FAQ Category: General

Trigger points (TrPs) are small, painful nodules in the muscles. There is a specific and predictable pain pattern present with each active TrP. There are also latent TrPs. With a latent TrP, the pain pattern only occurs when the nodule is pressed or palpated.

TrPs occur after a long period of immobilization such as being in a cast or bedridden for a period of time. They can also occur in muscles that are overused or held in a state of contraction too long. This can occur for example in people who sit for long periods of time typing at a computer or driving a car.

TrPs can be eliminated with treatment. A commonly successful method is to stretch the muscle while applying a cold stimulus along the length of the muscle. An ice cube can be used to do this. There is also a special vapocoolant product that physical therapists use to spray the muscle. This treatment technique is called spray and stretch.

Physicians have also used injections into the TrPs as a successful means of treatment. A combination of steroid and numbing agent such as lidocaine are often used. Studies have shown that dry needling may be just as effective. This means that just stimulating the area of the TrP with a needle but no injection has been shown to work well, too.

Acupuncture has a simliar local effect on the muscles as dry needling. Acupuncture also is believed to balance the energy flow to and from the muscles. Specific studies of acupuncture on TrPs are needed. It may help some people more than others. Finding out who might benefit the most would be helpful in guiding and directing patients with TrPs (and MPS) in choosing the best treatment for them.

Myofascial pain syndrome (MPS) is a painful condition that affects the muscles and connective tissue of the body. The affected individual may have one specific area that hurts, such as the neck or back. Or they may experience tender or sore muscles that are in constant spasm in many places throughout the body.

There is no known cure for this problem but it can be managed quite effectively with conservative care. Patients are often started out on muscle relaxants, nonsteroidal antiinflammatory drugs (NSAIDs) and/or antidepressant medication.

The physician works closely with the patient to find the right drug, combination of drugs, and dosages needed to control the symptoms. The goal is to get pain relief without a lot of unpleasant side effects. In some cases, a stronger analgesic (pain reliever) may be needed such as oxycontin (an opioid).

Many patients with MPS get help from a physical therapist. Heat and electrical modalities seem to provide pain relief. Trigger point (TrP) therapy is a central focus of treatment. TrPs are areas of localized pain in a muscle that cause tenderness when palpated. Often there is a referred pain pattern as well. With MPS there are often multiple TrPs contributing to the overall feeling of general body pain.

With this type of therapy, the TrP is released by stretching the muscle. While the muscle is in a stretched position, a coolant spray is used along the entire length of the muscle. The patient is taught how to keep the muscles balanced. Posture and habits that contribute to TrPs are identified and changed.

Once MPS is diagnosed, it becomes a matter of management. Though it can be a chronic problem, most patients are able to minimize the symptoms and even prevent flare-ups.

Any time implant devices are inserted into joint or disc spaces, there’s a risk of debris forming. Most of the parts are either plastic or metal of some type. Movement of the implant components causes microscopic particles to flake off. Over time, the debris that occurs can cause loosening of the implant.

Efforts are being made to change the design of implants to avoid this problem. The Bryan cervical disc prosthesis used in the cervical spine (neck) has some of these features. This implant is a metal-on-polymer (plastic) device.

It has a special cover that is designed to catch and contain any debris. The surfaces in contact with the bone are porous to allow bone ingrowth. A special lubricant is injected into the compartment formed by the sheath. This helps seal off any places debris might escape through.

There’s always a chance that these safety measures will fail. But the risk is low and results are good. Share your concerns and questions with the surgeon. Find out what type of implant device will be used and any features it may have to prevent loosening from debris.

It is possible that when a bone is set, it isn’t set exactly right. This is why follow-up appointments are very important, so the doctors can monitor the progress of the healing. When a bone doesn’t heal properly, this is called a malunion.

In cases where the bone heals completely when it hasn’t been properly set, there are a few issues of concern. The bone may not be completely straight; it may have turned or twisted a bit during the healing process. The bone may also end up being shorter than it would have been had it not be broken. This may be a very small difference or it may be noticeable. Both of these problems could require surgery to correct them.

Another problem that may be caused by malunion is arthritis if the fracture is near a joint.

Disappearing bone disease is also known as phantom bone disease, vanishing bone disease, or Gorham’s disease. It was first described by a doctor by the name of Gorham back in 1954.

There isn’t much that’s really known about this condition. It is a rare disease that usually affects the bone of the arms or legs. Most often, only one bone is involved. It can spread to nearby soft tissues and the next closest bone.

The condition is caused by a build-up of blood vessels within the bone. The result is massive osteolysis or the disintegration of large amounts of bone. The bone is replaced by fibrous tissue. Fractures are common and can lead to loss of function and disability.

