SHOULDER (PAIN AROUND THE SHOULDER)

Pain around the shoulder is a common problem especially after the age of 40. Males and females both are affected. Diabetics are more commonly affected with this than the general population. Inflammation of tendons around the shoulder is the commonest out of all. The painful site may be at the front or at the side. Range of shoulder movement in a certain direction may be restricted or you may find it difficult to raise the arm above a certain limit. in some the pain eases off after the arm passes a certain point.

In certain individuals, shoulder movements in many directions get restricted when the joint capsule get thick and non-stretchable (frozen shoulder).

Milder forms of the condition can be treated with medication, analgesic gels and physiotherapy. Some will benefit from cortisone injections and physiotherapy. More severe ones with long standing restricted movements will benefit from manipulation of the joint under a general anaesthetic to regain range of movement followed by aggressive physiotherapy to achieve a reasonable range of movement. Arthroscopic (key hole surgery) care for the joint will be needed in cases when these measures fail.

PAIN AT THE OUTER SIDE OF ELBOW

This condition is traditionally named tennis elbow and more technically termed lateral epicondylitis. Swelling and inflammation over the origin of outer group of muscles of the forearm from the outer side of the elbow causes this problem. It could affect both arms

Medication, local application of analgesic gels, infrared waves, massage and elbow bands are found to be helpful. Cortisone injection will help in some patients. The most resistant ones need surgical debridement of the site followed by rehabilitation for recovery.

PAIN OVER BACK OF THE ELBOW

This condition is traditionally named student’s elbow. It starts with long standing rubbing of the elbows on the study table as you read books. There will be a little lumpiness and pain. Some will get calcium depositions forming spurs.

Medication, local application of analgesic gels, infrared waves, massage and elbow bands are found to be helpful. Cortisone injection will help in some patients. The most resistant ones need surgical debridement of the site followed by rehabilitation for recovery.

PAIN OVER THE INNER SIDE OF ELBOW

This condition is traditionally named golfer’s elbow and more technically as medial epicondylitis. Swelling and inflammation over the origin of inner group muscles of the forearm from the inner side of the elbow causes this problem. It could affect both arms.

Medication, local application of analgesic gels, infrared waves, massage and elbow bands are found to be helpful. Cortisone injection will help in some patients. The most resistant ones need surgical debridement of the site followed by rehabilitation for recovery.

TRIGGER FINGER

Trigger finger is commonly seen around age of 40s. It starts with a painful straightening of affected finger. Later the finger triggers associated with sharp pain. When the condition advances, the affected finger needs to be pulled to straighten it. It may even get locked in severe cases. The condition can affect any of the fingers. But it commonly affects ring finger and thumb of diabetics.

We will assess how severely your finger is affected and suggest treatment. Milder forms will settle with medication. Moderately severe ones need a tiny injection. More severe trigger fingers will need operative release of tendon block at the base of the finger. This is a minor operation done under a local anesthetic. It will take about 7-10 minutes to complete the procedure in outpatient setting. The wound will heal in 5-7 days after which the sutures will be removed.

The condition may recur following medical treatment and injection. Recurrence is rare after surgery.

No known major complications

CARPAL TUNNEL SYNDROME

This is another common condition affecting mainly females. it could affect any age but it is found to be common around 40-50 years of age. The condition caused by internal pressure on one of the nerves serving the hand at the wrist.

You will have pain and numbness over 1-3 fingers. Pain may radiate up to the elbow. Pain and numbness are worse at nights. You would feel comfortable after shaking the hand few times. Some will find it difficult to hold on to something above your head, milking coconut and squeezing anything for few seconds. Individuals with arthritis, thyroid hormone lack and during pregnancy may develop this condition.

A nerve function test named nerve conduction study for median nerve will be done. The test will confirm if you have nerve compression and it will also say how severe the compression is. Night splinting and medication will help in milder forms. Others will need surgical release of pressure on the nerve.

This is a minor operation done as opd basis. 3-4 cm cut is made over the palmar side of the wrist under a local anesthetic. There will be a pressure cuff inflated over the upper arm which you will feel little tight towards the end of the procedure however everyone manages it without a problem.

The procedure can be done under 10 minutes. The will be 3-4 stitches. Your hand will be bandaged with cotton and crepe. You will be given few pain killers and an antibiotic to take home.

The wound will be checked in one week and the stitches will be taken off in 10 days.

PAIN AND SWELLING SIDE OF THE WRIST AT THE BASE OF THE THUMB.(DE QUIERVAIN’S TENOSYNOVITIS)

This condition arises with inflammation and swelling of tendons serving the thumb at the side of the wrist at the base of the thumb as they slide under a tissue sling. Movements of the thumb aggravate the pain. Swelling will be felt bony hard as the problem becomes chronic. Pregnancy may precipitate or aggravate the condition.

Milder forms can be treated with medication and cortisone injections. It may recur. Severe ones will need surgical release under a local anesthetic. The procedure is similar to carpal tunnel release described above.

PAIN AT GROIN

orthopaedic concern of pain at the groin is something to do with your hip joint. Commonest cause will be to have arthritis of the joint. There will be more pain in the mornings in inflammatory type arthritis and osteoarthritis will give you more pain towards the evening and the nights. Over stretching of tendons around the hip may also cause pain at the groin.

Clinical examination could sort out this for you. an ultrasound examination and an x-ray of the hip joint will provide more information.

PAIN OVER THE LOWER BUTTOCK REGION

There will be conditions giving rise to pain over the lower buttock and the pain goes down back of the leg, over the hamstrings up to the knee. you will find it difficult to sit on a hard surface. Bending forward is also difficult. This is technically termed ischeal bursitis. This usually settles with an injection to the site.

PAIN OVER THE KNEE CAP

You will feel pain at the top, the lower end and behind the knee cap. Pain behind the knee cap is mainly due to wear and tear of the inside surface of the knee cap. It can be treated with medication, knee supports and physical therapy.

Advanced damage to the knee cap needs surgical replacement which is usually done along with total knee replacement surgery.

Pain over the top and the bottom of the knee cap are due to inflammation at the site of tendon attachments to knee cap. This settles with medication, knee bracing and physical therapy.

PAIN AROUND THE ANKLE

Pain around the ankle could start as early as 40 years of age. There are few common reasons for pain around this area. Most of the conditions are inflammatory in origin. Discomfort and pain are more in the morning hours and get better toward the day or few minutes after starting movement.

PAIN UNDER THE HEEL

This is called plantar fasciitis. Pain settles with medication. Wearing soft rubber footwear will help most of you. There are readymade heel cushions available in the market. It takes about 3-4 weeks to settle. Some will need a cortisone injection.

PAIN AT THE SIDES OF THE ANKLE

Swelling under the bony prominences at either side of the ankle is another common finding. This is due to inflammation around the tendons lying underneath the bones. Medication, physical therapy, wearing an ankle support will help.