Fibromyalgia
Fibromyalgia is a chronic disorder characterized by widespread body pain and tenderness of the joints, muscles, tendons and other soft tissues. Fibromyalgia may also be associated with fatigue, headaches, difficulty sleeping, depression, and anxiety.
Causes
The cause of fibromyalgia is not known, but certain factors such as sleep disorders, physical or emotional trauma, viral infection, and abnormal pain perception may trigger fibromyalgia.
Middle-aged women are at an increased risk of developing fibromyalgia. Several other conditions such as chronic neck or back pain, chronic fatigue syndrome, Lyme disease, hypothyroidism, sleep and depressive disorders mimic the symptoms of fibromyalgia and may coexist with it.
Symptoms
The predominant symptom of fibromyalgia is generalized body pain. The intensity of pain may vary from mild to severe. Tender points, localized painful areas in the neck, shoulders, back, hips, arms or legs, are present. The pain may either be continuous or there may be a diurnal variation in pain, with an aggravation of the pain during the night. The pain may either be aching in nature or a shooting, burning pain that may increase with stress, anxiety, physical activity and cold or damp weather. Most people with fibromyalgia also experience fatigue, depression, and sleep disorders where they wake up with a feeling of tiredness despite long periods of sleep.
People with fibromyalgia may also have other associated symptoms such as irritable bowel syndrome (IBS), headache, memory and concentration disorder, numbness and tingling sensation in the hands and feet, irregular heartbeat, and decreased ability to exercise.
Diagnosis
The diagnostic criteria for fibromyalgia includes:
- Widespread pain lasting for at least three months
- Pain in at least 11 of the 18 tender points including elbows, buttocks, chest, knees, shoulders, lower back, neck, rib cage, and thighs.
Blood and urine tests may be recommended to rule out other conditions with similar symptoms.
Treatment
The treatment for fibromyalgia is aimed at resolution of the symptoms and helping the patient to cope with these symptoms. The treatment options for fibromyalgia include physical therapy, fitness and exercise program, stress relief techniques, and medications. Several medications such as antidepressants, muscle relaxants, anticonvulsants (anti-seizure), and pain killers can be prescribed to patients. These medications provide symptomatic relief from pain and also improve their quality of sleep.
Cognitive behavioral therapy (CBT) is an important aspect of fibromyalgia treatment and helps in modification of an individual’s response to pain. Support groups may be also helpful in managing fibromyalgia. A well-balanced diet, abstinence from caffeine, a regular sleep pattern, and acupuncture therapies may also relieve fibromyalgia symptoms.
Tennis Elbow
Tennis elbow is the common name used for the elbow condition called lateral epicondylitis. It is an overuse injury that causes inflammation of the tendons that attach to the bony prominence on the outside of the elbow (lateral epicondyle). It is a painful condition occurring from repeated muscle contractions at the forearm that leads to inflammation and micro tears in the tendons that attach to the lateral epicondyle. The condition is more common in sports activities such as tennis, painting, hammering, typing, gardening and playing musical instruments. Patients with tennis elbow experience elbow pain or burning that gradually worsens and a weakened grip
Your doctor will evaluate tennis elbow by reviewing your medical history, performing a thorough physical examination and ordering X-rays, MRI or electromyogram (EMG) to detect any nerve compression.
Your doctor will first recommend conservative treatment options to treat the tennis elbow symptoms. These may include:
- Limit use and rest the arm from activities that worsen symptoms.
- Splints or braces may be ordered to decrease stress on the injured tissues.
- Apply ice packs on the elbow to reduce swelling.
- Avoid activities that bring on the symptoms and increase stress on the tendons.
- Anti-inflammatory medications and/or steroid injections may be ordered to treat pain and swelling.
- Physical therapy may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased.
- Pulsed ultrasound may be utilized to increase blood flow and promote healing to the injured tendons.
