Dr. Bharath Raj .R

Shoulder pain can be a persistent dull and nagging sensation in the upper arm or shoulder area. It can be easily differentiated from neck pain as it is related to the movement of shoulders i.e. it will increase and decrease with shoulder movements, especially overhead activities. The other signs to identify shoulder pain is if your shoulder movements are reduced.

If you find it difficult to scratch / wash your back, comb your hair or reach your back pocket, it clearly shows you are suffering from shoulder pain. Shoulder pain can happen due to various reasons, it varies from person to person depending on the activities he/she is involved in, for e.g. sports, manual job etc. It can be a single major injury or multiple small injuries due to repetitive usage patterns. Also, degenerative changes in various parts of the shoulder can lead to shoulder pain.

In case of middle to old age, injuries that can cause shoulder pain are:

• Biceps Tendonitis
• Acromio-clavicular Joint arthritis
• Scapular Dyskinesia
• Trapezitis
• Suprascapular nerve entrapment In young age, injury due to sports or gym activity can cause shoulder pain
• Superior labral anterior/posterior (SLAP tear)lesion

Also, traumatic or repeated dislocations of shoulder can cause shoulder pain due to:

• Bankart lesion

Diagnose Shoulder Pain

Shoulder pain can be diagnosed only after thorough history taking and clinical examination. However, some imaging studies can be very helpful like:

1. X-rays: Through an x-ray one can view the shoulder in many different views.
2. Ultrasound: With an ultrasound, you can also check the damaged caused to the tendons and muscles of the shoulder but the quality of reporting depends upon the expertise of the doctor.
3. MRI: MRI gives a clear picture of the shoulder as it shows everything related to a shoulder joint that is joints, vessels, tendons and muscles that too from different angles.
4. Diagnostic Arthroscopy: A surgical procedure often used by orthopaedic surgeons to diagnose and treat issues inside a joint. Arthroscopy has the big advantage that one can use it to diagnose as well as treat at the same time.

Treatment for Various Types of Shoulder Pain

1. For Shoulder Impingement or Rotator Cuff tear: Give rest to the shoulder for a few days only Dedicated Physiotherapy Protocol Bursal injections If these fail then, (Surgery)Arthroscopic sub-acromial decompression If Cuff tear is found, then one can go for Arthroscopic/Mini-open repair
2. Labral Lesions: For anterior Labral lesions (Bankart's) following anterior shoulder dislocation then surgery in the form of Arthroscopic Bankart's repair is the only option to reduce risk of recurrence and degeneration.

SLAP Lesions

1. Pain relief and physiotherapy as first step If this fails then following surgical options are available
2. Arthroscopic debridement or repair of labrum
3. Biceps tenotomy or tenodesis

Arthritis

In this case, the joint is already destroyed and has to be resurfaced for pain relief and to maintain ROM. If Rotator cuff muscles are working, then Shoulder resurfacing hemiarthroplasty (preferred in young people), that has a life of 10 to 15 years, Total shoulder replacement (preferred in middle aged to old people) has a life of 10 to 15 years. But, if rotator cuff muscle are not working then Reverse Geometry Shoulder replacement is recommended, that has a life of 10 years.

It is always advisable to get yourself diagnosed properly in case of shoulder pain as management changes depending on clinical situations. Neglecting shoulder conditions can lead to bigger problems later on.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Bones are similar to a porous framework which is filled with minerals that make it hard and strong. With age, there is gradual degradation and the mineralized portion is lost, thereby leading to thinning of the bone. The word osteoporosis literally translates to porous bones, which is due to the gradual demineralisation. In addition to the natural ageing process, there are other diseases that can accelerate the demineralization process.

Women are more prone to demineralisation, and after the age of 40, they should take extra precaution to slow down the onset of the condition. The following are some ways to improve bone health and halt osteoporosis in the long run-

1. Diet: Ensure that your diet has sufficient amounts of vitamin D and calcium. Though calcium is the essential mineral for bone formation, vitamin D is required for the absorption of calcium, and therefore both these elements play a vital role in maintaining the quality of the bones in our body. Most people require about 1,000 mg of calcium and about 500 units of vitamin D for optimal bone health. This requirement goes up slightly in postmenopausal women.

