Chiropractor Chandler AZ – Carpal Tunnel Syndrome

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this morning to write about Carpal Tunnel Syndrome.  Carpal Tunnel Syndrome is one of those syndromes that we have all heard about, but we seem to be hearing less and less about it every year.  A few years ago it was the diagnosis everyone got when their wrists hurt, which lead to a lot of misdiagnosis, which in turn, lead to a lot of people having surgery for something they did not have.  Furthermore, Carpal Tunnel Syndrome can generally be treated without surgery.

The image above by MMG 2003 clearly shows compression of the Median Nerve in the right hand, which is the cause of Carpal Tunnel Syndrome.  The reason I mention that it is the right hand is because the image below by 2004 MedicineNet, Inc. will demonstrate the area of pain and numbness, but it is showing it in the left hand.

The Median Nerve runs through runs through the Carpal Tunnel created by the Transverse Carpal Ligament and the carpal bones, which are the bones of the hand.  Carpal Tunnel Syndrome can occur through compression from ganglions, fractures, and dislocations; however, it is more common to have a history of direct pressure on the tunnel or a history of extended periods of wrist use in full flexion or extension.  The pressure in the tunnel will increase with these extreme positions.  Other additional factors have to do with fluid retention such as with pregnancy, RA, diabetes, and connective tissue disorders.  It has also been shown that individuals who are deficient in vitamin B may be predisposed.

Treatment for Carpal Tunnel Syndrome does not have to include surgery.  Initial treatment involves night splinting in in extension of neutral positions, avoiding the compressive or overuse activities such as resting the wrists on the desk while typing, and perhaps the use of a B-complex vitamin.  It has been shown that adjustments to the lunate bone, one of the carpal bones, is extremely helpful.  Myofascial release techniques such as Active Release Technique (ART) and Graston Technique are also utilized to help relieve the pressure within the Carpal Tunnel.

If you are struggling with Carpal Tunnel Syndrome or any other form of Wrist Pain or Hand Pain, call my office today (480) 366-4041.  We can Help!

Chiropractor Chandler AZ – de Quervain’s Tenosynovitis

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer trying to squeeze this article in between patients this afternoon.  Today I am going to focus on a tendinitis in the wrist known as de Quervain’s Tenosynovitis.  This is a very common condition, but most doctors just says you have Wrist Tendinitis or Thumb Tendinitis, but the actual name is de Quervain’s Tenosynovitis also known as Stenosing Tenosynovitis.

The image above gives a great example of what we see with de Quervain’s Tenosynovitis.  There is chronic microtrauma to either the tenosynovium or the tendon sheath causing a narrowing of the area surrounding the abductor pollicis longus and extensor pollicis  breveis muscles.  Pollicis meaning thumb.

These patients come into my office complaining of pain on the thumb side of the wrist with a history of activities that require forceful gripping with bent towards the little finger or repetitive use of the thumb such hitting the space bar all day long typing.

Treatment for this condition is rather simple.  Modification of the inciting activity is a must along with ultrasound therapy, Kinesiology Tape to relieve pressure on those muscles, and ibuprofen.  If this does not relieve the pain within 2-3 weeks use of a thumb spica may be necessary.  If none of these conservative efforts are successful referral for a local steroid injection would be made.

If you are struggling with Wrist Pain or Hand Pain, call my office today (480) 366-4041.  We can Help!

Chiropractor Chandler AZ – Little League Elbow

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this morning in preparations for Spring Training and the start of the Little League baseball season I thought it would be could to write about Little League Elbow, which is becoming more and more prevalent with the specialization in sport that kids are moving to these days.

In the image above by MK Carlton, we are able to see the possible injuries in young baseball players sustained from pitching all called Little League Elbow.  In all reality Little League Elbow is a syndrome.  The repetitive valgus (a valgus deformity is a term for outward angulation of the far end of a bone or joint) stress brought on by pitching causes a stretch injury to the inner portions of the elbow and a possible compression injury to the outer portions of the elbow as seen in the image above.  Pain at the inner aspect of the elbow is due to microtrauma to the medial anterior oblique ligament as well as causing accelerated growth and fragmentation of the medial epicondylar growth plate.  On the outer aspect of the elbow osteochondritis dissecans (Osteochondritis Dissecans of the elbow is a condition that causes pain in the elbow of children 8 to14 years of age. It most commonly involves the portion of the humerus called the capitellum, which helps to form the elbow joint and allows the forearm to rotate, turning the palm up or down.) of the capitellum with the possibility of injury to the head of the radius bone, including premature closure of the growth plate.