The cause of Gorham’s disease is unknown. A genetic link is suspected. Treatment does not stop the process. Generally, people affected by Gorham’s Disease take Vitamin D, calcium, and drugs such as bisphosphonates to help stop the bone destruction. Pain relievers and antiinflammatories are used when there is pain.

Gorham’s disease is a rare condition that causes the destruction and disappearance of bone. This process is called bone osteolysis. Depending on which bone is affected, the result can be severe loss of function and disability.

The disease has two stages. In the first stage, extra blood vessels develop in the connective tissue around the affected bone. Usually only one bone dissolves, but the process can extend into the nearby soft tissues and adjacent bones.

In the second phase of the disease, fibrous tissue takes the place of the missing bone. Without the strong support of the bone, the patient is left with deformities and bone fractures.

There isn’t a 100 per cent effective treatment for Gorham’s disease yet. Vitamin D, calcium, and bisphosphonates are prescribed. Bisphosphonates are a class of drugs that stops the resorption of bone.

They are used most often to prevent and treat osteoporosis, bone metastasis from cancer, and any other condition with bone fragility. The process of bone destruction can be slowed down by these drugs but not always stopped.

Cast wedging is used when the broken bones are set inside a cast but do not stay in good alignment. The fractured ends of the bones move away from each other. This is called a loss of reduction. Unless it is corrected, the limb will heal with a deformity.

If the cast is a good fit, it may not be necessary to remove it and reset the bones. An X-ray of the arm can be taken. The angle of the malaligned arm is traced from the X-ray. The tracing is transferred to the cast to show the position of the angled fractures.

Now the plaster is cut nearly all the way around the arm at the apex of the deformity. A small bridge of plaster is left at the apex. Wedges made of cast material or cork are applied opposite this bridge. Enough wedging is used to bring the line drawn on the cast straight.

Another X-ray is taken to confirm the correct position of the bones. The cast is reinforced in this position. If this method does not realign the bones, then surgery may be needed to make the necessary reduction.

That’s a very good question that may not have a simple, straightforward answer. There are several factors at work here. The first is training and preparation.

Today’s athletes have much better counseling and assistance with improved training techniques. When injuries occur, they have the muscle strength to support joints allowing them to bounce back faster.

And we know more about the natural history of many injuries. With time enough to do long-term studies, we know better now which injuries respond well to rehab and which ones don’t.

Rehab procedures have also improved. Specific training for sports physical therapists and athletic trainers enables them to get players back in action quickly. Good nutrition aimed at wound healing combined with rehab principles is an added bonus.

In many cases, better care on the field at the time of the acute injury has made a difference. And surgeries are possible now to repair ligament injuries that would have put players out of the game 30 years ago.

Orthopedic surgeons continue to look for ways to improve surgical technique. It’s possible to restore many damaged soft tissues to their normal location, strength, and function. All of these factors together make it possible to stay in the game longer and return after injury.

Fluoroscopy is in use more and more to guide orthopedic, cardiac, and other surgeries. With greater use, there have been an increased number of skin injuries reported.

Damage to the skin ranges from redness to ulceration. This adverse reaction is often delayed by hours to days and even years later. Necrosis or death of the skin and tissue underneath occur in up to half of all cases. The higher dose of radiation associated with fluoroscopy is the main reason for these injuries.

The areas of skin injury are easily traced to previous use of fluoroscopy by their location. Healing may be delayed months up to more than a year. This is because the radiation damages the tiny blood vessels to the skin. Infection is another possible problem.

Even with treatment, radiation ulcers can get worse and may come back after they are healed. Small amounts of trauma can provoke skin damage. Pay very close attention to skin care suggestions provided by your doctor.

Treat even the smallest problem right away. Practice careful skin protection of the area that was exposed to the radiation. With an increased incidence of this problem, stricter controls and prevention techniques are being used. These measures should help reduce this adverse effect of fluoroscopy.

The diagnosis of rheumatoid arthritis (RA) can be very difficult — especially in the early stages when treatment is so important. Improved imaging has shown us that even before patients have symptoms, joint damage is occurring.

To prevent this, early and aggressive treatment is advised. Doctors can’t always rely on lab tests. In 20 per cent of patients who do have RA, the test will not show the presence of RA. In such cases, the physician relies on the history and clinical exam.

Joint stiffness that lasts more than 30 minutes in the morning is a red flag symptom of RA. Swelling in more than three joints adds to the suspicion of this disease. Many people with early symptoms of RA have joint pain in both hands or both feet.

