Care for shoulder pain and related problems

Shoulder problems usually happen because of internal problems or external trauma. People who are into any form of manual labour, pick up a lot of heavy things regularly or play sports experience shoulder pain at some point of time or other. Shoulder pain can be detected by physical examination, mri, x-ray, ultrasound and medical history.

The most common types of shoulder problems are arthritis, fracture, dislocation, frozen shoulder, rotator cuff tear, and rotator cuff disease. Cures for the different shoulder pains are different. Follow these simple ways to help you manage the pain.

1. Rest the hurtful shoulder: you need to take ample rest. Using the arm which is affected is not a good idea and needs to be avoided. If your job involves manual labour, it is advised that you stay at home to rest.

2. Ice pack healing: applying ice pack on the wound is also advised around 3-4 times in a day. This varies as per the kind of shoulder pain, so doctor's advice must be followed.

3. Be consistent with exercise: depending upon the source of pain, physiotherapist will advise certain sets of shoulder exercises. It is very important that they should be performed diligently for fast recovery.

4. Support it well: wearing a sling is extremely important and should not be taken lightly at any point of time. A good support will ensure there is no mislocation and faster recovery.

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Shoulder Pain Care - 4 things you must not ignore!

Do you know you can suffer from a torn bicep accidentally? A bicep is a muscle which begins from your upper arm and is attached to the shoulder via bones and to the elbows by tendons. If you do heavy lifting in the gym or somehow put excessive pressure on that area, chances are you may suffer from torn biceps.

There are two kinds of bicep tears you may encounter:

Complete Tears where the tendons are split into two parts resulting in tremendous pain.
Partial Tears result when the biceps are hurt but the tendon is not completely severed.
Among the various types of torn biceps, the muscle that is attached to the shoulder experiences the maximum number of bicep ruptures. Suddenly, the bicep tendons get detached from the bone resulting in pain and numbness. You will find a number of sportspersons suffering from this kind of torn biceps.

But why do your biceps get torn?

One of the reasons why you suffer torn biceps is a prolonged period of ignorance. If you have been putting continuous pressure on your shoulder, the biceps muscle can weaken over time. Overuse of the muscles can give rise to conditions of tendinitis (inflammation of the bone to muscle connecting tissue) and injuries in rotator cuff which, in future, might result in torn biceps.
A sudden injury like falling over your arms or hurting your shoulder can result in torn biceps.
Aging is another reason why you can have this complication. Added to this are unusually heavy tasks and overuse of shoulder which can result in this problem.
Some steroids such as Corticosteroids are directly related to the weakening of muscles and tendons.
When you suffer from torn biceps, you encounter symptoms such as:

Weakening of the elbow and the shoulder. You will find it troublesome to move your hand.
Swelling of the elbow with bruises visible on the elbow and the forearm.
You find trouble in twisting your forearm
You will experience spasms in the muscles.
You can also hear a snapping sound of the muscles.
What should you do if you face this problem?

Continuous applications of ice packs are a must. Repeat the activity 4 times a day with a duration of 20 minutes. You may need to do it for 2 or 3 days.
Avoid activities which put pressure on your hands and shoulders.
Consult a doctor immediately and get some painkillers as recommended.
If you have complete tears, you may need to undergo surgery. Talk to your doctor regarding that.

How to Treat Torn Biceps - Types, Causes, Symptoms

As children, you have probably learnt that paralysis is complete inability to move, sense, touch or control other bodily sensations. But little did we know that paralysis comes in many forms depending on the extent to which a person is immobilized. So, what is the difference between partial and total paralysis?

What is Total Paralysis?
Whether temporary or permanent, paralysis is the inability to move part of the body due to nerve damage. However it does not mean that people with total paralysis cannot move any parts of the body   they can still use their faces and necks. The extensive form of paralysis is typically referred to as quadriplegia, which involves diminished or absence of movement in the trunk, arms, legs, hands and feet. Some common symptoms of total paralysis are as follows:

Difficulty swallowing
Unable to control bowels and bladder
Pain anywhere in the body
No sensation below the site of injury
Difficulty breathing
What is partial paralysis?
A smaller portion of the body is affected by partial paralysis. One of the most common types of partial paralysis is Paraplegia that occurs below the waist. If affects both the legs, hips and other functions. Other forms of partial paralysis can be Monoplegia where a single area like one limb gets affected and Hemiplegia where parts of the body on the same side get affected. Some common symptoms of partial paralysis are as follows:

Inability to walk
Difficulty with sexual functioning
Pain below the site of injury
Unable to feel or move your legs or arms
How to Predict the type of paralysis?
The location of the injury or site of nerve damage will usually determine the type of paralysis. Damages in the cervical spinal cord almost inevitably lead to total paralysis associated with quadriplegia. The higher the injury is located, the more extensive the paralysis will be. Lower injuries commonly lead to partial paralysis. The prognosis is generally much better with this type of paralysis. With proper care and therapy, individuals may experience intermittent difficulties with movement and can regain.