These patients usually come into my office as teenage baseball pitchers complaining of pain on either the inner or outer aspects of the elbow.

Two different routes can be taken depending on the severity of the injury.  If the x-rays show changes to the bones and growth plate an orthopedic consultation is necessary; however, if the x-rays are normal, rest from pitching needs to happen immediately.  Also, modifications to pitching mechanics must be made, specifically to how the curve ball is pitched.

If you are struggling with Elbow Pain, contact my office today (480) 366-4041.  We can Help!

Chiropractor Chandler AZ – Posterior Impingement Syndrome

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this morning to write a little bit more about injuries to the elbow.  Today, I will be reviewing a condition called Posterior Impingement Syndrome.  We hear more about Shoulder Impingement Syndrome, but it can also occur in the elbow as well.

 

In the image above we have a clear picture of the elbow joint.  Posterior Impingement Syndrome is caused by the repetitive extension of the elbow that leads to compression on the back side of the elbow between the ulna, which is the bone on the bottom and the humerus, which is the bone on the top.  This may cause what is called a reactive synovitis (Synovitis is the inflammation of a synovial (joint-lining) membrane, usually painful, particularly on motion, and characterized by swelling, due to effusion (fluid collection) in a synovial sac.) or progress to degeneration and the production of osteophytes (bone spurs) or loose bodies as seen in the image above, which is seen by the top arrow.

These patients usually come into my office complaining of sharp pain on the back side of the elbow, especially on rapid extension of the elbow.  There may be associated complaints of popping or clicking with extension of the elbow or an occasional locking of the joint.

Management of this condition varies depending on if there are loose bodies or not.  If there are loose bodies, the individual will be referred to an orthopedic surgeon for surgical consultation.  In all other cases rest and ice is needed, and the patient is taped in a manner so as to not be able to fully extend the elbow.

If you are struggling with Elbow Pain, call my office today (480) 366-4041.  We can Help!

Chiropractor Chandler AZ – Triceps Tendinitis

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this evening to talk about an injury that we do not hear about too often in Triceps Tendinitis.  It is also known as Posterior Tennis Elbow.  Triceps injuries have been getting a little more publicity over the past few weeks with the Baltimore Ravens star middle linebacker Ray Lewis having torn his, and star defensive tackle Justin Smith of the San Francisco 49ers injuring his triceps as well.

In the image above by MMG 2000 we are able to clearly see the triceps tendon.  Irritation or strains of the triceps tendon are usually due to common athletic skills performed by boxers, weight lifters, pitchers, shot-putters, and some tennis players.

These patients typically come into my office complaining of pain at the tip of the elbow after performing an activity that required repetitive straightening of the elbow, or one single event that required forceful straightening of the elbow.

Treatment for Triceps Tendinitis is quite simple.  Myofascial release techniques such as Active Release Technique (ART) and Graston Technique are implemented to encourage healing and to prevent scar tissue formation.  Ice and rest from the activity that caused the pain is essential.  If the individual is working out the amount of weight utilized during elbow extensions needs to be reduced.

If you are struggling with Elbow Pain, call my office today (480) 366.4041.  We can Help!

Chiropractor Chandler AZ – Golfer’s Elbow

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this morning to piggyback on the article I wrote the other day on Tennis Elbow and write one on Golfer’s Elbow today.  Golfer’s Elbow is also known as Medial Epicondylitis affecting the inner portions of the elbow differing from Tennis Elbow that affects the outer portions of the elbow.

