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:

    X-rays: Through an x-ray one can view the shoulder in many different views.
    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.
    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.
    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

    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
    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

    Pain relief and physiotherapy as first step If this fails then following surgical options are available
    Arthroscopic debridement or repair of labrum
    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.

Always remember 'a stitch in time saves nine'

Shoulder Pain: Causes, Diagnoses & Treatment

In preparation for the possibility of conception, a woman's body undergoes the menstrual cycle every month which culminates into the periods. This is a normal process which all women of reproductive age go through every month. However, in certain cases, the periods can be really painful where you may suffer from menstrual cramps or could be generally in much pain. This condition is known as Dysmenorrhea.

What exactly is Dysmenorrhea
As mentioned above, Dysmenorrhea is a disorder that many women got through while having their periods where they may suffer from painful cramps. The pain usually occurs in the pelvis area along with the lower abdomen and it may also be accompanied by other symptoms.

Some symptoms of Dysmenorrhea
Some of the symptoms of Dysmenorrhea could be any combination of the following factors
I. Very painful menstrual cramps accompanied by lower back pain
II. Diarrhea and nausea along with the cramps
III. Pain in the inner thighs, lower back and hips
IV. Being hypersensitive to light, loud sounds, specific smells and touch
V. Being fatigued all the time, even causing you to faint

Causes of Dysmenorrhea
Dysmenorrhea is usually caused by the contraction of the Uterus. While the uterus does contract a little even in normal periods, during Dysmenorrhea the contractions tend to be a little too much. Due to this the uterus presses against the blood vessels and organs within the vicinity causing oxygen loss to them. This causes elevated levels of pain and discomfort.

Some of the underlying causes which may result in Dysmenorrhea are:
1. Narrowing of the cervix - Also known as stenosis, the lower part of the uterus which is the cervix may become narrow due to scarring and cause Dysmenorrhea.
2. Endometriosis - This is where the uterine lining is found outside the uterus, especially in the pelvic cavity and thus may cause painful cramps.
3. Inflammatory pelvic diseases - This is when a bacterial infection in the pelvic area can spread to multiple organs, including the uterus and thus may cause painful menstrual cramps.
4. Tumors - Tumors or fibroids which are unwanted growths on the inside of the uterus may also trigger Dysmenorrhea.

What to do if you are suffering from Dysmenorrhea
Below are some of the basic steps which you can take to ease pain from Dysmenorrhea
1. Avoid smoking and abstain from alcohol
2. Ample rest during periods
3. Keep the body dehydrated
4. Don't consume foods high in salt
5. Don't drink coffee or any caffeine rich foods
6. Lower back massages and hot water bag treatments to relieve pain
If severe pain still persists for long or if dysmenorrhea occurs repeatedly, then you should consult a doctor first rather than trying to resolve the problem yourself.


All about Dysmenorrhea

The Anterior cruciate ligament (ACL) is an important ligament that gives stability to the knees. An injury to this ligament can result in a host of complications and discomfort. Children or adults who are into sports such as gymnastics, volleyball, tennis, basketball, soccer, football, often injure this ligament. As per various studies and surveys, ACL injury is more likely to affect female athletes as compared to their male counterparts.

Depending on the severity and extent of the damage, an Anterior Cruciate Ligament Injury may be ranked on a grade of 3.

Grade 1 sprains indicate a mild injury or stretching of the ligament, seldom affecting the stability of the knees.
Grade 2 sprains are indicative of a partial ligament tear (the ligament loosen up). The damage is still under control.
Grade 3 sprains are extensive and severe, indicating a complete ligament tear (the ligament often breaks in two pieces). With a complete ligament tear, the stability of the knee is also affected (the knee becomes highly unstable).
What causes Anterior Cruciate Ligament (ACL) Injury?
While a host of sports activities mentioned above increases the risk of the injury, a person may also suffer a partial or a complete anterior cruciate ligament tear under the following situations.

A jump down a ladder, a tree, or a wall. An incorrect jump or a landing may be equally responsible for the ligament tear.
A collision or a hit, especially on the knee (while playing football).
Slowing down suddenly while still in running motion. A person suddenly stopping or missing a step can also injure the ligament.
Symptoms associated with ACL injury

An excruciating pain (especially in the back and outside of the knee) is often seen in people with a complete ligament tear (the movement is yet not affected). However, within a few hours, there may a swelling around the knee, indicating the severity of the injury with internal bleeding within the knee joints.
There may be restricted knee movement. The knee also feels unstable, further limiting the movement.
Sometimes a pop in the knee can be heard just at the time of the ACL injury.
Prolonged ACL injury left unattended can result in a painful complication such as knee osteoarthritis.
Diagnosis
To diagnose the extent of the damage, the doctor may suggest

Physical examination, including a quick brief about the case history.
Imaging tests such as X-rays and MRI can go a long way to analyze the ligament injury.
In the case of extensive swelling of the knees, the doctor may carry out an arthroscopy to have a closer look inside of the knee.
An accurate and timely diagnosis is important to avoid the aggravation of the injury. In the case of swelling and knee pain, consult a doctor, and get yourself thoroughly examined.

Anterior Cruciate Ligament Injury- Causes, Symptoms, and Diagnosis

The toes and heels are the most load bearing components within your feet which take most of the weight when walking, running, exercising or even standing up. The heels are an especially vulnerable part of the body which can become painful either due to injuries or excessive stress put on it. Pain in your heels can also be a sign of other problems in your body.

