Category Archives: Conditions

Signs and Symptoms of Frozen Shoulder

Frozen ShoulderIf you’ve had a “frozen shoulder”, you know this is an extremely painful condition where you are unable to move your shoulder or lift your arm upward or backward, either on your own or with the help of someone else. It’s scary when everyday activities such as sleeping, dressing, washing dishes, combing hair, clasping and unclasping a bra, or reaching for a wallet in a back pocket can become difficult or impossible.

What is a frozen shoulder?

First, to clear up a misconception, frozen shoulder is sometimes confused with arthritis, but the two conditions are unrelated – whereas signs of a rotator cuff tear could be instead a frozen shoulder. Sometimes called “adhesive capsulitis”, a shoulder “freezing” occurs when the shoulder’s joint capsule membrane thickens. This tissue band surrounding the joint becomes stiff and tight and can also grow new adhesions making mobility even more difficult. View OrthoConnecticut’s animation from ViewMedica, which illustrates this process well. Click here.

Why does this happen?

It’s not well understood why the shoulder “freezes”, but these situations make it more likely to happen:

  • Following swelling
  • After an injury or fracture
  • After surgery
  • After shoulder immobilization – note it doesn’t take long for the frozen shoulder process to begin

Who does this most often affect:

  • People 40 years old and older
  • Females more than males – 70% of people with frozen shoulder are women.
  • People with diabetes are more prone to frozen shoulder, but these conditions can also increase the risk: stroke, over or under active thyroid, cardiovascular disease, and Parkinson’s disease

What are the symptoms and stages?

Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years. The stages are fairly typical across patients:

  • Freezing stage (6-9 months):
    • Starts slowly, mild pain worsens over a few months
    • Difficulty sleeping because of the pain
  • Frozen stage (4 to 6 months):
    • Movement restricted, difficulty lifting arm or moving it backwards, pain level even or decreasing
    • A good self-test is to stand in front of a mirror and try to raise both arms in front of you and overhead. You may have difficulty raising the frozen shoulder arm just past parallel to the floor, plus you may find that your shoulder blade rises painfully toward your ear in an unnatural motion.
  • Thawing stage (6 months to 2 years)
    • Movement gets easier or returns to normal, pain may lessen or reoccur periodically

What can you do for a frozen shoulder?

See a physician for a diagnosis which may include a review of symptoms, physical exam of arms and shoulder, and x-ray or MRI to identify structural issues.

For 9 out of 10 patients, time and treatment bring relief.

Here are some options to help reduce pain and improve functionality:

  • Gentle exercises: Harvard Medical School suggests these exercises to reverse stiffness: pendulum stretch, towel stretch, finger walk, cross-body reach, armpit stretch, and strengthening rotator cuff with outward and inward rotation exercises.
  • Wait it out: frozen shoulder will resolve on its own but that can take up to three years, total time.
  • If swollen, alternate between applying hot and cold packs to reduce pain and swelling.
  • Medication: medications to reduce inflammation and can help relieve mild pain.
  • Injections: your orthopedic surgeon may consider corticosteroid injections or nerve blocks.
  • Physical therapy: including TENS electrical nerve stimulation, training and mobility exercises, and manipulation to unfreeze the adhesions and stretch the shoulder capsule.
  • Arthroscopic Surgery: if advised by your orthopedic surgeon:
    • Gentle shoulder manipulation under general anesthetic.
    • Shoulder arthroscopy to remove any scar tissue or adhesions.

Here is an interesting takeaway from OrthoInfo that reviews some of the basics of a frozen shoulder. Click here.

OrthoConnecticut Can Help
Our physicians and physician assistants are available to help you if you’re experiencing frozen shoulder or other mobility issues. Contact us today for a telemedicine or in person appointment and #getmovingCT.

Text Neck, It’s a Real Thing!

Man experiencing Text Neck discomfort

Neck Pain? Texting too much at the wrong angle (15 to 60 degrees forward) for too long can lead to “Text Neck”.

Also called “Tech Neck”, it’s a real, modern-age issue of neck muscle pain, headaches, and potentially “dowagers” hump. Less common symptoms are numbness, weakness, balance issues, and jaw pain.

Adults have it. Children are now developing it, and worse still, it may impact how young bodies’ grow and develop – leading to prolonged neck, shoulder, curving of the spine, and low-back issues.

