The following are common conditions treated by our physiotherapists and chiropodists

The Shoulder

Impingement Syndrome

This primarily involves the impingement of the rotator cuff, subacromial bursa, and/or the bicep tendon by the boney coracoacromial arch. Typical symptoms experienced with impingement are:

• Pain on the outer aspect of the upper arm, possibly extending below the elbow.
• Sharp twinges felt on various movements, such as putting on your jacket or reaching above shoulder level.
• It is usually a gradual onset with no known injury to the shoulder.

Management - Typical treatment for impingement syndrome involves the use of ultrasound, friction massage, instruction on appropriate use of the arm, and a re-strengthening program.

Instability

Shoulder instability can be caused by general weakness of the muscles surrounding the shoulder joint (the rotator cuff) or damage to the internal and/or external joint structures (joint capsule, ligaments, and/or labrum).

Patients who have instability due to general weakness will complain of discomfort brought on by certain arm positions or activities.

Patients who have experienced a significant injury causing damage to the shoulder structures often describe a feeling of the shoulder ?slipping out of the joint? momentarily but going back into place spontaneously. Apprehension of certain arm positions is a common feature as well.

Management ? The strength of the rotator cuff muscles is the single most important consideration in managing shoulder instability. Strengthening exercises of the rotator cuff and scapular stabilizing muscles are critical to optimal recovery and will be the focus of rehabilitation.

Adhesive Capsulitis ? Frozen Shoulder

What is involved in the condition is tightening of the joint capsule which surrounds the shoulder joint. This results in restricted, painful movement which often interferes with daily activities and may interrupt sleep.

Symptoms patients often complain of are:

• Pain on the outside of their upper arm, possible extending down below the elbow.
• Pain experienced varies from a constant dull ache to pain felt only on activities involving movement in the restricted ranges.
• Being awakened at night when rolling onto the painful shoulder.
• Very gradual onset of pain, possibly related to minor injury, immobilization, chest surgery, or myocardial infarction.

Management ? Ice/heat and gentle joint mobilization, active assisted range of motion exercises, a strengthening exercise program, posture re-training if needed as well as ultrasound and more aggressive joint mobilization as the condition improves.

The Elbow and Forearm

Elbow Tendonitis

This is a very common condition involving inflammation of the tendons crossing the elbow. There are three groups of tendons which can be involved, the lateral, the medial, or the posterior compartments.

Symptoms that patient's experience are:

• Pain over the inside, outside, or back of the elbow, depending on which tendons are involved.
• The onset of pain is usually gradual. It may be related to wrist extension activities (lateral tendonitis) or wrist flexion and downward rotation (medial tendonitis).
• The pain varies from a dull ache or no pain at rest to sharp twinges or a straining sensation with activities.

The Wrist and Hand

Carpal Tunnel Syndrome

The cause of this syndrome varies from a displace fracture, a joint dislocation, swelling of a tendon sheath, to decreased blood supply to a nerve at the carpal tunnel.

The onset of symptoms is usually gradual and unexplained, unless they follow an injury of the wrist. The symptom most often mentioned is a pins and needles sensation in the first three or four fingers.

The Hip

Degenerative Joint Disease (osteoarthritis)

DJD is the most common disease affecting the hip. There are two types of DJD, primary and secondary osteoarthritis. Primary osteoarthritis is considered a result of aging alone; secondary osteoarthritis occurs when the condition follows previous damage by disease or mechanical injury.

The patient often describes an unexplained onset of pain in the groin or outer hip region. This pain is first noticed after prolonged use of the joint, such as long periods of walking. As the condition progresses the pain may extend down into the thigh and knee. Rarely is pain referred below the knee.

The Knee

Patellar Tracking Dysfunction

This is a condition in which the patella, or knee cap, tends to be pulled too far outwards each time the knee is straightened under load. This causes the patella to move abnormally within the patellar groove of the femur, or thigh bone. The result is a low grade, painful inflammatory response.

Typical complaints of a patient presenting with patellar tracking dysfunction are a gradual onset of pain, pain felt primarily over the inside aspect of the knee, and pain aggravated by activities involving increased patellofemoral compressive stresses, such as descending stairs and sitting with knees bent for long periods of time.

The Ankle

Ankle Sprain

The most common injury affecting the ankle is a sprain or tear of one of the many ligaments.

The patient will always experience immediate pain following a traumatic incident causing the injury. The level of pain experienced depends on the severity of the injury, however, the degree of pain and disability does not always correlate well with the severity of the injury. A person sustaining a mild or moderated sprain may experience more pain than one who completely ruptures a ligament. This is because the ligament has been completely severed and there are no longer intact fibers to be stressed, from which pain can be elicited.

The Neck

Whiplash

The mechanism of injury for whiplash is acceleration of the head and neck relative to the body. It usually results from the collision of two automobiles, but can also result from contact or high-velocity sports such as football or skiing.

The patient will generally feel very little pain or stiffness immediately after the accident. As the large muscles swell and develop spasm, the patient will note onset of muscle soreness, stiffness, and swelling. Active range of motion will be limited with muscle spasm associated. As the larger muscles heal and are no longer swollen or tender the original pain is replaced by deep, aching pain that may be referred to the head, the upper back, or the upper limb. The range of motion will continue to improve as the tissues heal.

The Lower Back

Intervertebral Disc Prolapse

This is when the intervertebral disc bulges against a ligament, tissue surrounding the spinal cord, or a nerve root. The pain associated with this varies from a dull, deep, poorly localized pain in the lower back to a sharp nerve pain that can extend into the buttock and thigh.

Feet

We see and treat an enormous variety of foot problems every day. It would be impossible to list all of them here. However, here are some of the most common problems we see on a regular basis and some of the treatments we employ: