Dr. Amit Shridhar

The shoulder is one of the most important joints in the body that uses a ball and socket to join the arm to the rest of the body. Any pain can make it difficult to carry out motion in a comfortable manner. The shoulder consists of the long arm bone called the humerus, the collarbone or the clavicle, as well as the shoulder blade called the scapula. A layer of cartilage provides essential padding to the bones in this area and its two main joints. There are a number of issues that can cause shoulder pain. Let us get to know the six most common ones. 

1. Rotator Cuff Injury: This is the most common cause of shoulder pain and it occurs when the four muscles or the tendons are injured. These muscles and tendons usually control the movement of the arm. This injury can involve strains and tears which may also be caused by constant lifting of heavy objects. 
2. Rotator Cuff Tendonitis: This condition affects the tendons and muscles that help in moving the arm freely. This usually happens due to inflammation in the tendons. It is commonly experienced by patients who are actively involved in sports and other heavy physical pursuits in their line of work. 
3. Frozen Shoulder: This is a debilitating condition that restricts the free movement of the arm and is also known as adhesive capsulitis. When the shoulder tissues become too thick, it leads to the growth of scar tissue that hinders proper movement and causes pain. 
4. Osteoarthritis: Osteoarthritis is a condition that comes as part of aging bones that also become hollow and brittle over the passage of time, which leads to joint and bone pains in various parts of the body. It is a degenerative disease that is caused due to prolonged wear and tear as well as other factors including family history and sports injury.
5. Bursitis: This condition is known to affect the fluid filled sacs that lie in between the joints. These are known as bursae. When the bursae suffers from swelling, the effect usually shows up as pain in the joints. 
6. Tendon Sheath Inflammation: The fibrous tissue that connects the bones and the muscles is called a tendon. The presence of the tendon makes it possible to pursue activities like running, jumping, lifting, gripping and more. It is protected by a sheath known as synovium, which also lubricates the same. Any injury or tear to this sheath can cause shoulder pain.

Acute and persistent pain that does not abate and gets even worse should be treated with immediate medical intervention.

What is spinal stenosis: The narrowing of the gaps in the spine or the backbone is called as spinal stenosis. This leads to pressure on the nerves and the spinal cord. 5% of cases of spinal stenosis are seen in the low back of the lumbar spine. In some cases, the narrowing of the spine leads to the compressing of the nerve root, which leads to pain in the leg.

Causes of spinal stenosis: It can be caused by aging, arthritis, trauma to the spine, spondylolisthesis and tumor of the spine

Symptoms of spinal stenosis: There is a constant pain in the back and legs as stenosis pinches the nerve responsible for sensation and muscle power. Other symptoms are numbness and tingling in the legs, frequent falling and pain while walking.

Treatment of spinal stenosis:

1. A routine program with exercises and physical therapy are the best treatment for spinal stenosis. The exercises are not a complete cure but they are beneficial in keeping the patient active. A physical therapy can be supervised and once the period of the same is over people easily transition to the exercise program. The key for exercise is starting slowly in order to build strength.
2. Generally, the patients are counseled not to perform strenuous activities as that might worsen the symptoms of spinal stenosis. In case of lumbar stenosis, patients find it comfortable when they are flexed forward. The doctor might recommend walking while being bent over and leaning when using a walker if not walking upright; sitting in recliners is also recommended instead of straight back chairs.
3. Injections of cortisone are usually given in the epidural space. This is believed to relieve the symptoms of spinal stenosis temporarily. Though there have been studies which question the use of these injections as they lead to the risk of osteoporosis-related fractures. This is still being pondered over by the doctors as a suitable treatment option as it has its own benefits and risks.
4. Medications such as the anti-inflammatory medicines like ibuprofen or aspirin are helpful in controlling the symptoms of spinal stenosis. Narcotic drugs might also prove to be helpful if used with care and for a short while. This is helpful for severe pain related to the nerves. Muscle relaxants like gabapentins might also be recommended. In some cases, antidepressants might also be given to provide relief from pain. 

Though side effects are a concern when using these medications and the patient should let the doctor knows about their allergies. If you wish to discuss about any specific problem, you can consult an orthopedist.

The lower back or the lumbar area is the region that lies right below the rib cage. Pain in the lower back is usually a result of persistent muscle spasms that make it a chronic pain. While many people suffer from this kind of pain at some point at the other, there are few who actually take up exercise as a long-term solution to deal with the pain. A proper exercise schedule and regular yoga can actually strengthen your lower back and help it support the spinal cord in a better manner. Also, most orthopedic specialists recommend constant movement to alleviate the painful symptoms of lower back pain. Do go through this list of exercises to find one that suits you.

