Arthritis Pain Relief

Posts Tagged ‘Upper Arm Bone’

by law_keven

Chiropractic And Shoulder Joint Pain

This is a very common problem that is seen daily in chiropractic practices. I have patients who come in to my offices  and complain about their painful and stiff shoulder. By this they usually mean that their upper trapezius muscles are tight and painful and that they have restricted movement and pain in the region of the upper thoracic spine where it meets the cervical spine at the neck.

Chiropractors enjoy a large success rate with these patients who respond well to manipulation and muscle stretching. The second category of patients are those who have a genuine problem with the shoulder. By this I mean the area where the head of the humerus or upper arm bone inserts into the glenoid fossa of the scapula or shoulder blade.

The muscles that hold the humerus in place are called rotator cuff muscles and there are four of those. Painful shoulder conditions that limit movement are common, and are caused by problems with the shoulder joint and its surrounding structures. The shoulder is more prone to injuries than other joints because of its wide range of movement

What are some of the common causes of shoulder pain? There are several conditions that cause pain and limit movement of the shoulder joint, including:

* Rotator cuff disorders. The rotator cuff is a group of muscles and tendons that help to move the shoulder and hold the joint in place. Rotator cuff disorders result from
inflammation or damage to the rotator cuff muscles or tendons, or inflammation of the subacromial bursa (which is a fluid-filled pad that sits under the highest part of the shoulder). The inflammation can be caused by general wear and tear that occurs with age, activities that require constant or repetitive shoulder motion (especially above
shoulder level), heavy lifting, trauma, or poor posture. Serious  injuries and untreated inflammation of the tendons can cause the rotator cuff to tear.

The pain associated with rotator cuff problems is normally felt at the front or on the outside of the shoulder, particularly when you raise your arm or lift something above your head. You may also notice the pain more when lying in bed. Severe injuries can cause weakness of the shoulder muscles, restricted shoulder movement and continuous pain.

Your rotator cuff is a group of muscles and tendons that hold the shoulder joint in place and help move the shoulder. The 4 muscles (and their tendons) that make up the rotator cuff include:

* the supraspinatus;
* the infraspinatus;
* the subscapularis; and
* the teres minor.

Usually it is the rotator cuff tendons (the thick bands of tissue that connect the muscles to the bones) that tear, but sometimes the tear occurs in the muscle. The most common site of a tear is in the supraspinatus tendon. Severe injuries can cause several of the tendons and muscles to tear. There are special movement tests that your doctor can use to help determine which of the muscles or tendons has been torn.

Frozen Shoulder is another painful condition. Frozen shoulder, also known as adhesive capsulitis, is characterised by progressive pain and stiffness in the shoulder. The pain is felt deep in the shoulder joint and may be worse at night. It can be treated by cortisone injections or by a hydrodilatation, a surgical procedure developed by Dr. Frank Burke of Melbourne. This procedure involves an injection of saline and local anesthetic into the shoulder capsule. It is usually not overly painful and is done at his practice in Prahran, Melbourne. This procedure has been very successful in a great majority of patients. The old idea that one had to endure pain for 2 years has been largely disbanded.

Dislocation of the shoulder can occur after a fall. Shoulder dislocation occurs when the ball-shaped head of your upper arm bone (humerus) comes out of the shoulder socket. It may be caused by a fall, a sporting injury, or trauma, and is an extremely painful condition. A dislocated shoulder is visibly deformed or out of place, and there may be swelling or bruising around the joint. Shoulder movement is severely restricted in people with a dislocated shoulder.  Doctors can usually put the shoulder bones back into place using gentle manoeuvres.

Following a dislocation, the shoulder joint sometimes becomes unstable and is susceptible to repeated dislocations. This condition is known as shoulder instability, and causes pain and unsteadiness when you raise your arm or move it away from your body. Your shoulder may feel as if it is slipping out of place when you lift your arm over your head.
 
Arthritis can cause shoulder pain. Arthritis causes progressive joint pain, tenderness, swelling and stiffness. Both rheumatoid arthritis and osteoarthritis can affect the
shoulder joint. Shoulder pain can come from other causes such as referred pain. Sometimes shoulder pain is actually due to problems in your neck or a mixture of several different problems. Rarely, shoulder pain may be caused by infection, problems with the nerves, or a tumour.

Tests need to be done to determine the cause. You may also need to have an X-ray, or other scans, such as an ultrasound scan or MRI. Sometimes, an arthroscopy is needed. In this  test, your doctor can look inside the shoulder joint using a small, telescopic instrument that has a camera on the end.  Your chiropractor will refer you to your doctor if necessary and a referral to a shoulder specialist can be arranged.

