In order to cure or relieve pain, it is important to confirm and understand the source of the pain. Treating the symptoms may be just as detrimental, or worse, than no diagnosis at all. Therefore, it is important that before a treatment plan is started, the cause of the pain has to be addressed.

The following are some of the more common injuries and conditions that may pertain to your pain syndrome. Please note that all these conditions range in severity from one person to another, and recovery depends on several factors which include the timeliness of treatment, age, lifestyle, weight, prior injuries, prior surgeries, and diseases other conditions such as diabetes or auto-immune disease may be factors in what procedures can be performed and the ability of the patient to recuperate.

Therefore, when reading about diagnoses, surgical procedures and the recuperation time, please keep in mind that this website is meant to provide you with general information. Each individual patients diagnosis, treatment options and recovery should be thoroughly discussed with your physician and surgeon, and if necessary, a second opinion may be appropriate.

HEADACHES

There are many factors that can cause headaches:
  1. Headaches can be caused by side effect of medication or intoxication
  2. Headaches can be a result of a hormonal imbalance
  3. Headaches can be caused by stress
  4. Headaches can result from injury or instability in the neck.
  5. Headaches can also be the result of injury or instability of the jaw.
  6. Headaches may be the sign of a more serious condition such as a stroke, high blood pressure or diabetes.

The different types of the headaches are easily diagnosed via physical examination, and occasionally blood tests, CT scan or MRI of the brain is necessary to rule in or rule out possible artery blockage or tumors. However most headaches are treated with conservative measures such as medication specifically designed for specific types of headaches, gentle chiropractic manipulation of the neck and acupuncture/

A rare type of headache is called a CLUSTER HEADACHE. Although this type of headache is the least common, it is also the most severe. Cluster headache suffers describe the pain as intense pain that has a throbbing or stabbing quality, behind the eye, that is constant, and so severe that the sufferer may not be able to sit still or lie down. However the sufferer must pace during an attack. The term "cluster headache" refers to headaches that attack in groups, i.e., several times per day, during a period of time that lasts anywhere from two weeks to three months at a time. The headaches may disappear completely for months or years, only to recur.

SINUS HEADACHES are described as “tightening” pain in the forehead and nose that radiates into the cheeks. The pain can be exacerbated with head movement or straining and is associated with nasal discharge, feeling of ear aches, fever, and facial swelling.

Headaches that start in the neck and radiate into the back of the head, onto the crown, are known as CERVICOGENIC (serv-ih-koh-GEN-ik) HEADACHES, or headaches that originate in the neck. These headaches are described as “throbbing” pulsating” headaches usually caused by instability in the cervical spine, and/or muscle spasms.

A type of headache that has its own category is known as a MIGRANE (MY-grane) HEADACHE. The exact causes of migrane headaches are still unknown. There are a number of factors that may trigger migrane headaches, including chemical or hormonal imbalances, hereditary factors, and structural issues that include arterial contractions or even traumatic injury to the head, face or neck.

Migraine pain is described as “pounding, throbbing” pain that may be behind one eye or the other, and can last from four hours to two days. Symptoms include sensitivity to light, noise or odors; nausea or vomiting; loss of appetite; and a abdominal pain.
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TMJ PAIN

Injury to the jaw, dental disorders, teeth grinding or even instability or injury to the neck can cause a type of jaw pain and headache known as TEMPOROMANDIBULAR (temp-OR-oh-man-DIB-u-lar) JOINT SYNDROME . This is pain that is described as “sharp” pain that radiates either from the neck into the jaw or from the jaw into the neck. Sudden movements of the neck, chewing or teeth grinding (during sleep) exacerbate the pain. TMJ syndrome is diagnosed via physical examination, and often a dentist or TMJ specialist is needed to make a mouth guard to alleviate the symptoms.
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SPINE

The spine is made up of twenty six bones called VERTEBRA (ver-teh-BRA) and support the whole body. Twenty-four of the vertebrae are separated by spongy substances called discs. The human spine is divided into five parts: The CERVICAL (serv-i-KUL) spine, the THORACIC (thor-AK-sik) spine, the LUMBAR (LUM-bar) spine, the SACRUM (SAKE-rum) and the COCCYX (KOK-siks). Nerves exit holes in each vertebra, from the cervical spine, through the thoracic spine and ending half way through the lumbar spine. The nerves exit out of holes in the vertebra, called “foramen” (for-AA-men) and branch out to innervate most of the body.

For example, the nerves exiting the cervical spine, innervate the shoulders, arms and hands. Nerves that exit the thoracic spine innervate the vital organs in the thorax such as the heart, stomach, spleen, pancreas, etc. Nerves that exit the lumbar spine innervate the organs in the pelvis as well as the buttocks, legs and feet.

Because pain in the neck, upper, middle or lower back can come from so many sources, i.e., fractures, disc herniations, muscle strains, there are multiple diagnostic tools the physician will use in order to come up with a correct diagnosis. A complete history and physical examination are key diagnostic tools, in order to determine whether the pain comes from a traumatic injury, congenital deformity (birth defect), organic disease, or a combination. Finally, MRI studies of the spine can determine whether there is a disc herniation, at what level or levels or the spine, the size of the herniation, and whether or not the disc is impinging on the nerve root, causing pain that may radiate into the hips and/or the legs. The sooner the correct diagnosis is ascertained, the better the chances for a faster recovery.
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CERVICAL SPINE

The CERVICAL SPINE is made up of seven (7) vertebra. It is the narrowest part of the human spine, but its main function is to hold up, turn, bend and extend the entire head. If you think about it, its like holding up a bowling ball with a drum stick. The cervical spine is definitely an area in which stability was sacrificed for mobility, making the neck vulnerable to injury.

