F

(Plantar) Fasciitis

(Focal) Dystonia

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.

Frozen Shoulder (Adhesive Capsulitis)

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.
Four stages are described in the literature:
1.Stage One, between 0-3 months: There is pain with active and passive motion, and limited motion in all directions.
2. Stage Two between 2-9 months: Known as the "Freezing" stage, this time period is marked by chronic pain with active and passive motion. There is significant limitation of motion in all directions.
3. Stage Three between 4-12 months: The "Frozen" stage exhibits significant limitation of motion in all directions, but minimal pain, except at end range of motion
4. Stage Four between 15-26 months: This "Thawing" stage presents with the gradual improvement in motion and minimal pain.
The goal of treatment is to decrease pain and inflammatory response, increase motion, and reestablish normal mechanics of the shoulder(1). A number of studies have found that physical therapy can be effective in the treatment of adhesive capsulitis(8-10). Physical therapy treatment may include exercise for range of motion, shoulder blade stabilization and joint mobilization.