A positive squeeze test is an even better way to test for RA. The examiner places his or her hand on both sides of your fingers or toes and squeezes. Pain brought on by this test is a more dependable sign of RA than even these other indicators.

If you have not had the anticyclic citrullinated peptide (CCP) antibody assay, you may want to ask your doctor to consider this test. The test is not available everywhere. It has a much higher specificity for RA. Again, a negative test result does not rule out RA.

Research shows that patients who are treated early have the best results. The longer the symptoms are present, the less chance there is for remission (control of the disease). Medications available now are very effective in halting the progression of RA.

Our thinking about the treatment of rheumatoid arthritis (RA) has changed over the last 10 years. Improved technology has made it possible to identify the disease earlier. Disease-modifying antirheumatism drugs (DMARDs) are now available to stop the progression of disease.

Studies confirm that early diagnosis and aggressive treatment DO make a difference. Patients who begin treatment early have less pain and less joint damage. Their motion and function are preserved. The bottom line is that there’s less disability now than ever before for patients with RA.

Making the diagnosis can be difficult. There are many possible causes of joint pain. Arthritis is only one. Other diseases can present with joint pain as an early symptom. Seeing your doctor now can help sort out the true cause of your joint pain. This could make a big difference for you in the long-run.

There is much hope on the horizon. Even now new agents that target various aspects of the disease process are under investigation. Drug companies are striving to find medications that are effective without so many side effects.

Doctors are always trying to find a medication or combination of drugs that give the patient the benefit of the drug(s) without so many adverse responses.

The idea of tolerable side effects will eventually be replaced by drugs with no side effects. Right now, many people have to put up with mild to moderate symptoms in order to get the positive benefit for their arthritis.

Be assured that new biologic therapies are in clinical trials. There are also more drugs in the early stages of development. In the meantime, rheumatologists advise patients to be patient with the trial and error process needed to find the right mix of medications.

Sometimes it can take several years or more. The use of more than one medication at a time does work better than monotherapy (single drug use). The use of triple disease-modifying antirheumatic drugs (DMARDs) is effective and not more toxic than monotherapy.

Today’s disease-modifying antirheumatic drugs (DMARDs) have changed the outlook for many people with rheumatoid arthritis (RA). Patients should see a decrease in joint swelling and tenderness.

With improved motion, they also have better function and fewer limitations. Lab tests also show measurable improvement of inflammation. X-rays confirm a slowing of the disease process.

Helping people mainatin their physical functioning reduces disability and improves quality of life. Twenty years ago, many people ended up on disability and were unable to continue working. Today, that scenario is far less common.

Some patients do not respond to the new medications. Scientists think this is because there are many mechanisms behind RA. They may not all be based on joint inflammation. Solving the mystery of RA will eventually lead to drugs that are effective without toxic side effects.

A recent review by the Cochrane Collaboration reports that any form of exercise will improve balance. Some types may work better than others. Even sitting exercises can make a difference.

These conclusions came from 34 randomized, controlled studies. Almost 3,000 healthy adults were involved. Most were over the age of 75. The exercise programs that were reported on included walking, dance, and Tai chi. Specific strength-training and balance programs had the best results.

But any activity that required movement, coordination, and strength also had an indirect effect on balance. More studies are needed to find out which type of exercise is best. It may be possible that each person has a different need and would respond best to a specific exercise program.

Simply practicing standing on one leg without support may be a good place to start. You can do this any time you are standing in line at the grocery store, while brushing your teeth, or even talking on the telephone.

If you tend to lose your balance and are at risk for falling, then hold on to a sturdy object at first. Keep the foot you are lifting off the floor close to the floor. This will allow you to touch your toes back down to regain balance if you start to sway too far.

As the old saying goes, practice makes perfect so try to do some type of balance activity every day. If you miss a day or two, just start over and keep it up. Good balance is good prevention against falls, fractures, and injuries that can result in loss of function and disability — especially in our older years.

The National Institute on Drug Abuse did a survey that may help answer your question. They reported that if every worker between the ages of 18 and 40 were tested on any given day, up to 25 per cent would test positive for substance use.

The National Institute of Mental Health did another survey of work days lost to disability related to mental disorders. They found that 1.3 billion disability days were linked to mental disorders.

Alcohol or other drugs contributes to a significant portion of lost work days. But disability days due to other problems such as neck and back pain are far more common. Other common physical and mental conditions that lead to lost work days include cancer, heart disease, diabetes, anxiety, and impulse control disorders.

Many of the large box companies employ workers who operated forklifts or other similar types of equipment. Lifting and loading may be another job duty. Contact with the public is also common. All of these responsibilities require clear thinking and a safety-minded approach.