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by Earl – What I Saw 2.0

Doctor… My Shoulder Really Hurts. What Do You Recommend?

Patients with inflammatory types of arthritis such as rheumatoid arthritis and psoriatic arthritis often have shoulder problems. However, more often than not, a patient presenting with shoulder pain to the rheumatologist will have another reason besides the arthritis for the discomfort they are feeling.

The shoulder is a complicated and complex joint consisting of the interaction of two major bones forming the glenohumeral joint- the joint that joins the upper arm bone to the shoulder blade. The acromioclavicular joint which joins the clavicle (collarbone) to the shoulder blade is also part of this complex. The muscles that help move the shoulder consist primarily of the rotator cuff muscles and their associated tendons: supraspinatus, infraspinatus, subscapularis, and teres minor.

The biceps muscle and tendon are also responsible for shoulder movement as is the deltoid muscle. The shoulder complex is held together via a complicated network of ligaments and tendons that allow the shoulder to have the widest range of motion of any joint in the body. The shoulder complex is surrounded by small fluid filled sacs, called bursae that help to cushion the shoulder joint and allow more purposeful gliding motions of the joint.

Shoulder pain is responsible for about 16% of all complaints having to do with muscles or joints. Shoulder pain becomes defined as being chronic if it lasts 6 months or longer. Age is a general predictor of cause. In patients younger than 40 years, shoulder instability and mild rotator cuff disease are more common. Older patients usually have conditions such as adhesive capsulitis (frozen shoulder), osteoarthritis, and more advanced rotator cuff problems.

Pain located at the top and front of the shoulder is usually due to problems related to the AC (acromioclavicular) joint – that is, the joint that joins the collarbone to the shoulder blade.

By contrast, pain involving the outside of the upper arm near the shoulder joint is often due to bursitis involving the bursa located beneath the deltoid muscle or to tendonitis affecting the rotator cuff.

A diagnosis starts with the history. During the history, the physician will inquire as to the location and duration of pain, whether the pain is present at night, and what types of body positions and movements aggravate the pain.

In addition the range of motion of the shoulder will be assessed. There are two methods for measuring range of motion. Active range of motion is the range of motion a patient can perform on their own. Passive range of motion is what the patient can do with the assistance of the physician.

Problems like tendonitis and bursitis will show that a patient has limited active range of motion but relatively normal passive range of motion.

Loss of both active and passive range of motion suggests adhesive capsulitis or glenohumeral arthritis (arthritis affecting the joint that joins the humerus [upper arm bone] to the scapula [shoulder blade]).

Certain maneuvers designed to “pinch” the rotator cuff against the acromion (the outside part of the shoulder blade) can reproduce the pain in some patients. This condition is called impingement.

Imaging procedures such as x-ray may be helpful in some instances. For example, it can show calcium deposits in tendons or show severe arthritis in the AC joint.

The preferred imaging procedure for suspected rotator cuff disorders is MRI; however, ultrasound is becoming more popular as a cost-effective alternative to MRI. Some studies have indicated that diagnostic ultrasound is actually more precise than MRI for detecting rotator cuff tears.

Conservative treatment is usually initiated for most patients with chronic shoulder pain. This treatment should consist of modification of daily activities such as reduction of overhead activity in patients with rotator cuff disease, glenohumeral osteoarthritis, or adhesive capsulitis.

Cross-body shoulder movements such as swinging a baseball bat, tennis racket or golf club should be limited among patients with AC arthritis.

Non-steroidal anti-inflammatory drugs are frequently used and can be effective.

Injections of glucocorticoids (“cortisone”) into the space beneath the acromion are also useful for reducing inflammation. Injections of glucocorticoids directly into the glenohumeral joint are effective in reducing pain and increasing function among patients with adhesive capsulitis. These injections need to be guided using either ultrasound or fluoroscopy to be effective.

Adhesive capsulitis should be treated with a combination of steroid injections as well as physical therapy. Referral to an orthopedist for either manipulation of the shoulder under general anesthesia or arthroscopy is recommended for patients with adhesive capsulitis who do not respond to 2-3 months of therapy.

Osteoarthritis of the glenohumeral joint may respond to NSAIDS and injections into the glenohumeral joint. Physical therapy may also be useful but it should be done gently since too vigorous therapy can aggravate this condition.