• Partial crunches: This one requires you to lie down, prop your knees up with your feet firmly on the ground and your hands behind your head. Now bring your body partially up and stop shy of doing a full on sit up. This will help in relaxing the muscles in the lower back, to a great extent.
• Hamstring stretches: Get on your back and prop up one knee. Take a towel and loop it under the ball of your other foot. Now lift and hold as you press your foot into the towel, to gradually relieve some of that stress as it plays on your lower back.
• Ankle and heels: The classic ankle pump involves lying flat on your back and stretching your feet before you begin to move your ankles in an up and down motion. Repeat it ten times for each set. You can combine this exercise with the heel slide where you have bend and straighten your knee ten times each, in the same position as you lie flat on your back.
• Wall squats: While actual squats can be painful if you are suffering from lower back pain, you can take the support of a nearby wall for squats that will work the muscles in a more soothing manner and give you a good workout at the same time.

Touching your toes, running on the treadmill, sit-ups and other forms of intense exercise that make the back work too hard should be avoided if you are suffering from lower back pain.

Arthritis is a common musculoskeletal condition that affects elderly men and women. Joint pain, stiffness and inflammation are the most common symptoms of this condition. This pain can get so bad as to affect your movement and leave you unable to do simple things like walking up stairs or even simply turning a doorknob.

Arthritis cannot be reversed but with medication and a few lifestyle changes, your quality of life can be improved.

1. Exercise and weight loss: Though it is difficult to do, losing weight can help relieve the pain of arthritis. This takes the pressure off your joints and increases the range of possible motions. Though exercising may be the last thing you want to do, it can help increase your flexibility and help strengthen your muscles. Aerobics, stretching and strength training are ideal for arthritic patients.
2. Assistive devices: Arthritis can make a person knock kneed or bow legged. Wearing unloading braces, shoe inserts or walking with a cane or shoe inserts can help redistribute your weight and take the pressure of your joints. It can also help relieve pain and prevent arthritis from worsening.
3. Eating right: Some types of food can worsen arthritic symptoms. This includes processed foods like white flour and sugar, yeast, chemical additives, gluten, hydrogenated and trans fats, milk products, caffeine, alcohol and tobacco. Hence, avoid consuming these foods and instead have a diet rich in fruits, vegetables, nuts and whole grain. You could also try alkaline foods like green leafy vegetables, wheatgrass and aloe vera.
4. Massage therapy: A massage not only de-stresses the body, but can also relieve muscle and joint pain by improving blood circulation. Massages also help break up muscular waste deposits and increase the amount of oxygen circulated in the body. This helps transport nutrients to tissues and carries toxins away. Ideally, an arthritic patient should have a massage 2-3 times a week in the beginning and at least twice a month once the condition has stabilised.
5. Supplements: Along with eating healthy, including a few supplements in your daily diet can also help alleviate arthritic symptoms. When it comes to rheumatic arthritis; the anti-inflammatory properties of vitamin C help fight arthritis by promoting bone and cartilage growth and reducing infection. Fish oil is rich in omega-3 fatty acids that help reduce inflammation, Vitamin D is another supplement that helps relieve arthritic pain by helping the bones absorb calcium faster and preventing further loss of cartilage. If you wish to discuss about any specific problem, you can consult a rheumatologist.

Cortisone shots are injections that help relieve pain and inflammation. They are injected directly into the joints such as the ankle, wrist, knee, hip, shoulder, elbow or spine. These injections are a combination of corticosteroids and local anaesthetics. These corticosteroids are similar to the hormones produced by the adrenal gland. Cortisone injections are often used to treat arthritis, carpal tunnel syndrome, trigger finger, shoulder bursitis and plantar fasciitis. Though they do not cure the disease but they provide temporary relief.

These injections may be slightly painful but provide relief in a day or two that lasts for a few weeks or months at a stretch. Hence, cortisone shots provide relief faster and have longer lasting results than other forms of anti-inflammatory medication. Another benefit of cortisone injections as compared to other drugs that need to be taken in through the mouth is that it avoids side effects of anti-inflammatory medication such as an upset stomach etc. Cortisone injections can also be used to treat backaches and pain that radiates from the spine to an arm or leg.

However, cortisone injections are associated with a number of risks. These include:

1. Infection in the joints
2. Nerve damage
3. Thinning of tissue and skin around the injection site
4. Pain and inflammation in the joint
5. Weakening or rupturing of tendons
6. Osteoporosis or thinning of bones
7. Lightening of skin around the injection site
8. Osteonecrosis or death of bones in the injected area
9. Blood sugar spikes – this is seen mostly in diabetic patients
10. Weakening of the immune system if the person has an underlying infection

In most cases, these side effects are short-lived. Higher dosages and frequent administration can increase the body’s exposure to the corticosteroid. This increases the risk of long-term side effects such as:

1. Acne
2. Easy bruising
3. Weight gain
4. Cataract formation
5. Puffiness of the face
6. High blood pressure

Cortisone may also be held responsible for the deterioration of cartilage inside a joint. For this reason, doctors do not advise cortisone injections to be had more than 3-4 times a year. The minimum interval between two cortisone injections must be 6 weeks. Doctors also typically limit the number of injections given in one joint.
When used judiciously, cortisone injections can greatly improve the quality of a patient’s life. Hence it is very important to get treated only by a qualified doctor and to completely understand the pros and cons of using this form of treatment. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.