Holding phones and mobile devices at different angles is linked to pounds of downward pressure exerted on the neck. Studies have shown how holding the phone at different angles varies this pressure:

  • 0-degree angle (looking straight ahead) = 10-12 lbs. pressure
  • 15-degree angle = 27 lbs. pressure
  • 30-degree angle = 40 lbs. pressure
  • 45 degrees angle = 49 lbs. pressure
  • 60 degrees angle = 60 lbs. pressure

So, what can we do to prevent pain and inflammation associated with texting, or treat it if you already have it?

  • Use good posture: hold your phone at eye level and sit up straight
  • Take breaks and stretch your neck periodically by tilting your ear toward your shoulder and then arching the neck and upper back to lengthen and ease muscle pain
  • Exercise and stretch your neck as part of your overall exercise routine to increase neck strength and flexibility
  • Seek treatments such as joint mobilization, posture correction exercises, taping, braces, massage, posture reeducation, and pain creams. Yoga can be helpful also.
  • Consider calling instead of texting!

OrthoConnecticut Can Help
Our physicians and physician assistants are available to help you if you’re experiencing text neck or other spinal issues. Contact us today for an appointment and #getmovingCT.

Nine tips to help with Osteoarthritis

Arthritic seniors hands cutting flowers

If you’re middle-aged or older, it’s likely you have some Osteoarthritis in your hands, fingers, hips, knees, feet or spine. The most common form of arthritis, Osteoarthritis occurs when cartilage between joints and bone gradually wears away causing joint swelling, pain, stiffness, deformity, and reduced range of motion. Most often X-rays are used to diagnose and assess the amount of joint loss, or other issues that can occur like thinning bone, reduced joint space, joint fluid, or bone spurs. If you have osteoarthritis, here are some options your Orthopedist might recommend.

If you’re in pain, seek treatment and get help!

Nonsurgical treatment for joint mobility, strength and pain relief can include:

  • Lifestyle changes
    • Lose weight to reduce joint stress
    • Rest and ice when swollen
    • Include low-impact exercise such as stretching, walking, water exercise, swimming, muscle strengthening and cycling to help strengthen your muscles, joints and keep you active.
  • Medications to ease pain and swelling
    • Use oral NSAIDs (non-steroidal anti-inflammatory drugs)
    • Use corticosteroid or hyaluronan injections in the joint to provide pain relief and cushioning.
  • Walking aids as needed
    • Use supportive/assistive devices – braces, splint, elastic bandage, cane, crutches, or walker.
  • Physical therapy
    • Improve balance, flexibility, range of motion, reduce pain and strengthen the muscles supporting the joints.

OrthoConnecticut recommends you consult your orthopedist surgeon for advice on surgical options, which might include:

  • Arthroscopy
    • In some cases, can temporarily improve pain
  • Osteotomy
    • To realign and reduce joint pressure
  • Joint fusion
    • To fuse bones together and eliminate joint flexibility
  • Partial or complete joint replacement / arthroplasty
    • Resurfaces the arthritic bones with manmade components to eliminate the arthritis and substantially reduce or even eliminate pain.

OrthoConnecticut Can Help

Our physicians and physician assistants are available to diagnose and advise you on the best ways to treat your Osteoarthritis,. Contact us today for an appointment and #getmovingCT.

What You Should Know – Running Right to Avoid Common Injuries

By Ross Henshaw, M.D., Sports Medicine Specialist, OrthoConnecticut

RUNNING-1024x576Running is a wonderfully efficient way to improve your health, except when it produces chronic injuries. The best way to safely enjoy a running program is to gradually build the intensity of your workouts.

WHAT THE PROS SAY

Typically, a running coach or trainer will recommend increasing distances no more than 10 percent a week. If you have an underlying health condition or are new to exercise, make your first step a consultation with your physician. If you have a history of orthopedic injury or joint pain, seek the advice of an orthopedic surgeon.

THE TOP FIVE COMPLAINTS

Hip Bursitis – This is an overuse injury caused by friction between the iliotibial tendon band and the hip bone. This large tendon travels over the bony prominence on the outside of the hip, goes all the way down to the leg and attaches just below the outer side of the knee. When we run, this band rubs back and forth over the outer hip bone; over time the friction creates inflammation. Our bodies have natural “cushions” called “bursa” that are designed to reduce this friction, but if they have not had time to adapt they can swell and hurt, causing pain in the front of the knee. This condition is common among runners.