Patients with acute massive rotator cuff tears are fairly easy to diagnose and should be referred to an orthopedist as quickly as possible to ensure a good surgical outcome. Massive tears that have been present for 6 weeks or longer are often difficult to repair.

Patients with small tears of the rotator cuff often respond to conservative treatment.

Newer techniques involving the use of tenodesis (“irritating” the tendon to stimulate bleeding) followed by ultrasound guided injection of platelet rich plasma to help with the healing process may allow patients with rotator cuff tears to avoid surgery. This same procedure is being evaluated for arthritis processes as well.

Patients with rotator cuff tears not responding to more conservative measures can be referred to an orthopedist.

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by euthman

Arthritis Knee Surgery – The Pros and Cons

Elbow Replacement In India

Elbow replacement involves surgically replacing bones that make up the elbow joint with artificial elbow joint parts (prosthetic components). The artificial joint consists of two stems made of high-quality metal. They are joined together with a metal and plastic hinge that allows the artificial elbow joint to bend. The artificial joints come in different sizes to fit the patient.

The elbow is a hinge joint consisting of three bones. The upper part of the hinge is at the end of the upper arm bone (humerus), and the lower part of the hinge is at the top of the two forearm bones (radius and ulna) which are side by side. When the elbow is bent, the ends of the two forearm bones rub against the end of the humerus.

Anatomy

How does the elbow joint work?

The elbow joint is made up of three bones the humerus bone of the upper arm, and the ulna and radius bones of the forearm.

The ulna and the humerus meet at the elbow and form a hinge. This hinge allows the arm to straighten and bend. The large triceps muscle in the back of the arm attaches to the point of the ulna (the olecranon). When this muscle contracts, it straightens out the elbow. The biceps muscles in the front of the arm contracts to bend the elbow.

Inside the elbow joint, the bones are covered with articular cartilage. Articular cartilage is a slick, smooth material. It protects the bone ends from friction when they rub together as the elbow moves. Articular cartilage is soft enough to act as a shock absorber. It is also tough enough to last a lifetime, if it is not injured.

The connection of the radius to the humerus allows rotation of the forearm. The upper end of the radius is round. This round end turns against the ulna and the humerus as the forearm and hand turn from palm down (pronation) to palm up supination).

Indications

Your physician may determine that an elbow replacement is appropriate if you have one or more of the following conditions:

1. Bone injury or bone loss contributing to elbow instability
2. Abnormal stiffness, immobility, and consolidation of the elbow joint (ankylosis)
3. Painful deterioration of the elbow joint cartilage (osteoarthritis)
4. Painful inflammation in the lining of the elbow joint (rheumatoid arthritis)
5. Arthritis resulting from physical injury to the elbow joint (traumatic arthritis)
6. Elbow joint instability or loss of motion, which cannot be satisfactorily addressed by more conservative treatment options
7. A previous elbow joint replacement, which has worn or failed.

Total Elbow Replacement Surgery

Painful and unstable elbow joints frequently limit or prohibit successful use of a normal hand in activities of daily living. Semi-constrained elbow replacement is an alternative to elbow fusion.

This surgical procedure is suited for active people who agree not to hammer, use pneumatic tools and try to avoid any activity that might cause a fracture in a normal elbow due to a fall, such as unprotected roller blading or skate boarding.

Candidates are people with severe deterioration due to osteoarthritis, rheumatoid arthritis or the metabolic arthritides in one or both elbows, or in the non-dominant elbows of someone who must perform extreme activities in his or her profession. In the case where one of the arthritic elbows has been previously infected and is not a candidate for joint replacement, the uninfected elbow may be replaced while the only option for the infected elbow is fusion.

Elbow Fusion

A fusion surgery (also called arthrodesis) eliminates pain by making the bones of the joint grow together, or fuse, into one solid bone. Fusions were very common before the invention of artificial joints. Even today, joint fusions are commonly used in many different joints to get rid of the pain of arthritis.

An elbow fusion will greatly decrease the motion in your arm. However, it does leave you with a strong and pain-free elbow. People who need a good range of motion in their elbow should consider another type of operation, such as an elbow joint replacement.

After Surgery

Your elbow will be bandaged with a well-padded dressing and an elbow splint for support. Physical or occupational therapy sessions may be needed for up to three months after surgery. The first few treatment sessions will focus on controlling the pain and swelling from surgery. You will then begin to do exercises that help strengthen and stabilize the muscles around the elbow joint. Your therapist will give you tips on ways to do your activities without straining your elbow.

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