Tennis Elbow is an injury that affects the muscles that extend the wrist, and those muscles originate from the bump on the outer portion of the elbow.  This bump is where the pain is felt with Tennis Elbow.  Golfer’s Elbow is an injury that affects the muscles that flex the wrist, and those muscles originate from the bump on the inner portion of the elbow.  And, as you may have guessed, this is where the pain is felt with Golfer’s Elbow.  Golfer’s Elbow is believed to be a tendinopathy (The term tendinopathy includes both inflammation and microtears, but many doctors may still use the term tendinitis to describe a tendon injury.) of those muscles that flex the wrist as well as the pronator teres muscle.

These patients come into my office complaining of pain on the inner portion of the elbow following activities that require a lot of repetition such as hammering or using a screwdriver.  In athletes, it usually occurs when flexing and pronation (rotating the hand towards the ground) such as in serving an overhead and forehand strokes.  Golfing or throwing may also cause symptoms.  These patients occasionally complain of pain or weakness when gripping.

Treatment for Golfer’s Elbow is no different than that of Tennis Elbow other than we would apply the Kinesiology Tape on the opposite side of the arm to relieve the tension being placed on the wrist flexor muscle group.  Myofascial release techniques such as Active Release Technique (ART) and Graston Technique have proven to be very beneficial with this injury, and they are utilized to prevent scar tissue formation and encourage healing.  Manipulation of the wrist and elbow have proven to be very effective as well.

If you are struggling with Golfer’s Elbow or any other sort of Elbow Pain, call my office today (480) 366-4041.  We can Help!

Chiropractor Chandler AZ – Tennis Elbow

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer during my lunch to write about a topic we have all heard about.  In fact, when we think of Elbow Pain, the first thing we think about is Tennis Elbow, also know as Lateral Epicondylitis.  Today, I will be explaining what Tennis Elbow is, how we get it, and how we go about treating it.

There are many different theories out there as to what is the cause of Tennis Elbow; however, the theory that currently has the most backing right now is that initially there is a tearing of the extensor carpi radialis brevis at its origin.  There also may be some tearing in the extensor digitorum communis or the extensor carpi radialis longus.  All of these muscles have a primary responsibility of extending the wrist back, and a secondary responsibility of flexing or bending the elbow.  Repetitive movements that require forceful extension of the wrist, radial deviation (moving the wrist toward the thumb), and supination (holding the hand in a cupping position) are the most common causes.  Although it has been linked to tennis, other sports and occupational activities are also causes.  Meat cutters, plumbers, carpenters, and others  with similar jobs requirements are all affected.  With tennis, beginning players with poor backhand technique account for the majority of all cases.  With professional players, the forehand or serving are generally the cause.  The more frequent the individual plays, the higher risk they have of developing this injury.

In the acute cases, ice and rest from activities causing the discomfort.  Use of a splint on the wrist at 30-45 degrees of extension may be required to impose rest to relieve the tension on the extensor carpi radialis brevis.  This can also be done with Kinesiology Tape.  Myofascial release techniques such as Active Release Technique (ART) and Graston Technique are very effective to encourage healing and prevent scar tissue formation.  Mobilization of the wrist has proven to be very effective as well.

If you are struggling with Tennis Elbow or any other Elbow Pain, contact my office today (480) 366-4041.  We can Help!

Chiropractor Chandler AZ – Little Leaguer’s Shoulder

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this afternoon to review a topic known as Little Leaguer’s Shoulder.  This is something that concerns me a lot because both of my older boys are playing baseball, and the oldest has just reached the level where the boys start pitching to each other.  Furthermore, I am certain that he will be doing some pitching.

In the image above by RelayHealth, we can see the damage that is done with Little Leaguer’s Shoulder.  Rotational stresses on the growth plate of the humerus up near the shoulder results in a Salter-Harris Type 1 fracture in pitchers who over-pitch or pitch to frequently.  More rarely, this may cause a Salter-Harris Type 2 fracture.  The different types of Salter-Harris fractures can be seen in the image below.

These individuals come into my office complaining of shoulder pain that occurs mainly when throwing hard.  The pain began as a very minor pain, but over time it progresses to a substantial amount of pain.  They are able to point directly to the point of pain in the arm near the shoulder.