Kneecap Pain and Patella Tendonitis – This results in pain in front of the knee and is common among runners. The quadriceps muscle in the front of the thigh powers our ability to straighten the knee. It works by using the kneecap or “patella” for leverage across the knee. This generates pressure and can cause the kneecap to become sore. The quadriceps muscle tapers to become a tendon that attaches to the kneecap and then to the shin bone (tibia) via the patella tendon. When strained, the quadriceps and patella tendons can also develop micro tears and become inflamed. Treatment includes rest, anti-inflammatories, strengthening exercises, cross training and progressing back to running while avoiding hills.

Shin Splints – This can occur on one or both shins, but most commonly on the dominant leg. This condition is caused by inflammation where the Soleus muscle in the calf attaches to the tibia. As the muscle helps runners with “pushing off,” it pulls on the attachment site, which may become inflamed and swollen. This pain usually hurts only when running. Treatment for this overuse is rest and cross training.

Achilles Tendonitis – The strong Achilles tendon is prone to inflammation when starting a running program. Our calf muscle tapers off to become the Achilles tendon that inserts into the heel and powers the push-off of the running stride. Running uphill demands more stretch from the calf, forcing it to work harder. This can lead to micro tears of the small Achilles fibers.

Micro tears do not become full tendon ruptures, but cause inflammation and swelling as the body tries to repair and regenerate the area. The usual treatment is rest, stretching, strengthening, cross-training and as the pain dissipates, a gradual return to running with limited hills.

Plantar Fasciitis – The most common early symptom of this comes with morning’s first step. The plantar fascia is a tight band of tissue that supports the foot arch. It attaches to the heel and traverses across the sole, attaching broadly across the end of the foot.

When we run, the plantar fascia can become overstressed at the smaller attachment on the heel, especially in individuals with tight calf muscles. Initially, inflammation starts after the run and hurts upon standing after a period of inactivity. When the foot and ankle bend to stand flat, the fascia stretches and hurts. The best treatment is to recognize it early and rest.

PAIN IS A WARNING!

Most of us can enjoy running without ever suffering from these common maladies. My best advice is to cross train and to recognize symptoms early and not ignore the pain. If you pay attention to symptoms, you can help avoid painful injuries and stay active.

About OrthoConnecticut
OrthoConnecticut is the region’s premier, multi-specialty orthopedic and pain management practice. Thirty-one fellowship- trained, board-certified physicians offer patient care at nine offices in Danbury, Darien, New Canaan, New Milford, Norwalk, Ridgefield, Sharon, Southbury and Westport. The practice’s urgent care service, OrthoCare Express, is open 7 days a week for emergencies and is available in Danbury, Darien, Norwalk and Westport. To make an appointment with Dr Henshaw, or to learn more about OrthoCare Express, please visit http://www.myorthoct.com/, or call 1.833.ORTHOCT (1.833.678.4628).

Download article as pdf:
pdf(English) Running Right to Avoid Common Injuries
pdf(Español) Correr Correctamente para Evitar Lesiones Comunes
pdf(Português) Correr Corretamente para Evitar Lesões Comuns

Tennis Elbow

By Paul D. Protomastro, M.D.
Hand & Upper Extremity Surgeon, OrthoConnecticut

Mixed race Woman Playing TennisTENNIS AND GOLFER’S elbow are common orthopaedic conditions that lead to pain, weakness and disfunction of the elbow. Both conditions actually represent tears of the forearm tendons off of the humerus bone at the elbow. A tear on the outside (lateral) part of the elbow is known as Tennis elbow. A tear on the inside is known as golfer’s elbow. The muscles involved in this condition help to extend (tennis) and flex (golfer’s) the wrist. With both disorders there is degeneration of the tendon attachment usually following repetitive grasp or lifting activities and subsequent weakening of the anchor site leading to tendon detachment. Patients usually experience the insidious onset of elbow pain associated with activities in which this muscle is active, such as lifting, gripping, and/or grasping. Sports such as tennis, golf and weight training are common causes. The problem can occur with many different types of activities such as home renovation and gardening.

A direct blow to the bony prominence of the elbow may result in an acute tear or swelling of the tendon that can lead to degeneration. A sudden extreme action, force, or activity, such as starting a lawn mower, can also injure the tendon. The most common age group that this condition affects is between 30 to 50 years old. It affects both men and women with equal frequency. Pain is the primary reason for patients to seek medical evaluation. With tennis elbow the pain is located over the outside aspect of the elbow, over the bone region known as the lateral epicondyle, and is exacerbated by overhand lifting or power grip activities. With golfer’s elbow the pain is on the inside part of the elbow (medial epicondyle) and exacerbated by resisted wrist flexing or underhand lifting. The bone and tendon insertion often becomes tender to touch. Pain is also produced by any activity which places stress on the tendon, such as gripping or lifting. With activity, the pain usually starts at the elbow and may travel down the forearm to the hand. Occasionally, any motion of the elbow can be painful.


