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When the bones comprising a joint lose contact with each other, this is referred to as a dislocation. The joint looks out of alignment. When the bones retain only partial contact with each other, it is termed a subluxation. Dislocating once may be a singular event in a life or may be the beginning of a chronic problem. This is usually a very painful condition, with resulting bleeding and swelling into the joint. Treating that first event optimally with a period of immobilization then rehab is typical, but controversial as to its efficacy in further prevention. Allowing the overly-stretched, or torn ligaments to heal or scar down in those first few weeks is the goal of initial conservative treatment. Consulting a physical therapist is important in order to be taught selective strengthening and stretching exercises that may counter the effects of the stretched tissues. Consulting an orthopedic surgeon may become necessary to surgically stabilize the joint if dislocations are recurrent. This is followed by intensive rehab.
Some patients suffer from an involuntary movement disorder referred to as dystonia. This can be generalized or it can affect only one part of the body (eg: focal hand dystonia, cervical torticollis) or only involve a particular task (eg: keyboarder's cramp, musician's cramp). The treatment for this disorder is often the use of botulinum toxin injections to decrease the uncontrollable spasms. However, there is increasing evidence that focal and target-specific dystonias may respond positively to retraining paradigms. At UCSF's Faculty Practice, we have experience working with patients with these types of problems.
Repetitive strain injuries can occur when individuals perform rapid, repetitive movements usually as part of their work. These injuries can lead to acute and sometimes chronic pain which may be difficult to treat. The intervention requires an understanding by each patient and careful education about stressfree hand use to minimize the effects of performing jobs that require high repetition. Patients also need to be instructed in appropriate neurological and musculoskeletal movement strategies to facilitate healing, normal movement, good posture and ultimately a balance of strength and stability in the involved upper limb.
Neurovascular entrapment syndrome of the upper limb involves compression of the neurovascular tissues in the axilla(armpit). This condition can occur as a result of poor posture, overuse, high stress, and muscle spasm and tension of the muscles around the neck, the chest wall and the shoulder blade. This condition can lead to numbness and tingling, cold hands and pain. It must be addressed with appropriate education that includes breathing exercises, posture exercises, relaxation exercises and neural gliding routines. Therapy must be progressed slowly with insightful consideration of prevention and progression of healthy aerobic, flexibility and strengthening exercises.
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