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Shoulder, Elbow, Wrist, Hand

Biceps Tendinopathy Biceps tendinopathy describes a painful inflammation or degeneration of the biceps tendon. In the case of a recent acute injury, inflammation (tendinitis) may be a potential diagnosis. However, many cases of tendinopathy occur without inflammation and are the result of chronic overuse, which leads to microscopic tearing, failed healing and eventually degenerative changes within the tendon (tendinosis). Patients with bicipital tendinopathy often complain of a deep throbbing ache over the anterior shoulder. Nighttime symptoms are common, particularly when sleeping on the affected shoulder.

Carpal Tunnel Carpal tunnel syndrome (CTS) is caused by mechanical compression of the median nerve within the carpal tunnel. This compression causes local ischemia and results in sensory and/or motor deficits in the distribution of the median nerve. Symptoms include numbness and tingling into the thumb, index finger, middle finger, and complaints of weakness in the hands. The symptoms may be worse at night.

Rotator Cuff Injuries Rotator cuff injury is the most common problem to affect the shoulder, accounting for over 4.5 million physician office visits per year. Strains of the rotator cuff can occur abruptly from a single trauma, however, 90% of cases develop from multiple factors including repetitive injury and age-related attrition. Rotator cuff tendons may also suffer tendinopathy and tearing depending on the trauma and mechanism of injury. Symptoms will differ depending on the specific rotator cuff tendon involved. Many complain of pain while sleeping on the affected shoulder and with shoulder movement. Pain with movement will also depend on the tendon involved.

Bursitis Bursitis is inflammation of the bursae. Bursae are fluid filled sacs which are located where muscles and tendons move over a bone or bony prominence. These sacs help reduce the friction between tissues as they move past each other. However, when one of these sacs gets inflamed, it can be painful to move that particular joint.

Frozen Shoulder Adhesive capsulitis, or “frozen shoulder syndrome” describes an ongoing and painful limitation of active and passive shoulder motion. Adhesive capsulitis may be subdivided into 3 or 4 contiguous stages. Stage 1 is the “pre-cursor” phase characterized by achiness that becomes sharp during movement. Stage 2 is recognized as the “painful” or “freezing” stage that demonstrates a gradual progressive loss of shoulder range of motion over the next weeks to months. Stage 3 is the “frozen” stage, characterized by pain and significant loss of range of motion for the next several months. Stage 4 is the “thawing” stage that is associated with progressively decreasing pain and stiffness. Patients may require up to nine months to regain a functional range of motion.

Lateral Epicondylitis Lateral epicondylopathy is the most common cause of elbow pain. The condition is related to repetitive wrist extension and is commonly referred to as tennis elbow. The mechanism of injury for Lateral Epicondylitis entails repetitive wrist extension causing micro-tearing of the common extensor tendon. This ultimately leads to a failed healing response and degeneration. Since Lateral Epicondylitis is primarily a degenerative condition rather than a chronic inflammatory process as once hypothesized, the term “tendinitis” has been replaced with “tendonosis” or “tendinopathy”.

Impingement Syndrome Shoulder impingement is caused when the supraspinatus tendon becomes painfully entrapped between the acromion process of the shoulder blade and the humerus. This entrapment is usually increased during elevation and internal rotation of the arm. Impingement Syndrome is the most common disorder of the shoulder and accounts for more than 50% of all shoulder complaints seen by physicians. Those who perform repetitive overhead activity are at greatest risk for Impingement Syndrome. This group includes athletes who participate in: swimming, baseball, volleyball, weight lifting, and tennis as well as professions like electricians, and painters.

De Quervains De quervain's is inflammation of the tendons that help move the thumb. De Quervain's tenosynovitis results from repetitive friction and microtrauma causing the tendons and sheath to swell, making normal motions painful. Symptoms include pain on the lateral aspect of the wrist. The pain may begin abruptly but more commonly is of gradual onset, increasing over weeks or months.

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