Alcohol and other drugs can cloud judgment and lead to workplace accidents and disability. Many large companies have started pre-employment screening as one way to combat lost money and productivity attributed to substance use and abuse.

According to a recent study by the National Institute of Mental Health, billions of days are lost each year due to mental disorders. Twice as many days are lost to physical disorders. Together, mental and physical disability days total 3.7 billion in the United States.

Not only are employers affected, but so are families and the workers themselves. There is a definite need for more study to look into these problems and find both solutions and ways to prevent them in the first place.

Social and psychologic stresses have been shown to be an important part of physical disability due to neck and back pain. But other problems such as cancer, diabetes, heart disease, and arthritis also contribute to work loss.

Substance abuse, mood disorders, anxiety, and other mental health issues are responsible for mental health days. On average, workers with any of these physical or mental disorders lose 32.1 days of work per year.

There may not be a single answer to this problem. Results of studies so far suggest that physical, psychologic, and social factors must all be addressed. Finding risk factors that can be reduced or avoided is the first step. Identifying people at risk will also be important. Then workable solutions can be found.

Osteoporosis is a condition caused by decreased bone density that results in brittle bones. Fractures, especially vertebral compression fractures of the spine and hip fractures are a common problem with osteoporosis.

In many people, this disease is asymptomatic or silent with no obvious symptoms. A gradual loss of height and/or rounded upper back may be the first signs of a problem. Some older adults complain of back pain. In other cases, bone fracture is the first indication of osteoporosis.

Measurements of bone mineral density (BMD) can be used to look for osteoporosis. In men, hip BMD can be used to predict the risk of hip fracture. BMD is tested using a special scanning device. Results are given as a T-score. A T-score less than -2.5 is defined as the cut off for osteoporosis in men.

If you have concerns about your father, these can be addressed by his primary care physician. A history will be taken, a physical exam performed, and risk factors will be assessed.

Baseline testing can then be ordered if needed. This is the best way to find out for sure if your father is at risk or in need of prevention or treatment for this potentially disabling disease.

There are genetic, environmental, and hormonal factors in men that can lead to bone loss and osteoporosis. Sometimes it is related to some other disease or condition but in up to half of all cases, the cause is unknown.

The effects of aging is probably the most common cause in men 70 years old and older. After age 50 to 60, there’s a natural decline in hormones that contributes to osteoporosis. Certain changes in genes affecting bone may also put some men at risk.

Prostate problems that result in the loss of the prostate and decline in hormones can also lead to osteoporosis. Other medical problems can also lead to osteoporosis. This can include thyroid dysfunction, GI problems, and other chronic diseases of the liver or lungs.

Your brother may not have any of these risk factors. As mentioned, there are some men who develop osteoporosis with no known cause. Treatment will depend on an accurate diagnosis. If the physician can find a specific cause, then management is aimed at that problem. If not, then measures are taken to supplement calcium and vitamin D. Drugs to restore bone may also be used.

Milk-leg is a term for what we know in modern day language as phlebitis, thrombophlebitis, or thromboembolism. This is also known more simply as blood clots.

Back in the 1700s, it was thought that this condition occurred as a result of milk retained in the blood vessels. There may be a connection between drinking raw milk and phlebitis.

In some rare cases, brucellosis found in raw milk has been associated with blood clots. Brucellosis is an infectious disease transmitted from animals to humans. It is caused by the Brucella bacteria.

Obstructing clots in the veins often travel to the lungs, causing death. Today, thromboembolism in pregnant women is treated successfully with low-dose heparin. Heparin is an anti-coagulant (clot buster). It does not cross the placenta to the fetus.

Although death can still occur from this problem, it is rare today in developed countries or with proper medical care.

Good question! Falls leading to fracture is the number one cause of disability in older adults. Exercise IS the answer! And it’s never too late to start.

Studies show that any kind of exercise helps maintain and even improve balance. Specifically, exercise that moves you away from your center of balance is ideal. Many seniors have added programs such as yoga and tai chi to their regular exercise of walking, biking, golf, or swimming.

Activities that challenge your balance seem to have the greatest benefit. But even riding a stationary or recumbent bike has been shown to improve balance. Strength-training with weights or resistance of some type (e.g., elastic bands) keeps your muscles strong and toned, ready for any challenges to your center of balance.

But a program of exercise that isn’t kept up may result in a loss of skills, strength, and balance. All older adults should maintain a daily program of some type of exercise and activity. If illness or injury causes a setback, then try to resume any kind of exercise and level of activity possible as quickly as you can.