Shoulder Injuries and Disorders- Impingement Syndrome

Shoulder impingement syndrome causes limitation of shoulder movements in one or more directions, but never complete global loss of movements.
Also known as a "Painful arc syndrome"; when the arm is taken overhead in the window cleaning position, patient catches pain. Pain is reproduced on every attempt to do this manoeuvre.
The patholy lies in the reduction of space for the free excursion of the rotator cuff tendons mainly Supraspinatus, beneath the acromion process.
This may occur due to inflammation of tendon itself, due to thickening of acromion process of shoulder blade (scapula); or due to repetitive stress injuries of the rotator cuff.
Treatment of this disorder is mostly conservative.
Most patients respond to suitable modification of activity or local steroid infiltration.
In patients who are resistant to conservative trials, decompression of the sub-acromial space may be performed surgically (Acromioplasty).

Non discogenic Backache : Facet joint Arthropathy

Most Sciatica is labelled to be because of a protruding disc (disc prolapse). However, there are other reasons to it. Making a correct diagnosis, is therefore important to correctly relieve the symptoms.
Pain due to disc disease are usually aggravated with forward bending; however, pain of facetal arthropathy is worsened by backward bending.
In case of Facetal Arthropathy, the facet joints become more blurred on the MRI images, with some enlargement and irregularity of the surrounding bones.
The treatment varies from supervised physiotherapy, to local injections to fusion surgery.
Physiotherapy focusses on building the tone of abdominal and back muscles, and general postural training.
Injection therapy includes local steroid infiltration in the facet joints; this procedure is performed with the help of portable xray control images. It offers rlief in 60-80 percent of patients.
The last resort to a troublesome facetal arthropathy is fusion surgery.

Elbow Pain - Tennis Elbow

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Dr Anurag Awasthi  Orthopaedic Specialist, Sohna Road, Gurgaon 9718112112

Tennis Elbow or Lateral Epicondylitis got its fame when one of our best cricketers Sachin Tendulkar reported his symptoms. He had pain in the outer aspect of his elbow and had difficulty in gripping the cricket bat.

Tennis Elbow is a common cause of Elbow pain in people engaged in repetitive forearm rotational activities. Common in sportsmen- Lawn Tennis players, Badminton players and Cricketers.

It occurs due to degeneration in the fibres of origin of one of the forearm muscles, namely Extensor Carpi Radialis brevis which runs between the lower end of the arm to the wrist joint

Symptoms- Pain over elbow outer aspect; aggravated with gripping and squeezing movements.

Signs- Tenderness over Lateral Epicondyle of Humerus.
Pain aggravated with passive stretching of forearm muscles.

Treatment-

1. Physiotherapy - Ultrasonic therapy or Interferential therapy over the point of maximum pain helps relieve the pain.

2. In patients not responding to physiotherapy, steroid injection may be infiltrated locally. This offers a temporary short term relief.

3. Tennis elbow splint helps in reducing the strain in the affected muscle. It should be worn over the maximum width of forearm, approximately 2 inch below the elbow joint.

4. In resistant cases, a manipulation under anesthesia may be performed.

5. Surgery is the last resort if the symptoms are not responding to any of the above mentioned manoeuvers. In this, the origin fibres of Extensor Carpi Radialis brevis may be surgically opened and debrided.

Patients need to avoid certain provocative movements in the region of Elbow joint for a period of 4-6 weeks after surgery.

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