Painful Musculoskeletal Conditions

Frozen shoulder

Frozen shoulder is a common name for adhesive capsulitis, a shoulder condition that limits the range of movement. Frozen shoulders happen when the tough connective tissue surrounding the shoulder joint, called the shoulder joint capsule, becomes thick, stiff, and inflamed. Although many shoulder conditions involve pain and loss of movement, frozen shoulders are more commonly caused by inflammation (swelling, pain, and irritation) in the tissues surrounding the joint

Frozen shoulders are characterized by an initial pain, followed by progressive restriction in the range of motion of both active and passive glenohumeral (GH) joints, with a spontaneous full or near-full recovery occurring over an interval of several months. Imaging studies are not required to diagnose adhesive shoulder capsulitis, but can be useful in ruling out other causes of aching, stiff shoulders.

Physiotherapy is used as an initial treatment for adhesion capsulitis, or frozen shoulder, using range-of-motion (ROM) exercises and manual treatment techniques for shoulder joints to restore range of motion and function. Occasionally, injections of corticosteroids and numbing medications into the joint capsule. Surgical interventions are designed to lengthen or release a contracted joint capsule in the shoulder. Surgical intervention is considered only when no improvement is seen in the level of pain or movement in the shoulder following physical therapy and anti-inflammatory medications.

Image guided therapy involves procedures such as Hydrodilatation which is performed by Dr Darshan Angadi using precise ultrasound guidance. Scientific studies have demonstrated this technique to be very successful in relieving the symptoms of frozen shoulder.

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Rotator cuff damage

Rotator cuff tendinitis – the inflammation of key shoulder tendon tissues is the most common cause of shoulder pain. It is inflammation or irritation of the tendon and muscles of your cuff, which help move the shoulder joint.

While there are many potential causes for shoulder pain, the two most common sources are due to either tear of the rotator cuff, or to tendinitis. Rotator cuff tendonitis develops over time, and may result from multiple activities, ranging from sleeping on the shoulder to playing sports that require a lot of overhead reaching. Rotator cuff tendinitis is commonly seen alongside shoulder impingement, and may appear acutely after a trauma or from chronic, repeated, overuse activities. Rotator cuff tendonitis is an inflammation of these muscles together with an inflammation of a lubrication mechanism called subacromial bursa.

Rotator cuff tendinitis typically develops over time, often from holding the shoulder in one position for long periods of time (such as sleeping on your shoulder each night), from overhead activities related to jobs, or athletic activities like tennis, baseball and cricket
Consultation with an expert is required to arrive at the correct diagnosis of rotator cuff impingement. Treatment usually consists of analgesia, physiotherapy and image guided injection therapy in some patients depending on their symptoms. Injection therapy can be in the form of biological fluids like platelet rich plasma (PRP) or cortisone injections.

However, if symptoms continue to increase then in some patients surgery may be required.

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Disc prolapse of spine

‘Slipped disc’ is a common term for intervertebral disc prolapse (IVDP) or herniated disc. Herniated discs are most common in the lower back (lumbar spine), but they can occur in the neck as well (cervical spine). Disc herniation of the lower back is one of the most common causes of lower back pain associated with leg pain, occurring up to 15 times as frequently as herniation of a cervical disc (neck).

If you have a herniated lumbar disc, you might experience pain radiating out of the lower back region, down one or both legs, and sometimes down to your feet (called sciatica). Herniated discs often cause nerve pain called sciatica, which runs down the length of your sciatic nerve, from the lower back to your legs. Most herniated discs happen in your lumbar spine, where spinal nerves emerge between the lumbar vertebrae, and then reconnect again to form your sciatic nerve, which runs down your legs. A herniated disc in your lumbar spine can result in radiated pain from your nerves to the lower limbs or the groin, and can sometimes be associated with incontinence of your bowel or bladder. If herniation of the disk occurs in the neck, for instance, it may result in pain that radiates to the shoulders and arms.

It is becoming more recognized that back pain caused by herniated discs is not always caused by compression alone on spinal cord or nerve roots, but can be caused by chemical inflammation as well. In some cases, a herniated disk tear can cause neural or spinal cord compression-related pain, or dysfunction, aka myelopathy. Spinal disc herniation can cause pain in the back, pain or sensations in various parts of the body, and physical disability.

Management of disc prolapse begins with structured assessment of your condition, scans to identify the structural issues in the spine followed by progressive treatment to help with pain and other symptoms.

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Arthritis of spine

Degeneration or wear & tear can affect the different joints of the spine. This process can often cause symptoms of stiffness, reduced flexibility, weakness and backache. In some patients if the appropriate intervention is not undertaken then symptoms of chronic or long-lasting fatigue and pain can occur.

Although back pain is a common symptom, it is not experienced by everyone, even people who have advanced spinal arthritis. Back pain starting early in life can be due to chronic inflammatory disease, like rheumatoid arthritis. Inflammatory types of arthritis typically strike people younger than osteoarthritis, and are not common causes of back pain.

Helpful first-line treatment methods include rest, heat and/or cold therapy and physiotherapy. In many cases, medications that reduce pain and inflammation, slow bone loss, or even slow or stop the progression of an inflammatory condition are important parts of back care plans. While there is no cure, treatments may enhance joint function, minimize pain and joint inflammation, and prevent further injury.

Treatment of arthritis in the back depends on a number of factors, including your age, the degree of pain, the type and severity of the arthritis, other health conditions and medications, and your personal health goals. Consultation with an expert is necessary to identify the cause of your back pain and symptoms and start the customised treatment to give best results.

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