The bone and tendon insertion often becomes tender to touch. Pain is also produced by any activity which places stress on the tendon, such as gripping or lifting. With activity, the pain usually starts at the elbow and may travel down the forearm to the hand.

There are several theories as to why the elbow is so prone to these tendon injuries. Firstly, these tendons are taut and under great stress with repetitive wrist and hand activity. Secondly, the tendon origin is very small relative to the muscles that attach to them which leads to high forces on a tiny insertion site. Thirdly, these tendons have a very poor blood supply and take a long time to heal. All these factors result in prolonged pain and dysfunction in most cases. On average a case of tennis or golfer’s elbow takes 12-18 months to fully heal. On rare occasions people can be pain free and return to their sports, work or hobbies in 2-3 months.

TENNIS ELBOW TREATMENT OPTIONS

Activity modification
Initially, the activity causing the condition should be limited. Limiting the aggravating activity, not total rest, is recommended. Modifying grips or techniques, such as use of a different size racket and/or use of 2-handed backhands in tennis, may relieve the problem.

Medication
Anti-inflammatory medications may help alleviate the pain temporarily to make the tendon tear heal.

Bracing
A tennis elbow brace, a band worn over the muscle of the forearm, just below the elbow, can reduce the tension on the tendon and decrease pain while using the arm and possibly allowing the tendon to heal.

Occupational Therapy
May be helpful, providing stretching and/or strengthening exercises. Ultrasound, lasers, deep friction massage and heat treatments may be helpful by increasing blood flow and decreasing pain.

Steroid injections
A steroid is a strong anti-inflammatory medication that can be injected into the area. These injections have been shown to temporarily decrease the pain of elbow tendonitis but do not help the tear heal. In fact, steroids may further harm the tendon and lead to chronic tendon damage. No more than (3) injections should be given.

Surgery
Surgery is considered when the pain is incapacitating, has not responded to conservative care, and symptoms have lasted more than six months. Surgery involves removing the diseased, degenerated tendon tissue and then repairing healthy tendon back to the humerus bone. This 15-20 minute procedure is performed in the outpatient setting under sedation and local anesthesia.  Recovery from surgery requires physical therapy to first regain motion of the arm and then a strengthening program after 6 weeks. Most patients can return to usual activities by 3-4 months. Complete recovery, including a return to tennis, golf and high impact/repetition work, can be expected to take 4–6 months. The success rate of this surgery is over 90%.

Running Right – to Avoid Common Injuries

Story by Ross Henshaw, MD, Sports Medicine Specialist, Danbury Orthopedics

family runnersDANBURY, CT – As any runner will tell you, this simple sport is one of the most rewarding and convenient exercise activities. It’s a wonderfully efficient way to improve your health, except when it produces chronic, nagging injuries. So what’s the best way to safely enjoy a running program? Start smart, with a progressive training schedule that gradually builds the intensity and duration of your workouts.

What the Pros Say

Typically, a running coach or trainer will recommend increasing distances no more than 10% a week. If you have never been a runner, seek advice from friends, trainers or your local athletic store. There are also great resources online and in print. But if you have an underlying health condition or are new to exercise, make your first step a consultation with your physician to be sure it’s OK to start running. Orthopedically, running is a safe exercise for most people but there are exceptions, even among athletes. So if you have a history of orthopedic injury or joint pains, particularly those involving the legs or spine, seek the advice of an orthopedic surgeon.

While any form of exercise can cause or aggravate a preexisting injury, endurance sports generate typical injury patterns. Endurance sports by definition involve prolonged repetitive motion. While a soccer player may run 3-7 miles in a game, depending on position, he or she is rarely only running straight ahead at the same speed. But runners go straight ahead at a maintained speed, which means your hip, knee, ankle and arm motions are roughly the same for the duration of the exercise. Hills change the degree of motion and add more jarring forces.

The longer the duration and hillier the terrain, the more our joints are cycling and the more our tendons and ligaments are pulling and rubbing around our joints. When we start an endurance sport like running and build up too quickly, the abrupt increase in joint motion can lead to ‘overuse’ injuries.

