Category: Treatments

Certain areas of the musculoskeletal system experience significant stress from everyday living. Fluid filled sacs, called bursae (bursa) cushion the bones, tendons and muscles near your joints. Unfortunately bursae can become inflamed and irritated and this is call bursitis. Bursitis often occurs near joints that perform frequent repetitive motion. The most common sites for this to occur are the hips knees, shoulders and elbows.

Diagnosis

The patient with bursitis will complain of well-localized pain in the shoulder, hips or other joints. The pain may travel from one of these areas into the arm or thigh. When the doctor examines the patient, he or she will look for swelling and tenderness over the locations of the bursa.  Doctor can often diagnose bursitis based on the medical history and physical exam. If further testing is needed, the doctor my order x-rays. X ray images can’t positively establish the diagnosis of bursitis but they can help to exclude other cause of your discomfort. The bulk of bursa inflammation occurs in the soft tissue, which cannot be seen on X-ray.

Treatment

There are many treatment for bursitis. In the early stages, an anti-inflammatory drug will frequently help the problem. Ice should can also be applied over the inflamed area several times during the day to assist with swelling.  It is important to rest the affected area. For example, avoid elbow pressure by not leaning on the elbow or if the right hip is affected, try to sleep on the left side.  If these treatment strategies fail to work, the doctor may inject an anti-inflammatory drug and /or corticosteroid directly and into the bursa. These drugs are very useful for the relief of inflammation. These drugs generally bring rapid pain relief and in many cases, one injection is all you need. Although if more than one injection is needed, these medications can only be used a few times each year. Physical therapy may be ordered to strengthen the muscles in the affected area to ease pain and prevent recurrence. The physical therapist may use ultrasound and soft tissue manipulation that can sometimes be helpful. Sometimes an inflamed bursa must be surgically drained.

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Peripheral neuropathy is a burning or aching pain due to nerve diseases. The pain can either be constant or intermittent and most often occurs in the arms or legs; however, it has been known to occur in the trunk, abdomen, head and neck. The pain can occur from irritation of one nerve or from several nerves. Generally, peripheral neuropathies are a consequence of diabetes, alcoholism or other neurological diseases.

Diagnosis

Doctors will use a physical examination to confirm the area involved. Neurological examinations can sometimes reveal loss of sensation to pinprick or to hot and cold temperatures. Weakness is sometimes noted in the affected extremity. Reflexes may be affected and there may be changes in the skin over the region. Evaluations of peripheral neuropathies usually involve tests appropriate for the primary disease, which doctors suspect is causing the problem such as diabetes. Evidence of nerve damage can sometimes be demonstrated with electrical nerve testing. Doctors who treat the pain as peripheral neuropathy will often use a nerve block procedure to help diagnose the problem.

Treatment

For some patients with peripheral neuropathy, the use of oral non-steroidal anti- inflammatory medications along with traditional pain medications can be helpful. For others, special medications help directly with nerve pain. These medications are often started at low doses and gradually increased until the desired affects are reached. Long-term relief can often be obtained with the use of therapeutic nerve blocks. These include injections of anesthetic medications along with anti-inflammatory medication around the painful nerves. The injections are usually performed in a short series over several weeks until symptoms subside or a plateau is reached in the treatment. If helpful, these injections can be repeated at appropriate intervals.

Nerve stimulation techniques can be helpful in certain types of peripheral neuropathy. Stimulation can either occur on the skin over the affected region, or in some cases, with stimulator electrodes placed surgically around the nerves or in the spine at the origin of the affected nerves. Although physical therapy is not usually helpful in relieving the pain from peripheral neuropathy, therapeutic exercises can help restore loss of function and allow patients to lead more active lives. In addition, behavioral modification techniques or biofeedback training with muscle relaxation exercises can help patients be less sensitive to the irritation from the affected nerves.

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This disorder is a type of headache with discomfort noted at the back of the head, beginning at the base of the skull and radiating upward toward the top of the head. The symptoms can occur on either side of the head, or it can include both sides. The symptoms can be sharp, spasm-like pains that occur at different intervals. It is caused from irritation of the occipital nerves, which begin at the back of the head and extend to the top of the head. Occipital neuralgia is caused by inflammation or injury to these nerves. It can also be caused by excessive muscle tension in the muscles at the back of the head through which these nerves pass.

Diagnosis

A physical examination will usually show signs of increased tenderness in the tissues at the base of the skull and at the top of the spine. Doctors can use X-rays to determine whether there is any narrowing of the vertebra at the top of the spine, where the occipital nerves pass to the back of the head. The best test to confirm occipital neuralgia is an injection of anesthetic, called a nerve block, given at the base of the skull around the occipital nerve itself. If blocking the occipital nerve results in resolution of the symptoms, the diagnosis of occipital neuralgia is usually confirmed.

Treatment

One of the greatest concerns to doctors treating this problem is to make sure that these symptoms do not indicate an increase in intracranial pressure within the skull, which could signal a vascular, infectious or other significant problem. Some patients will find temporary relief from the pain with the use of non-steroidal anti-inflammatory drugs and muscle relaxants. Physical therapy exercises will also provide some limited effectiveness. Doctors believe the best approach for long-term relief is the use of nerve block treatments. In some cases, an injection of local anesthetic combined with medication to reduce inflammation can result in long-term relief following a series of treatments. At times, the pain at the base of the skull is related to other disorders or arthritis in the joints of the upper portion of the spine. Doctors may use nerve block injections around these structures to help in the treatment of occipital neuralgia. Surgery can sometimes provide relief for several months, but most patients find the pain may return. Surgery is usually reserved as a last option. Some patients will find additional help through a combination of muscle relaxation techniques, known as biofeedback, in conjunction with physical therapy that focuses on manual therapy to the muscles at the back of the neck and head.    Newer block treatments at the occipital nerves can also be utilized for long-term treatment at appropriate intervals.

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Osteoporosis is a disease in which bone mass decreases. Osteoporosis literally means “porous bone” because the bones have less substance and are less dense. As bone mass decreases, susceptibility to fractures increases. A fall, a blow or lifting a heavy object that would normally not strain us, can easily cause a broken bone in somebody with osteoporosis. The spine, the wrist and the hip are the most common sites for osteoporosis fractures. This disorder is particularly common in females. It affects more than half of the women over the age of 45 and over 90 percent of women over the age of 75. It has been called the silent disease because it begins without symptoms when we are much younger. Osteoporosis is six to eight times more common in women than in men. There are a number of risk factors for osteoporosis:

• Female gender
• Post menopausal women
• Early menopause before age 45
• White, Caucasian or Asian
• Low calcium intake
• Lake of physical exercisse
• Family history of osteoporosis
• Cigarette smoking
• Excessive use of alcohol

The symptoms of osteoporosis prior to a bone fracture are:

• Occasional back pain
• Loss of height or curvature of the upper back

Treatment

The doctor may prescribe estrogen replacement after menopause for women who are at risk for osteoporosis. Menopause occurs naturally in most women by the age of 50, or earlier if the ovaries have been removed by surgery. Estrogen reduces the amount of calcium taken out of the bone and slows or halts postmenopausal bone loss. It cannot, however, restore bone mass to pre-menopausal levels. Once osteoporosis develops there are drugs that may be beneficial to slow bone breakdown. Your doctor can help you develop a program that will best treat and prevent further osteoporosis.

Prevention

• Avoid smoking
• Calcium intake between 1,000 – 1,500 mg/day
• Proper strength training
• Regular proper physical activity
• Moderate to no alcohol consumption

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