over a few months and do not require treatment. Avoiding wrist positions that cause numbness or using a wrist rest on your keyboard can eliminate most symptoms. Continuous numbness, any weakness, or pain that interferes with work or activity should be evaluated by your doctor. You may be fitted with a cock-up wrist splint to wear at night or at work.. If symptoms persist, surgery has a very high success rate.

       

Arthritis- Joint pain in the hips and knees that worsens with walking is common as we get older and can be a sign of degenerative joint disease usually related to wear and tear. People in their 30's and 40's usually do not have joint pain from arthritis. Older patients generally limit activity as they begin to "slow down" but this is not always necessary or beneficial. Regular exercise can strengthen joints and decrease pain. YOUR DOCTOR CAN HELP YOU DEVELOP AN EXERCISE PROGRAM that is simple, quick and fun, which can provide many other health benefits for your body and mind. Tylenol is a proven, effective first line treatment for early arthritis. Progressive pain and activity limitation may require prescription anti-inflammatory pain medication from your doctor as well as devices to decrease the stress on your joints, a cane or walker. Weight loss can eliminate the need for any treatment. Physical therapy can strengthen muscles to decrease pain and one or two cortisone shots into the joint can provide medium term pain relief. Surgical treatment is beneficial for patients who continue to have disabling pain and activity limitation and has been proven to improve quality of life. When to have joint replacement surgery is an individual decision between you and your doctor but should generally be postponed for as long as possible.

 

Osteoporosis- weakening of the bones due to aging or disease can cause fractures of the hip, wrist, and spine requiring surgery. Prevention is the best medicine. Regular exercise strengthens bones and eating a well balanced diet provides bone with enough calcium and vitamin D to stay strong and should begin as soon as possible. It's never too late to start! Hormones play a role and many women need estrogen therapy after menopause to help prevent fractures. Bone density measurements can predict your fracture risk. Your doctor can tell you if this is needed and decide if medications or vitamin supplements are indicated to build bone mass to prevent fractures.