With this condition there is no agreed upon course of treatment; however, it is recommended that the arm be rested for a minimum of three months, and it made need up to a year.  Once it has healed, gradual return to throwing is needed with pain be a limiting factor.  Complications of Little Leaguer’s Shoulder include avascular necrosis, loose bodies, and early closure of the growth plate.

If you are struggling with Shoulder Pain, call my office today (480) 366-4041.  We can Help!

Chiropractor Chandler AZ – Shoulder Separation

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this afternoon to quickly receive a condition that I see quite often in my office, and that is the Shoulder Separation also known as Acromioclavicular Separation or AC Separation, not to be confused with a Shoulder Dislocation.  We often hear people say that they separated their shoulder, but what does that mean?  Today, I will answer that question.

In the image above by Healthwise, Incorporated, we can easily see the three different grades of an AC Separation.  The grades of the AC Separation are based on the severity of the injury.  There are also six different types of AC Separations based on the directionality of the collar bone after separation.  Grade I (first degree) indicates some tearing of the AC ligament, but there is no instability.  Grade II (second degree) indicates a rupture of the AC ligament, and Grade III (third degree) involves tearing of the coracoclavicular ligaments.  Both the Grade II and the Grade III separations are unstable.

These patients usually come into my office with shoulder pain following either a fall on an outstretched arm or a fall  onto the top of the shoulder.  I see the fall onto the top of the shoulder mainly in football players, mostly quarterbacks, and we see the fall on the outstretched arm in football players; however, I see it a lot in my extreme sports patients such as skateboarders, BMX riders, motocross, cyclocross, and so forth.

All AC Separations can be treated conservatively; however, Grade III separations will leave a permanent bump as depicted in the image below, and for some patients may be a site for minor persistent discomfort.  Surgery is an option for those that require cosmetic perfection, or for those that attempted conservative care and are not back to full function.  Standard care for an AC Separation includes some time in a Kinney-Howard sling followed by mild isometric and on to isotonic exercises with the focus being the deltoid and upper trapezius muscles followed by biceps and pectoral exercises.  This is also couple with soft-tissue therapies such as Active Release Techique (ART) and Graston Technique to encourage healing and prevent scar tissue formation.

If you are struggling with Shoulder Pain contact my office today (480) 366-4041.  We can Help!

Chiropractor Chandler AZ – Rotator Cuff Tear

Your friendly Chiropractor in Chandler AZ, Dr. Dan Rae, is back at the computer this afternoon trying to catch up on all the things that got pushed aside during the holiday season.  Today I want to address a condition known as a Rotator Cuff Tear or a Strained Rotator Cuff.  This is something that I see quite often because I have come to be known in the community here as somewhat of a shoulder guru.

The rotator cuff is made up of four different muscles known as the supraspinatus, infraspinatus, teres minor, and subscapularis, also known as the SITS muscles.  The most common tears occur in the supraspinatus.  There is typically two different areas where the tears occur in the supraspinatus.  One occurs where the arm and shoulder blade form a joint known as the articular sided tear, and the other occurs next the fluid-filled sac known as bursa, which would make it the bursal sided tear.  Most partial tears are articular sided and may be related to poor blood flow to the area.  Tears can be due to trauma, but most often they are due to chronic degenerative changes to the tendon.  Thus, leading to patients complaining of shoulder pain, but they do not know why they have shoulder pain because they have not experienced any trauma.

The patients that I see in my office generally give some sort of history of an acute traumatic event such as lifting a heavy object or a fall on an outstretched arm.  Older patients may not even recall any sort of traumatic event.  These individuals usually complain of pain with overhead activities or weakness in lifting the arm.

Partial tears can be treat in my office with great results.  We do this by implementing soft-tissue therapies such as Active Release Technique (ART) and Graston Technique to stimulate the healing process.  Kinesiology Tape is also used to help encourage the muscles to function properly as well as stabilize the shoulder.  Rehabilitation begins with isometric exercises gradually leading to to a strengthening program.  Complete tears usually require surgical repair in younger individuals.

If you are struggling with Shoulder Pain, call my office today (480) 366-4041.  We can Help!