If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend a surgical procedure to treat tennis elbow called lateral epicondyle release surgery. Your surgeon will decide whether to perform your surgery in the traditional open manner (single large incision) or endoscopically (2 to 3 tiny incisions and the use of an endoscope –narrow lighted tube with a camera). Your surgeon will decide which options are best for you depending on your specific circumstances.
Your surgeon moves aside soft tissue to view the extensor tendon and its attachment on the lateral epicondyle. The surgeon then trims the tendon or releases the tendon and then reattaches it to the bone. Any scar tissue present will be removed as well as any bone spurs. After the surgery is completed, the incision(s) are closed by suturing or by tape.
Following surgery, you are referred to physical therapy to improve the range of motion and strength of your joint.
Types of Systemic Sclerosis
Systemic sclerosis can be classified based on the location and involvement of internal organs into two types:
- Localized Systemic Sclerosis
- Systemic Sclerosis
Localized systemic sclerosis involves skin changes in isolated areas, either as morphea patches or linear systemic sclerosis. Morphea is localized patchy areas of skin that become hard and slightly pigmented and can sometimes cause multiple lesions on the skin. Linear Systemic Sclerosis is more common in children and features bands of hardened skin localized usually to the arm or leg on one side of the body. Localized systemic sclerosis is the milder form of the disease and will not progress to Systemic Sclerosis, a more severe form.
Systemic sclerosis affects connective tissues of the skin and also that of the internal organs such as the heart, lungs, kidneys and digestive tract. The tissues of the affected organs may become hard and fibrous decreasing their efficiency. Systemic sclerosis is also further categorized as limited or diffuse:
- Limited disease: This is a slower and more benign illness, typically confined to the fingers, hands, and face. It is also referred to as CREST syndrome which stands for Calcinosis, Raynaud phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia.
- Diffuse disease: This type presents with rapid skin thickening progressing to skin hardening and a high risk of developing fibrous hardening of the internal organs including the lungs, heart, bowels, esophagus and kidneys. Diffuse disease is a very serious form and can ultimately be fatal.
Causes and Risk Factors
The cause of systemic sclerosis is unknown.
Research studies indicate certain inherited genes may be responsible along with exposure to environmental factors such as silica dust and paint thinners or exposure to certain viruses. It is known that people with systemic sclerosis develop extra collagen in the skin and organs which leads to the symptoms associated with the disease.
Symptoms
The symptoms depend upon the type of systemic sclerosis and which organs are affected such as the skin, heart, lungs, kidneys, and digestive tract. Commonly seen symptoms of systemic sclerosis include:
- Thick, tight skin on the fingers
- Sores (ulcers) on the fingertips or toes
- Hair loss
- Red spots on the hands and face
- Pain, stiffness, and swelling of the fingers and joints
- Calcium deposits in connective tissues
- Joint pain
- Raynaud’s phenomenon i.e. narrowing of blood vessels in the hands or feet
- Swelling of the esophagus, the tube between your throat and stomach
- Constipation or diarrhea
- Shortness of breath
- Dry cough and wheezing
Diagnosis
Systemic sclerosis may be diagnosed through the following tests:
- Blood tests: To assess elevated levels of certain antibodies produced by the immune system
- Tissue sample: A biopsy of the affected skin is taken for examination in the laboratory
- Skin assessment: This involves a thorough evaluation of the skin to assess for clues of involvement of the internal organs.
Depending upon the condition of the patient and the results of the initial evaluation the doctor may recommend further specific diagnostic tests. These tests may include chest X-rays, lung-function test, CAT scan of the lungs, EKG and echocardiograms.
Treatment
There is no cure for systemic sclerosis but rather symptoms are controlled through medications such as immunosuppressants, corticosteroids, vasodilators, and blood pressure medications.
The skin lesions associated with systemic sclerosis can be camouflaged through cosmetic procedures such as exposure to ultraviolet light or laser surgery.
Physical or occupational therapy may be recommended to manage pain and to improve your strength and mobility.
