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A Achilles Tendinopathy and Rupture The Achilles tendon connects the calf muscle to the heel bone. Tendinopathy involves microtearing of the tissue in and around the tendon. Inflammation is not usually found. Causes of tendinopathy are many: sudden, unusual, repetitive or high loading; footwear; age etc. Risks such as obesity, gout, Rheumatoid Arthritis and smoking have been implicated. Symptoms include swelling and pain. Onset may be gradual or activity-related. Ruptures are sudden and painful, with an audible pop and an inability to point the toes. Man Ther. 2002 Aug;7(3):121-30 Foot Ankle Int. 2006 Apr;27(4):305-13 AcromioClavicular (AC) Separation AC separations result from a fall onto the point of the shoulder or from landing on an outstretched arm. The collarbone separates from the shoulder blade. The severity is generally graded as I, II or III. Grade I symptoms are mild. Grade III results in more pain, a very visible bump and a popping sensation. Grades II and III may involve wearing a sling for a while. Overhead activities are the most problematic. A physical therapist will outline safe exercises to regain range of motion and gradually, strength. Surgery for Grade III is still controversial, and may depend on whether function is being significantly restricted. References:* J Shoulder Elbow Surg. 2003 Nov-Dec;12(6):599-602 * Am J Sports Med. 2006 Feb;34(2):236-46. Epub 2005 Nov 10 Ankle Please see Ankle Anterior Knee Pain (Chondromalacia / Patello-Femoral Pain) The term "chondromalacia" is most often associated with the knee, but can also be associated with any joint that has articular cartilage. "Chondromalacia" is a Latin word meaning "cartilage softening" . Two common types of cartilage are: hyaline/articular and fibrocartilage. The former is a glistening, near friction-free surface that covers the ends of bones, allowing for smooth movement. The latter is a tougher type of cartilage, like the meniscus of the knee, which helps in stabilizing the joint. Chondromalacia is graded from I to IV, the latter implicating "bone on bone" wearing. A recent study (1) proved that one can have as much as a Grade III wearing without pain. So, pain is variable. The source of chondromalacia pain (2) is not the articular cartilage itself, but the thinning of it, which transfers loads onto the underlying subchondral bone, which is pain-sensitive.Patello-Femoral pain is the most common of knee problems. It is often a chronic, but episodically painful condition. There is often no one trauma associated with it, just a sense of discomfort with fluctuations of pain over time. It is often associated with sub-optimal biomechanics around the knee cap and lower limb, but not always. When biomechanics are good, but there is PF pain, this may be due to a predisposition towards soft articular cartilage, which is poorly understood. Direct trauma to the knee cap can instigate PF pain and softening of the cartilage over time. Biomechanics are unalterable conservatively, but can be influenced by selective muscle stretching and strengthening exercises around the knee, pelvis, hip and foot. This helps to reduce the abnormal vector forces influencing the patella. PF Pain is characterized by a poorly localized, deep aching under the knee cap, which often refers towards the front and inner aspects of the knee. Aggravating factors are: prolonged sitting, descending/ascending stairs or hills, and squatting. There is only rarely very mild swelling. The treatment of PF Pain is conservative. This means seeking the advice of a Physical Therapist who will identify selective exercises to optimize lower limb mechanics. McConnell PF taping may also be indicated. Occasionally, modalities such as Ultrasound and Biofeedback may be helpful. The prescribed exercises are a life-long committment, like brushing your teeth. If conservative care of PF Pain fails, and the pain is significant, then the advice of a surgeon should be sought. But surgery is the last resort. (The key to co-existing with this somewhat chronic problem is maintaining very strong muscles around the knee, pelvis and hip, so as to optimize functional mechanics. Selective stretches are also indicated. When conservative treatment doesn't help the pain, and the pain is significant, the last resort is to consult a surgeon.) Adhesive Capsulitis (Frozen Shoulder) Adhesive Capsulitis is an insidious condition, characterized by fibrosis of the shoulder capsule and a progressive loss of shoulder range of motion in all directions(8). Adhesive capsulitis or "frozen shoulder" affects approximately 2% of the population(2). Of those affected, 70% are women and 20-30% will go on to develop symptoms in the opposite shoulder(1). Adhesive capsulitis occurs more frequently in diabetics and in persons over 40 years of age(3). Other factors may include trauma(3), immobilization(4), thyroid