2. Sun Exposure: In most people, exposure to the sun allows the body to make vitamin D, but careful sun protection prevents this from happening. Also, with age, the body’s ability to form intrinsic vitamin D also declines. The body, therefore, relies on supplements. Most dairy products are good sources of calcium. In addition, spinach, salmon, turnips, and broccoli are some calcium-rich foods. Supplements of calcium carbonate or calcium citrate can be taken if your diet is lacking in calcium. Vitamin D also should be included in the supplementation. The treatment for osteoporosis is incomplete without these two supplements.

3. Exercise With Weights: The constructive tension that exercise puts on the body helps in bone building, whatever the age may be, which prevents the onset of osteoporosis. Any exercise which improves muscle mass strengthens the bones, and puts stress on the bones is advisable. Since the fractured area due to osteoporosis mainly includes the spine, lower back exercises, yoga, tai chi, and abdominal exercises all work wonders. Pick any of these and do them for 30 minutes three times a week.

4. Quit Smoking: Continuing to smoke while taking osteoporosis medications is completely useless. Nicotine negates all the effects which defeat the purpose of taking the medication and is as good as taking no medication at all. So if you want the bone thinning to stop, stop smoking.

5. Alcohol Consumption: While a drink or two per week is permissible, more than this can harm the bones significantly.

6. Constant Health Watch: Talk to your doctor about how other routine medications (if any) can affect your bone health. Also, identify how frequently you should check your bone mineral density and stick to the schedule.

Bone health and osteoporosis can be managed with some conscious efforts. Consult an Expert & get answers to your questions!

Back pain is a common source of pain, which can be acute, subacute or chronic in nature. Back pain is classified along the segments of the spine and can be divided into neck pain. middle back pain, lower-back pain or tailbone pain.

Lower back pain is a type of back pain, which affects the lower back portion of the body. It may occur from arthritis or due to sudden jerking during movement. Lower-back pain may cause serious discomfort and aching and may disable a person from moving about. It should be treated and cared for properly.

Here are several treatments and care procedures for lower-back pain:

1. Take some rest: Most people who get lower-back pain get obsessed with it and end up getting MRI scans, x-rays done and take injections without recognizing the intensity of the pain. It is advised not to rush into the matter. A simple way to cure the pain is by resting. 90% of lower back pains resolve by themselves in 6 weeks and so you must give your back a break instead of taking medical action and give your back some to heal.
2. Pills: Sometimes, a lower back pain can suddenly become severe. In this case, you should intake anti-inflammatory pills such as ibuprofen or naproxen. These pills will help you ease the pain. However, you should not take them for more than ten days at a stretch as continuous pill consumption can cause side effects.
3. Hot & cold compress: Apply a bag of frozen peas or an ice pack to the affected area in your lower back for 48 hours after the pain appears. Every session should be about of 20 minutes and you should take several sessions each day. After two days, repeat the same procedure using a heat pad. The cooling procedure shuts down your blood capillaries, reducing the flow of blood to the affected area. The swelling is then eased. The heating, on the other hand, loosens tight muscles and helps to increase blood circulation.
4. Replace your mattress: People who sleep on firm mattresses and cushions on their beds are at a higher risk of experiencing lower-back pain. If you sleep on a medium-firm mattress, your chances of getting lower-back pain are less. In case your mattress is sagging or is very old, you should replace it.
5. Acupuncture: When your lower-back pain is very severe, you can take acupuncture injections, which provide efficient pain relief. The injections change the way your nerves react and inflammation gets reduced.

Lower-back pain is likely to cause great discomfort and trouble. You will be unable to carry out your daily chores because of the pain. Therefore, proper treatment and care are required for lower-back pain. If you wish to discuss about any specific problem, you can consult an Orthopedist.