Living in Pain? You Don’t Have To
How to deal with common orthopedic injuriesBy Angela Bickford
The human body has 206 bones and even more ligaments, joints, muscles, and tendons. Is there any question why we find ourselves in pain at some point in our lives? According to the American Academy of Orthopaedic Surgeons, one in four Americans has a musculoskeletal impairment. The AAOS defines musculoskeletal conditions as those that include injuries to the bones, joints, muscles, ligaments, or tendons, and conditions such as arthritis or osteoporosis, and reports that symptoms of these injuries are one of the most common reasons for physician visits. Following are some common ailments, their symptoms, and ways to treat them.
The Everyday Conditions
•Carpal tunnel syndrome is a condition that affects the hand and wrist, and occurs in 10 percent of the population. It typically starts with a dull ache in the wrist that extends to your hand or arm, leading to tingling or numbness and a sense of weakness in your hands. Most people think this condition is caused by long hours at the keyboard, but there are actually numerous causes.
Carpal tunnel syndrome is caused by pressure on the median nerve, the main nerve to your hand, which is protected by the carpal tunnel, a narrow passageway located in your wrist. Pressure can be due to repetitive use or injury or other health conditions such as diabetes, thyroid disorders or menopause.
The National Institute of Neurological Disorders and Stroke reports that women are three times as likely as men to develop carpal tunnel syndrome. Fortunately, proper treatment usually relieves the pain and helps restore normal use of the hand and wrist. Treatment involves an assessment by a doctor, diagnostic tests, such as an electromyogram, which measures the tiny electrical discharges produced in the muscles, medications to help with the discomfort, and frequent breaks to rest the hands. Surgery is usually performed on patients with severe pain lasting longer than six months and when other treatment options are unsuccessful.
•Sprains and strains are common and can occur during everyday activities. A sprain is defined by the American College of Sports Medicine as an injury to a joint ligament, strong bands of tissue that connect bones to each other at the joint, and is normally accompanied by pain, swelling, bruising, and limited movement. A strain is damage to muscle fibers that attach the muscle to the bone, and is often accompanied by pain, swelling, muscle spasms, and limited movement. The ACSM suggests following the PRICE principle, which limits the amount of swelling and improves the healing process.
P – protect from further injury
R – restrict activity
I – apply ice
C – apply compression
E – evaluate the injured area
•The AAOS reports that back injuries are the most prevalent musculoskeletal impairments. People in their 30s through 50s are at the greatest risk of suffering from one particular back injury, a herniated disk. This condition occurs when disks, which act as soft cushions between the bones of the spine, begin to flatten and become less flexible. The outer part of the disk can tear, causing the inner part to press on the nerves. This causes almost constant pain—when you move, sit and bend—with sharp pain in your back or down your legs.
Non-surgical treatment of herniated disks treats more than 90 percent of patients, and includes bed-rest for a few days, anti-inflammatory drugs or corticosteroid injections, and leaves most people feeling better in about a month. However, sometimes surgery is needed, and the most common surgery for a herniated disk is a microdiskectomy. MayoClinic.com defines this as a spinal surgery that involves accessing the herniated disks and then moving the back muscles away from the spine as much as possible.
Not Just for Athletes
Due to the high-impact and fast-paced nature of most sports, injuries are common among athletes. Surprisingly though, the number of athletes affected is low compared to the general population.
•Tennis elbow, as defined by WebMD, is a condition caused by the overuse of the arm and forearm muscles that results in elbow pain. You don’t have to play tennis to get this condition, but it often affects more than 50 percent of players, and is likely the best known sports overuse injury. In reality, however, only about 2 percent of cases are actually sports related. Symptoms include pain around the elbow that can become worse with shaking or squeezing objects. Surgery is not a common treatment for this condition, and most people are treated successfully with rest, avoiding activities that cause pain, applying ice, and taking anti-inflammatory drugs.
•According to the AAOS, rotator cuff injuries are actually more frequently caused by degeneration of the tendon, rather than injury from sports or trauma. The shoulder can move and turn with a greater range of motion than any other joint in the body, and this flexibility can come at a price. Symptoms include shoulder pain during movement and tenderness or weakness. Even combing your hair can be painful. The most common surgery used is an arthroscopic repair, which uses of a small optical instrument that allows the surgeon to examine and fix the injured joint. Arthroscopy is also commonly used to diagnose and treat knee, shoulder, elbow, wrist, hip, and ankle injuries because it is minimally invasive and has a faster recovery time.
•Achilles tendonitis is considered a common condition by the AAOS, but one that remains a complex and difficult orthopedic challenge. It occurs when the Achilles tendon, located in the heel and noted as the strongest tendon in the body, becomes inflamed or irritated. Treatment usually involves over-the-counter medicine to reduce pain and inflammation, but a new treatment has also been proven to be effective. The AAOS recently put out a report on the effectiveness of PRP, or platelet-rich plasma, stating that PRP had clinical success in 93 percent of the patients studied. PRP injections deliver concentrated bioactive blood components rich in cytokines and growth factors directly to the site, which helps to relieve the area by stimulating gradual repair.
•Knee replacement surgery is one of the more commonly performed joint replacement surgeries. There are many reasons why the knee joint, the largest joint in the body, can wear out. Knee pain can be the result of certain injuries, such as an ACL (anterior cruciate ligament) tear, or certain medical conditions, such as arthritis.
According to MayoClinic.com, the Lachman test helps detect ACL injuries, which are most commonly caused when the knee joint is bent backward, twisted or bent to the side. In this test, the knee is bent at a 30-degree angle and then gently moved forward at the lower leg to see the range of motion. According to The American Orthopaedic Society for Sports Medicine, when surgery is needed, the results can be promising: 15 years after ACL knee reconstruction, 84 percent of male patients are still highly active.
Older, Wiser and in More Pain?
Older adults are more prone to certain ailments, such as arthritis and osteoporosis. In fact, according to the AAOS, arthritis is the leading chronic condition reported by the elderly, and the most common reason for joint replacement is pain and decreased quality of life from osteoarthritis. The tendency towards these ailments also leads to other, more serious conditions.
One of the more serious orthopedic injuries that can occur is a fracture of the socket part of the pelvic bone, called the acetabulum. In these cases, surgery is the more common treatment. Advances in surgical techniques, such as minimally invasive methods and use of computer-assisted surgical systems such as the ones Stryker makes (Stryker.com), aim to reduce post-operative pain, shorten recovery time, and improve surgical accuracy. Patients typically do better if the surgery is performed soon after the fracture occurs.
Joint Replacement Surgery and the Importance of Physical Therapy
Joint replacement surgery, a common treatment for many of the conditions mentioned, usually involves replacing a damaged joint with a prosthesis, which can last 10 to 15 years. However, operations often come with risks, and the most common complications for joint replacement are loosening of the new joints and infection. Keeping in touch with your doctor about how you are feeling is key, and physical therapy plays an important role in helping patients return to everyday activities.