In some cases, such as finger ulcers in severe Raynaud’s disease, surgical amputation may be recommended. Similarly, patients with severe pulmonary hypertension may require lung transplants.
Patients with a mild form of systemic sclerosis may not require any treatment.
Complications
Possible complications related to systemic sclerosis are as follows:
- Heart failure
- Pulmonary hypertension
- Cancer
- Kidney failure from elevated blood pressure
- Esophageal stricture
- Malabsorption of food nutrients
- Pulmonary Fibrosis (scarring of the lungs)
Rotator Cuff Tendonitis
Rotator cuff is the group of tendons in the shoulder joint providing support and enabling wider range of motion. Major injury to these tendons may result in tear of these tendons and the condition is called as rotator cuff tear. It is one of the most common causes of shoulder pain in middle aged adults and older individuals.
Causes
Rotator cuff tear results from pressure on the rotator cuff from part of the shoulder blade (scapula) as the arm is lifted. It may occur with repeated use of arm for overhead activities, while playing sports or during motor accidents.
Symptoms
Rotator cuff tear causes severe pain, weakness of the arm, and crackling sensation on moving shoulder in certain positions. There may be stiffness, swelling, loss of movements, and tenderness in the front of the shoulder.
Diagnosis
Your surgeon diagnoses rotator cuff tear based on the physical examination, X-rays, and imaging studies, such as MRI. Rotator cuff tear is best viewed on magnetic resonance imaging.
Conservative treatment options
- Rest
- Shoulder sling
- Pain medication Injection of a steroid (cortisone) and a Local anesthetic in the subacromial space of the affected shoulder to help decrease the inflammation and pain
- Certain Exercises
Surgery
Rotator cuff repair may be performed by open surgery or arthroscopic procedure. In arthroscopy procedure space for rotator cuff tendons will be increased and the cuff tear is repaired using suture anchors. These anchor sutures help in attaching the tendons to the shoulder bone. Following the surgery, you may be advised to practice motion and strengthening exercises.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.
Symptoms
Common symptoms of carpal tunnel syndrome include numbness and tingling sensation in all the fingers except little finger; pain and burning sensation in hand and wrist that may radiate up the arm and elbow; and weakness in hand with diminished grip strength.
Causes
Exact causes of the condition are not known. However certain factors increase the risk of developing carpal tunnel syndrome and they include congenital abnormalities, repetitive motion of hand and wrists, fractures and sprains, hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumor in the canal.
Conservative Treatment Options
Carpal tunnel syndrome may be treated using conservative approaches or surgery. The conservative treatments include:
- Treating underlying medical conditions
- Immobilization of the hand and wrist with a splint or wrist brace for 4-6 weeks
- Rest the hand for 2 weeks or more
- Ice packs to avoid swelling
- Avoid activities that tend to worsen the symptoms
- Medications such as non-steroidal anti-inflammatory drugs and steroid injections
- Strengthening and stretching exercises once symptoms diminish
Surgery
If conservative treatment options fail to resolve the condition your surgeon may recommend surgical procedure.
Carpal Tunnel Release Surgery
Carpal tunnel syndrome can be treated with carpal tunnel release surgery. Traditional surgery involves up to a 2- inch incision in the palm and wrist area, whereas endoscopic surgery involves one or two half-an-inch incisions and the use of an endoscope. During the surgery, the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. Your surgeon will decide which options are best for you based on your general and medical conditions.
Post-Operative Care
Your surgeon may suggest you practice certain post-operative procedures for better recovery and to avoid further complications.
- Elevate the hand above heart level to reduce swelling.
- A splint may be worn
- Ice packs to the surgical area to reduce swelling.
- Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
- Physical therapy may be ordered to restore wrist strength.
- Eating a healthy diet and not smoking will promote healing
Risks and Complications
Most patients suffer no complications following carpal tunnel release surgery. However, some patients may suffer from pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.
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