1) THE COMPLAINT: PAIN AND TINGLING IN THE THUMB, FIRST TWO FINGERS AND HALF OF YOUR RING FINGER.
What's causing it? Most likely this is Carpal tunnel syndrome. Repetitive motion causes irritation of the median nerve which results in tingling and numbness that may involve the entire palm and in some cases pain radiates up into the forearm, and occasionally to the shoulder. You may experience pain at night and be awakened by abnormal sensations.
What can you do about it? A physical exam and electrodiagnostic studies are done to make the diagnosis. Conservative options work well for mild to moderate carpal tunnel syndrome. These include wrist splints at night, oral corticosteroids or injections, ultrasound, nerve-gliding exercises, and yoga. For those with severe symptoms or when the above listed treatments have failed decompression surgery is an option that works.
2) THE COMPLAINT: SHOULDER PAIN, ESPECIALLY WHEN THE ARMS ARE RAISED ABOVE 90 DEGREES.
What is causing it? Shoulder impingement syndrome is the most common cause of shoulder pain in the outpatient setting. The impingement syndrome occurs when the rotator cuff is compressed against the undersurface of the acromion. The space is tight and any tissue enlargement or swelling may result in an impingement syndrome.
What can you do about it? Right when it starts hurting: ice, rest, anti-inflammatories followed by physical therapy should help. IF you doctor suspects a rotator cuff tear OR adhesive capsulitis (frozen shoulder) then you should see an orthopedic surgeon and an MRI may be warranted.
3) THE COMPLAINT: MEDIAL (INNER) KNEE PAIN. This is the most commonly described pattern of pain in the knee.
What's causing it? Medial knee pain (the inner knee) is the classic presentation of patients with medial collateral ligament strain (the most frequently injured ligament), and medial meniscal tear (the meniscus with the greater vulnerability to injury).With medial collateral ligament strain you will complain of knee pain along the inner aspect of the knee joint often with difficulty walking, pivoting, and twisting.
What can you do about it? You need a good physical exam to identify the problem. Surgery is rarely necessary and the conservative route with a knee brace and physical therapy is your way to go. Significant medial meniscal tears, on the other hand, can lead to loss of smooth motion of the knee (locking) and often a knee effusion (fluid in that area of the knee). Surgery may be necessary and an evaluation by an orthopedic surgeon is a good idea especially for persistent pain and fluid.
4) THE COMPLAINT: PAIN ON THE SIDE OF THE KNEE AND LEG
What's causing it? A common cause of pain in this location is the iliotibial band syndrome. The iliotibial band (IT band) is connective tissue that runs from the pelvis to the fibula (the calf bone on the lateral side of your leg). You would describe aching or burning pain at the site where the band courses over the lateral femoral condyle occasionally with pain radiating up the thigh toward the hip.
What can you do about it? To establish that it is IT band syndrome, a physical exam should elicit focal tenderness, with or without clicking, over the lateral femoral condyle. Treatment is usually conservative with physical therapy and antiinflammatories and most can expect complete resolution of IT band symptoms.
5) THE COMPLAINT: PAIN ON THE OUTSIDE OF THE ELBOW
What's causing it? Pain here is most commonly caused by lateral epicondylitis (tennis elbow). If you have this you can often point RIGHT TO the spot of the most pain and it will be the pointy outside prominence of your elbow (the lateral epicondyle). The pain from lateral epicondylitis is aggravated by strong gripping and activity that contracts the wrist extensors, including repetitious use of the forearm and wrist and shaking hands.
What can you do about it? Recovery from this will not require surgery and a counterforce brace (think of the brace people wear on their forearm), anti-inflammatories and specific exercises as guided by a physical therapist will all help.
6) THE COMPLAINT: NECK PAIN RADIATING DOWN THE ARM OR TO THE SHOULDERBLADE.
What is causing it? Pain that starts in the neck and radiates down the arm, the shoulder, or area between the shoulder blades is common with cervical radiculopathy. This is a nerve root being compressed as it exits the cervical spine, usually from degenerative changes. A good physical exam looking for sensory changes or weakness is necessary with a decision of whether or not to pursue imaging (MRI, CT, etc) based on those findings.
What can you do about it? Depending on the severity you can start with physical therapy and anti-inflammatories yet in some cases epidural steroid injections or surgery may be warranted.
7) THE COMPLAINT: YOUR HEEL HURTS WHEN YOU START WALKING, ESPECIALLY FIRST THING IN THE MORNING.
What's causing it? Plantar fasciitis is the most common cause of this pain. Degeneration and inflammation of the plantar fascia occurs for whatever reason. Risk factors for plantar fasciitis are obesity, prolonged standing or jumping, flat feet, and heel spurs.
What can you do about it? Early on rest and ice will help. Silicone heel inserts (over the counter) and stretching exercises for the calf muscles and plantar fascia are helpful. Athletic shoes, arch supporting shoes, or shoes with rigid shanks (a metal insert into the sole of the shoe) may also be helpful. Walking barefoot and in slippers may aggravate the pain. Steroid injections and surgery are last resorts but do work for some refractory symptoms.
8) THE COMPLAINT: LEGS CRAMP AT NIGHT
What's causing it? The most common form of leg cramps are idiopathic, meaning we don't know why they happen. Patients with the most common form of idiopathic leg cramps have NO fluid or electrolyte imbalance. Less common causes of leg cramps at night are prolonged sitting, inappropriate leg position during sedentary activity, and volume depletion due to diuretics or excessive sweating. Nocturnal leg cramps are also more common in diabetics, alcoholics, hypothyroidism and can occur after overexertion.
What can you do about it? Sedentary patients who get leg cramps benefit from 20 minutes of a stationary bike before bed. A hot shower or warm bath, ice massage, regular aquatic exercise for conditioning and stretching and increased hydration have all been shown to be helpful. Quinine is not recommended for nocturnal leg cramps. Benadryl, vitamin E and Gabapentin can also be considered for treatment.
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