disease(5), autoimmune disease(6), stroke or myocardial infarction(7). It is characterized by pain and a progressive loss of active and passive range of motion in the shoulder. * Hannafin JA, Chiaia TA. Adhesive capsulitis, A treatment approach. CORR.2000; 372: 95-109 * Binder A, Bulgen DY, Hazelman BL, Roberts S. Frozen shoulder: A long-term prospective study. Ann Rheum Dis 43:361-364, 1984 * Lloyd-Roberts GG, French PR. Periarthritis of the shoulder: A study of the disease and its treatments. Br Med J 1: 1569-1574, 1959 * De Palma AF. Loss of scapulohumeral motion(frozen shoulder). Ann Surg 135: 193-197, 1952 * Bowman CA, Jeffcoate WH, Patrick M. Bilateral adhesive capsulitis, oligarthritis and proximal myopathy as presentation of hypothyroidism. Br J Rhuematol 27: 62-64, 1988 * Bulgen DY, Binder A, Hazelman BL. Immunological studies in frozen shoulder. J Rheumatol 9: 893-898, 1982 * Mintner WT. The shoulder-hand syndrome in coronary disease. J Med Assoc GA 56: 45-49, 1967 * Gular-Uysal F, Kozanoglu E. Comparison of the early response of two methods of rehabilitation in adhesive capsulitis. Swiss Med Wkly 2004; 134:363-368 * Ryans I, Montgomery A, Galway R, Kernohan W, McKane R. A randomized controlled trial of intra-articular triamicinolone and/or physiotherapy in adhesive capsulitis. Rheumatology 2005; 44:529-535 * Vermuelen H, Rozing P, Obermann W, le Cessie SW, Vliet Vleeland T. Comparison of High-grade and Low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: A randomized controlled trial. Physical Therapy 86: 355-368 Amyotrophic Lateral Sclerosis (ALS) Amyotrophic Lateral Sclerosis, otherwise known as Lou Gehrig's Disease, is a desease that causes nerves in the brain and spinal cord that control movement ("motor neurons") to progressively die. As a result of these nerves dying, people with ALS may experience uncontrolled tightening ("spasticity") and/or weakness of their face, neck, trunk, arm and/or leg muscles. This may make speaking, swallowing, breathing, moving and walking difficult. Eventually, ALS patients are unable to breathe on their own. Unfortunately, the cause of ALS has not been fully determined. As such, there is no known cure for ALS at this time, and the average life expectancy after diagnosis varies from 2 to 4 years. Simmons Z. Management strategies for patients with amyotrophic lateral sclerosis from diagnosis through death. The Neurologist 2005; 11:257-70 Borasio GD, Miller RG. Clinical characteristics and management of ALS Seminars in Neurology. 2001; 21:155-66 Francis K, Back JR, DeLisa JA. Evaluation and rehabilitation of patients with adult motor neuron disease. Archives of Physical Medicine and Rehabilitation. 1999; 80:951-63 Arthritis Arthritis (arthrosis) is a group of conditions affecting primarily the joints of the body. There are many kinds of arthridites: Osteoarthritis, Rheumatoid, Septic, Juvenile Rheumatoid Arthritis, etc. Many are secondary to other metabolic problems. Osteoarthritis(OA) is very common. Too much activity or its reverse are instigators of the pain associated with OA. Many factors control the degradation of the lining cartilage and the extent to which the joint degenerates. It is often familial. Aging in itself is not causative. As inflammation persists, osteophytes (bony spurs) form and articular cartilage breaks down. Pain and stiffness are the hallmarks of OA. Diagnosis involves x-rays, MRI, blood work, clinical evaluation etc. Treatment is always conservative. Physical Therapy is critical in teaching patients how to keep strong, maintain range of motion and function. Changes in lifestyle should be considered to control symptoms or reduce impact on the joints. Doctors can recommend supplements, injection and medication. Surgery is always the last consideration when pain is severe and daily function is compromised. Arthroscope to "clean up" the joint is controversial in its pain control benefits(1). Replacing the joint partially or fully is the absolute last resort. Intense physical therapy thereafter is critical.References: 1. N Engl J Med, Vol 347, #2; July 11, 2002 Arthritis Today: An Arthritis timeline, Oct 2006 Atrophy Muscle atrophy refers to a weakening or wasting of muscle. The causes can be neurological (Muscular Dystrophy, nerve severance...) or orthopedic. Orthopedically, the causes are many: disuse, reflex inhibition, hormones, disease, aging etc. Muscle atrophy after an injury or surgery is a process where reabsorption and breakdown of tissue occurs. If severe, it may not reverse. There are genes associated with atrophy and with the rehabilitation of muscle. When safe, it is critical to keep muscles contracting after trauma. Persistence of non-optimal strength around a joint perpetuates its problems. Maintaining muscle balance (strength and flexibility) around a joint is critical to avoiding chronic problems.
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