ROTATOR CUFF TEARS
The rotator cuff is the thick band of muscles and tendons that covers the top of the upper arm and holds in it place, providing stability and a full range of motion to the shoulder joint. It is made of four muscles and their associated tendons. These tendons can become partially or completely torn as a result of a rotator cuff tear.
A rotator cuff tear most often occurs as a result of overuse of the muscles over a long period of time. As a result, this condition is most common in patients over the age of 40. It may also occur as a result of a traumatic injury, and involve pain when lifting or lowering their arm, muscle weakness and atrophy.
Many rotator cuff tears can be treated through nonsurgical methods that focus on relieving pain and restoring function to the shoulder. These may include:
- Rest
- Use of a sling
- Anti-inflammatory medication
- Steroid injections
- Physical therapy
Surgery may be recommended for tears that cause severe pain or that do not respond to more conservative treatments. The type of surgery performed depends on the size and location of the tear, but often involves trimming torn edges or suturing the tendon back together.
SHOULDER ARTHRITIS
Arthritis is a condition that causes pain, stiffness and swelling in the joints. Osteoarthritis is a common form of arthritis caused by the wearing down of the cartilage that protects the bones of a joint. Rheumatoid arthritis is an autoimmune condition caused by an inflammation in the lining of the joints. Both forms of arthritis, cause pain, tenderness, and swelling, and may result in loss of movement in the affected joints. Over time, joints affected by arthritis may become severely damaged. Arthritis occurs more frequently in older individuals, however it sometimes develops in athletes from overuse of a joint or after an injury. It can however, affect people of any age, including children.
The most common type of shoulder arthritis is osteoarthritis, or degenerative joint disease. It occurs when the cartilage covering the bones of the shoulder, the humerus, the scapula and the clavicle, wears away. Since the cartilage normally acts as a protective cover, without it the affected bones scrape against one another. This friction results in pain and swelling and may also cause the development of outgrowths of bone called bone spurs. This type of arthritis results not only in pain but in a limited range of motion in the affected area. Osteoarthritis may be caused by heredity, advancing age or traumatic injury.
Treatment of arthritis of the shoulder may consist of simple home remedies, physical therapy or, in more severe cases, surgical intervention. To some degree, treatment of arthritis of the shoulder depends on the causes of the disorder.
SPINAL STENOSIS
Spinal stenosis is the narrowing in one or more areas of the spinal canal as a result of injury or deterioration of the discs, joints or bones of the spine. Most cases of spinal stenosis develop as a result of the degenerative changes that occur during aging. Osteoarthritis is the main cause of spinal stenosis, since this condition causes deterioration of cartilage in the area that leads to the bones rubbing against each other. As bones make repeated abnormal contact, bone spurs form, narrowing the spinal canal.
Other causes of spinal stenosis are traumatic injury, herniated disc, ligament thickening and, in rare cases, spinal tumors, any of which can damage the alignment of the vertebrae. A subtype of spinal stenosis is foraminal stenosis. This condition is caused by a narrowing of the foramen, the opening within each of the spinal bones that allows nerve roots to pass through.
Symptoms of Spinal Stenosis
Patients with spinal stenosis may experience a number of troubling symptoms. These may include:
- Pain in the back, neck, shoulders or extremities
- Muscle cramping
- Loss of sensation in affected areas
- Loss of balance
- Bladder or bowel dysfunction
The loss of bladder or bowel control is a rare, but particularly distressing symptom, for which surgery is most often necessary.
Diagnosis of Spinal Stenosis
In order to diagnose spinal stenosis, a medical history and a physical examination are always necessary. The condition is often difficult to diagnose, not only because its symptoms may resemble the symptoms of other conditions, but because they may only occur intermittently. A diagnosis of spinal stenosis is usually achieved only after ruling out other disease conditions. Typically, imaging exams such as a spinal X-rays, MRI, CT or bone scans are administered to definitively diagnose the condition and to pinpoint the spinal region affected. An electromyography (EMG) may also be administered to measure electrical impulses in the affected skeletal muscles.
Treatment of Spinal Stenosis
Most cases of spinal stenosis can be effectively treated through conservative methods such as physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), rest and a supportive back brace or cervical collar. In some situations, corticosteroid injections may provide relief.
For more severe cases, surgical procedures such as a decompressive laminectomy, laminotomy or spinal fusion may be required to relieve pressure on the nerves. When the patient is diagnosed with foraminal stenosis, a surgical procedure known as a foraminotomy may be performed. This operation widens the area where the spinal nerve roots project from the spine.