Shoulder impingement syndrome
Impingement syndrome is the abnormal compression of the rotator cuff tendon trapped by the outer end of the shoulder blade (acromion) and the upper arm bone (humerus). Characteristically, pain is triggered by elevating the shoulder (pain arc), and pain radiating to the upper arm is also developed at night. It can be diagnosed by performing a physical examination followed by an X-ray, ultrasound, or MRI scan. Conservative therapy includes therapeutic exercises, the administration of anti-inflammatories, or injections. Surgical intervention is performed by minimally invasive arthroscopy, during which the occupied space is helped and the inflamed tissues are removed.
Rotator cuff tears
Tear of the supraspinatus tendon elevating the upper arm is the most common rupture, but it can happen to any tendon as well. Patients complain of pain and limited movement. It affects mainly the young adults. It is precipitated by work done overhead or by repetitive direct trauma. It can be diagnosed by performing a physical examination followed by an X-ray, ultrasound, or MRI scan. Conservative therapy includes therapeutic exercises, the administration of anti-inflammatories, or injections. Surgical intervention is performed by minimally invasive arthroscopy, during which the torn parts are removed, and if possible, the tendon is sutured.
Degenerative arthritis of the shoulder
Degenerative arthritis of the shoulder is a painful condition characterized by functional loss in the shoulder and typical presentation in radiology images. Besides the damage to the hyaline cartilage, the muscles and tendons of the rotator cuff are also affected by the degenerative processes. It can be diagnosed by performing a physical examination followed by an X-ray, ultrasound, or MRI scan. The therapy may be conservative (therapeutic exercises, the administration of anti-inflammatories, or injections). If conservative therapy does not seem to alleviate the problem, surgical intervention is needed, during which a prosthesis is implanted.
Tennis elbow (lateral epicondylitis)
Tennis elbow is an inflammation in the bony bump (epicondyle) outside the elbow. The extensor muscles of the wrist and hand arise from this area. As a result of their overuse, the patient may develop nagging pain around the elbow. According to statistics, tennis elbow is five times as common as golfer’s elbow (medial epicondylitis), that is, pain in the inside of the elbow. The correct diagnosis can be established by performing a physical examination. Therapy should be complex: the administration of anti-inflammatories, injections as well as wearing braces around the elbow are recommended. In case of long-lasting or non-ceasing pain, surgical therapy should be considered.
Elbow (olecranon) bursitis
Elbow bursitis develops on the extensor surface of the upper limbs, mostly above the elbow. It presents as a painless “squishy” swelling that can be moved on palpation. Redness of the skin can also appear over the swelling. The reasons of developing elbow bursitis may be chronic irritation, occupational harm, gout, diabetes, trauma, or infection. As a conservative therapeutic option, local or systemic (through the mouth) anti-inflammatories are administered, the extra fluid from the bursa can be drained and an injection can also be given. In chronic cases or in the presence of infection, surgical removal is needed.
Tunnel syndromes may develop at various locations; however, the most frequent sites are around the elbow and the wrist, where the nerves supplying the upper limb travel through narrow spaces called “tunnels”. The nerve might get compressed resulting in numbness and pain in the innervated areas. The syndrome can be diagnosed by performing physical examination and an ENG (electroneurography). Therapy may involve the application of relaxant creams, the administration of vitamins, or in more severe cases, surgical release of the nerves.
Carpal tunnel syndrome
Carpal tunnel syndrome is an inflammation of the wrist and hand of non-infectious origin. It usually develops as a result of overuse (working on the computer or playing the piano). Generally, pain and swelling develop over the wrist and the back of the hand. Patients may feel friction over the extensor tendons on movement. The grip strength in the hand may decrease. Therapy may include resting the affected body part and administering anti-inflammatories, using patches, or braces for the wrist. When the narrowing of the tendon sheath is accompanied by inflammation, a surgical intervention may be needed.
Trigger finger (stenosing tenosynovitis)
In trigger finger, the space within the tendon sheath of the affected fingers is narrowed in a circular manner, and thus, a nodule may develop in the tendon. When the nodule slides through the narrowing of the tendon sheath, a snap – like a trigger being pulled and released – is developed, which is accompanied by pain. In severe cases, the finger gets stuck in a bent position. In an early stage, conservative therapy can be applied by resting the finger and administering anti-inflammatories, using patches, or finger braces. In advanced cases, surgery is needed.
A ganglion cyst is a lump containing yellowish fluid or jelly-like substance. Ganglion cysts commonly develop along joints or tendons related to the bursa or the tendon sheath. They usually develop as a result of overuse. They may cease spontaneously. They may look like a tumor; thus, differentiation is important. In an early stage, conservative therapy can be applied by resting the affected body part and administering anti-inflammatories, using patches, or braces. If the size of the ganglion develops and it causes circulatory or innervation disturbances, surgical intervention is needed.
Dupuytren’s contracture is the shrinking of the skin of the palm and the underlying soft tissues. It is a benign but aggressively spreading condition. Usually the ring finger or the little finger is affected. The abnormality may rarely involve other fingers of the hand. It causes no pain or sensory disturbance. Patients usually present to the doctor in a very advanced stage, when the finger has already been pulled into and fixed in a bent position. It may accompany metabolic disorders, and familial accumulation is also common. Therapy may include the administration of products softening the scar tissue or injections. In advanced cases, surgical removal is needed.
Frozen shoulder (adhesive capsulitis) is caused by the adhesion and/or inflammation of the soft tissues around the shoulder joint. It mainly affects young and middle aged women. There is a higher risk for its development in diabetics and patients with other metabolic disorders. Clinical symptoms include pain in the shoulder area, which may also radiate to the upper arm. Pain at rest may also occur as well as limited range of motion. It can be diagnosed by performing a physical examination followed by an X-ray, ultrasound, or MRI scan. Conservative therapy includes therapeutic exercises, the administration of anti-inflammatories, or injections. Surgical intervention is performed by minimally invasive arthroscopy, during which the adhered soft tissues are released and the shoulder joint is manipulated. Unfortunately, healing is a long process; it may last for even 3 years.