The Top 5 Complaints

In my practice, the most common running injuries are hip bursitis, kneecap pain, shin splints, Achilles tendonitis and plantar fasciitis. Here’s a quick anatomy lesson:

Hip Bursitis – ‘Trochanteric Bursitis’ is an overuse injury caused by friction between the illiotibial tendon band and the hip bone. This large tendon travels over the bony prominence on the outside of the hip, goes all the way down to the leg and attaches just below the outer side of the knee. When we run, this band rubs back and forth over the outer hip bone; over time the friction creates inflammation. Our bodies have natural ‘cushions’ called ‘bursa’ that are designed to reduced this friction, but if they have not had time to adapt they can swell and hurt. (A related injury is ITB syndrome.)

Kneecap pain and Patella Tendonitis – Often grouped as ‘anterior knee pain’, this refers to pain in the front of the knee and is common among runners. The quadriceps muscle in the front of the thigh powers our ability to straighten the knee. It works by using the kneecap or ‘patella’ for leverage across the knee. This generates pressure and can cause the kneecap to become sore. It’s especially evident when people walk down stairs or inclines and is precipitated by excessive downhill running. The quadriceps muscle tapers to become a tendon that attaches to the kneecap and then to the shin bone (tibia) via the patella tendon. When strained, the quadriceps and patella tendons can also develop micro tears and become inflamed. Treatment includes rest, anti-inflammatories, strengthening exercises, cross training and progressing back to running while avoiding hills.

Shin Splints – Shin splints, or ‘posteromedial tibial stress syndrome’, can occur on one or both shins, but most commonly on the dominant leg depending on your stride. Pain originates at the lower third of the inner part of the shin just behind the bone. The pain is usually discrete and easily reproduced by pressing on the trigger point. This condition is caused by inflammation where the Soleus muscle in the calf attaches to the tibia. As the muscle helps runners with ‘pushing off’ it pulls on the attachment site, which may become inflamed and swollen. This pain usually hurts only when running, early or later in a run. Some people try to run through the pain, which worsens it so that even walking becomes painful. Treatment for this overuse is rest and cross training. Some people may be predisposed to shin splints because of running style or leg, ankle or foot alignment.

Achilles Tendonitis – The strong Achilles tendon is prone to inflammation when starting a running program, particularly on hilly terrain. Our calf muscle tapers off to become the Achilles tendon that inserts into the heel and powers the push-off of the running stride. Running uphill demands more stretch from the calf, forcing it to work harder. This can lead to micro tears of the small Achilles fibers. Micro tears do not become full tendon ruptures, but cause inflammation and swelling as the body tries to repair and regenerate the area. The usual treatment for this pain is rest, stretching, strengthening, cross-training and as the pain dissipates, a gradual return to running with limited hills.

Plantar Fasciitis – Dreaded heal pain! Its most common early symptom comes not with running, but with the morning’s first step. The plantar fascia is a tight band of tissue that supports the foot arch. It attaches to the heel and traverses across the sole, attaching broadly across the end of the foot. When we run the plantar fascia can become overstressed at the smaller attachment on the heel, especially in individuals with tight calf muscles. Initially, inflammation starts after the run and hurts upon standing after a period of inactivity. When the foot and ankle bend to stand flat, the fascia stretches and hurts. Best treatment is to recognize it early and rest, cross train and take an anti-inflammatory. More severe cases may require calf stretching, night splints that keep the plantar fascia stretched, and heel pads.

Pain is a warning!

While it sounds like a lot can go wrong, most of us can enjoy running without ever suffering from these common maladies. As a sports medicine specialist, my best advice is to recognize symptoms early and not ignore the pain. Early recognition and treatment generally lead to a quicker recovery. I also recommend cross training. Even if you prefer running as your primary aerobic exercise, you’ll benefit by incorporating other forms of conditioning such as biking, elliptical or swimming into your routine. If you pay attention to symptoms and mix it up, you can help avoid painful injuries due to repetitive overuse of the joints … and stay active.

Accidents happen

Should an unexpected injury occur, runners in the region can access the orthopedic urgent care service offered at Danbury Orthopedics. OrthoCare Express, the walk-in, orthopedic emergency treatment center, is open 7 days a week in the heart of downtown Danbury, CT at 226 White Street. The Center is staffed by fellowship trained orthopedic surgeons and highly trained Physician Assistants, and is open weekdays from 8 am – 8 pm, and on weekends from 10 am – 3 pm. No appointment is necessary and no referral is required. Visit orthocareexpress.com or call 203.702.6675 for more information.