Can paralysis be treated?
Whether it is total paralysis or partial paralysis, the positive prognosis is certainly possible, given the condition of the patient and other factors. Physical therapy involves teaching the brain and spinal cord to work around the damage and also aid neuron healing over time. Paralysis can be classified under a number of ways and the most basic classification is that of partial or complete paralysis. Talk to your doctor to understand what type of paralysis you have and adopt a positive outlook to help you towards recovery.

Partial Vs Complete Paralysis - Know The Difference!

Spinal fractures occur as a result of an injury or dislocation of the bony vertebra. This causes the bone fragments to pinch and damage the spinal cord. Fractures can occur anywhere along the spine but the most common site of fracture is the lower back.

What causes spinal fractures?

Spinal fractures are often a result of the following-

  A sudden traumatic injury
  A high-velocity accident
  Falling from a height
  Sports injuries
  Spinal instability
  A whiplash

Types of spinal fractures:

Spinal fractures are classified into three categories, such as the following-

  Compression fracture - If you exert excessive pressure on the vertebra, it will break. This type of fracture occurs when the bones in the spine become fragile or weak to the extent that they easily crumble. People living with osteoporosis, certain types of cancer or tumours are prone to a compression fracture.

  Dislocation - When the discs and/or ligaments linking the vertebrae is torn or stretched, the bones may dislocate or come out of alignment.

  Fracture-dislocation - Torn ligament and broken bone lead to this condition. A fracture-dislocation is a debilitating condition and often requires surgical intervention.

Symptoms of spine fractures:

Following an accident or an injury, you can tell if you have ended up fracturing your spinal column by identifying these symptoms-

  Excruciating pain
  Tingling sensation
  Numbness
  Muscle spasm
  Swelling of the muscle
  Sudden onset of back pain
  Restricted spinal mobility
  The pain worsens if you walk or stand for long
  Deformity or disability of the spine

How are spinal fractures treated?

Spinal fracture treatment begins with administering pain-management drugs and medications to ease the symptoms, and stabilization methods to prevent injury. Depending on the nature of the fracture, your doctor may follow these lines of treatment-

  Fusion and instrumentation - These are surgical procedures to cure unstable fractures. Fusion refers to the joining of the vertebrae using a bone graft along with hardware such as hooks, rods, plates, or pedicle screws. The bone graft joins the vertebrae below and above to form a solid piece of bone.

  Kyphoplasty and vertebroplasty - These are minimally invasive procedures, wherein the surgeon injects bone cement into the fractured body through a needle. During kyphoplasty, the surgeon first inserts and inflates a balloon to expand the compressed vertebrae and then fills it with bone cement.

Spinal fractures are an extremely uncomfortable and painful condition to live with. It can hinder your day-to-day activities and affect your quality of life. It is imperative that you seek immediate treatment if you end up with fractures or dislocation of the spine.

Spine Fracture - How Can You Get It Fixed?

Sciatica is a neurological condition that mainly arises due to problems in the sciatic nerve. The sciatic nerve is believed to be the largest nerve originating from the spinal nerves L4 to S3. It extends downward from the lower spine into the back of each leg (thighs) right down to the foot. The sciatic nerve acts as a connecting link between the spinal cord and the foot and the leg muscles. People with sciatica often experience a tingling sensation along with a shooting pain radiates downwards from the lower back (mostly the lumbar region) to the back of one of the legs. Some may also experience the sciatic pain down both the legs (rare).

Types of Sciatic Pain:

Sciatica that affects a person can be of two types depending on the severity of the associated symptoms

Acute sciatic pain: In this case, a person experiences a sudden radiating pain which often heals by itself within a week or two. More than often, the pain is triggered by an injury to the spinal joints, nerves, or the disc.
Chronic sciatic pain: This is a more serious condition where the pain may linger for long, often more than three months. The chronic sciatic pain may affect a person with severe Arthritis and nerve injury and damage.
Symptoms associated with Sciatica:

One of the characteristic symptoms of Sciatica is a shooting pain that radiates from the lower back (often the lumbar) to the back of one (or both) of the legs.
In some, the sciatic pain may result in weakness and a tingling sensation down the affected leg.
A person with sciatica may find it difficult to move his/her foot and legs (restricts their movement).
Some people may experience a shooting pain even while they are in a sitting position. In some others, the pain may be at its worst when a person is in a standing position.
Sciatica can also trigger a hip pain.
What triggers sciatica and the associated symptoms?

The disc is a protective shield that prevents any damage or injury to the vertebrae. A degenerative disc problem can interfere with the normal functioning of the disc triggering sciatica.
Spondylolisthesis: In Spondylolisthesis, also known as a Slip Disc, a bone (mostly in the lumbar region) slips over the bone which is located just below it. People with prolonged and untreated spondylolisthesis are often known to suffer from sciatica.
The sciatic pain can also affect a woman during her pregnancy.
Lumbar spinal stenosis: This condition is is characterized by the spinal canal narrowing down in the lumbar region. Lumbar spinal stenosis exerts pressure on the sciatic nerve, giving rise to sciatica.
A muscular strain or spasm in the buttocks can also be a contributing factor.
Proper management and prevention for sciatica are possible. One should be alert and consult a doctor in case they experience the associated symptoms or any discomfort.

Sciatica Pain - What Can Trigger It?

Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

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