Causes for heel pain:

1. Sprains or straining the leg: Exercising is one of the most common culprits behind heel damage. Wearing the wrong shoes over prolonged periods, which can cause your balance to be shifted and will lead you to put strain on your heels and cause pain. Falling or spraining during exercising or training can also cause heel pain.

2. Fractures: Stress or hairline fractures can occur even without impacts or trauma and also cause pain. It will slowly build up over time. In such cases, you should immediately consult a doctor and take remedial action.

3. Achilles tendon: A common cause for heel pain, the Achilles tendon connects the calf muscle to the heel. If this is torn or damaged, it can cause pain in your heel.

4. Arthritis: The deposition of uric acid crystals in parts of your body may result in arthritis; this is a fairly common cause for heel pain as well.

Treatments available

1. Change in shoes: Shoes play a major role in the development of heel pain. You will either need to change the shoes or adjust the heels to ensure that they are at an equal and comfortable height and keep your posture natural and balanced.

2. Foot supports: There are specialized heel supports and wedges, which you can wear with the footwear. These supports help redistribute weight from the problem areas and uniformly distribute it among the other parts of the foot. Heel cups are also another form of supports you could try.

3. Pain relief medications: Sometimes aspirin or ibuprofen may be required to numb and dull the pain, if getting through the day becomes difficult or you are in the middle of work.

4. Resting: Sometimes resting is the only medication you can take to relieve the pain as it can only subside once the underlying conditions are corrected.

5. Ice packs: Cold compress and cold therapy would definitely help in numbing the area and providing temporary pain relief.

It is however, advisable to visit the doctor if the pain persists and take specialized medical care in more complicated cases wherein the pain is prolonged.

Heel Pain its Causes and Treatments

Pain is unpleasant suffering caused by injury or illness. Back pain may be sudden/constant, dull, severe or not responding to short rest and medication. Constant pain in back in any region of spine for more than few days to weeks needs intervention.

Pain which is intense especially at night requires urgent visit to a specialist.

Sudden onset of pain in back with or without injury needs urgent attention.

Back pain with difficulty in walking, pain while getting up from position of comfort, pain during change of posture or pain after prolonged sitting (for work) can lead to serious permanent damage, if left untreated.

Pain which travels to one or both legs may be due to pressure on the nerve/s and if left untreated for long can lead to permanent weakness or damage.

Pain associated with numbness, tingling or weakness in legs, especially below the knees, commonly called Sciatica, needs to be investigated. Various spinal ailments can lead to weakness in one or two limbs or all four limbs. There may be associated or isolated numbness (loss of sensation to touch, pain or temperature) without back pain.

Numbness, tingling or weakness may be the only symptoms without any complaint or without history of back pain.

Problems related to bladder control which may be difficulty to control, hesitancy in passing or dribbling of urine. There may be associated constipation. Loss of bowel/bladder control is caused by pressure on spinal cord &/or nerves which may be due to injury, infection, disc prolapse or tumor.

Sudden swelling and redness in back usually happens after an injury or accident but sometimes are signs of underlying severe illness.

Loss of normal shape/curvatures of spine can present with or without pain. It can lead to forward, sideways or rarely backward bending.

Unintentional weight loss, loss of appetite, evening rise of fever or disturbed sleep with associated back pain/weakness/numbness needs visit to a specialist.

When Should You See Your Doctor in Back Pain?

Back pain is something that affects many people all over the world. Persistent and chronic pain seems to be one of the most common complaints. Middle back pain is back pain that is felt in the thoracic vertebrae region, which is located between the base of the neck and top of the lumbar spine. The ribs attach to a long, flat bone in the middle of the chest called the sternum and wrap around the back. In case, there is a nerve around there is squeezed, disturbed, or injured, you are likely to feel pain in different spots where the nerve goes through, for example, your arms, legs, chest and the stomach.

Some of the most common causes of middle back pain are as follows:

Middle back pain can happen as a consequence of injury or sudden damage or it can happen through strain or poor stance after some time.
The most widely recognized reason for middle back pain seems to begin from soft tissue problems or muscular irritation. These can emerge from poor stance, lack of strength, prolonged sitting in front of a computer, utilizing a heavy backpack, overuse injuries, (for example, repetitive movement), or injury, (like a whiplash damage brought about by an auto crash or as a consequence of a sports injuries).
The middle back is a moderately normal site for inflammatory, degenerative, metabolic, infective and neoplastic conditions.
Middle back pain and its dysfunctions are connected with various conditions, for example, essential and optional osteoporosis (particularly vertebral cracks and hyperkyphosis emerging from vertebral bone loss), ankylosing spondylitis, osteoarthritis and Scheuermann's infection.
Muscle strain, overuse or damage to the muscles, tendons, and discs that are backing your spine can also cause middle back pain.
Weight on the spinal nerves from specific issues, for example, a herniated disc.
A fracture in one of the vertebrae can also cause pain in this region.
Osteoarthritis created by the breakdown of ligament or cartilage that cushions the little joints in the spine.
Myofascial pain that influences the connective tissue of a muscle or gathering of muscles.
In uncommon cases, pain might be brought about by different issues, for example, gall bladder disease, cancer or an infection.
Getting hit hard in the back can also cause chronic pain.
Lift something too heavy may cause pain and a sudden pressure in this area.
A compression fracture of the vertebra can also bring about intense or chronic pain in the middle back. The injury may bring about a fracture, however in ladies over age 50 without critical injury or somebody known to have osteoporosis, an unconstrained vertebral fracture is possible.
Other contributing factors to injury include lack of strength which can be treated by a Pain Management Specialist using non-surgical methods.

Common Causes of Middle Back Pain

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