Injuries to the neck, or cervical spine can cause symptoms in other areas of the body, including headaches, shoulder and arm pain, numbness, and tingling in the arms and fingers and pain in the upper back.

Injuries to the cervical spine can cause headaches, known as CERVICOGENIC (serv-ih-ko-GEN-ik) HEADACHES, which are headaches that come from the neck. Disc bulges in the cervical spine can cause cervicogenic headaches, or pain radiating into one or both shoulders, arms and fingers, and the patient may experience numbness and tingling in one or both hands.

Additionally, a disc bulge in the cervical spine can impinge on the nerve roots that exit the various levels of the spine and cause pain, numbness and tingling in the arms and hands. A disc bulge is diagnosed by orthopaedic physical examination and MRI studies of the cervical spine. Treatment may include non-steroidal anti-inflammatory medication (NSAIDS), gentle chiropractic manipulation, physical therapy and sometimes series of EPIDURAL (ep-ih-DUR-al) INJECTIONS, in which a steroid is injected at the sight of the disc to shrink the bulge. As a last resort, a DISCOGRAM (DIS-koh-gram) is performed to determine which levels cause the pain. This procedure is performed by a pain specialist or an orthopaedic surgeon in which dye is injected into the “epidural space” and the effects are viewed under radiographically.

As a last resort, a MICRODISCECTOMY (mik-ro-disk-EK-to-mee) may be performed by an orthopaedic spine surgeon or neurosurgeon, who will surgically drill a hole into the “lamina” (LAM-in-ah) of the vertebra to open the spinal canal. Then the surgeon will use an illuminated microscope to carefully visualize all the structures in the spine. The surgeon will then remove all loose disc material away from the nerve root and disc. After the surgery, it will take approximately two to three months for the disc to regenerate.

Recovery will usually take longer than with the lumbar spine because the vertebrae in the cervical spine are smaller. Additionally, incisions made in the muscles in back of the neck called “paraspinal muscles”, take a long time to head, because the patient uses those muscles to move the head to look right, left, up and down. However, utilizing pain medication and physical therapy post surgically, the success rate is high.
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THORACIC SPINE

The THORACIC SPINE, also known as the dorsal spine, comprises the rear of the thorax. It is made up of twelve (12) vertebrae, and holds up the trunk of the human body. It is the most rigid part of the spine because each of the twelve vertebrae are attached to one or two of the twelve ribs. The thoracic spine is vulnerable to injury because, it is the longest part of the spine, and articulates with the cervical spine and lumbar spine.

Traumatic injury to the thoracic spine can also cause injury to the ribs, sternum, and if extremely traumatic, can cause injury to the organs, especially the lungs. The thoracic supports the rib cage which, with the sternum in front, houses vital organs such as the heart, lungs, pancreas, spleen, stomach, kidneys and liver. Strains to the muscles of the thoracic spine can be painful and take a long time to heal.

A non-traumatic pathology of the thoracic spine can include scoliosis. The thoracic spine has a natural curve that is convex toward the back of the body, called a KYPHOSIS. (kye-FOH-sis). However, when the thoracic curve goes sideways, either toward the left or right, it is called a SCOLIOSIS (skol-ee-OH-sis) or SCOLIOTIC (Skul-ee-AH-tik) curve. A scoliotic curve is sometimes detected during young childhood, but is more likely detected during adolescence. It is more common in girls than boys, at a 3:1 ratio. A scoliosis can usually be corrected non-surgically with a brace, chiropractic manipulation and/or physical therapy.

However, if the scoliosis is very unstable, and conservative treatment fails, surgical intervention may be the only option, especially if the curve is has a convexity too much toward the left, (also known as a “levo-scoliosis” (LEE-voh Skol-ee-OH-sis), which may cause displacement of the heart, stomach and spleen. Scoliosis with the curve toward the right is known as a “dextro-scoliosis” (DEX-tro skol-ee-OH-sis), which is why surgical intervention may be necessary when conservative measures have failed.
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LUMBAR SPINE

Like the cervical spine in the neck, the LUMBAR SPINE has a “lordotic” (lord-AH-tik) CURVE; that is, a curve that is slightly concave toward the front. However, when the lordotic curve has too much of a concave curvature, which is common in pregnant women and obese people, low back pain can occur. The lumbar spine is made up of five vertebra. The nerves that exit the lumbar vertabra, also known as “foramina” (for-AM-in-ah) innervate the organs of the pelvis, legs and feet.

In fact, the nerves that exit the five lumbar vertebra, join together to form two nerves, called the “common peroneal” (per-OHN-ee-al) nerve, and the “tibia” (tib-EE-al) nerve. They join together and form the SCIATIC (si-A-tik) NERVE.

The sciatic nerve is the largest nerve in the human body. It is as thick as your thumb and travels from the buttocks, down the back of the thigh, and separates again near the back of the knee, The two separated braches travel down to each side of the leg and end at the ankle. Injury to the lumbar spine, such as disc bulges, can cause extreme pain that radiates into the hip(s) and/or leg(s). A disc is a spongy substance situated between the vertebrae and acts as a shock absorber. The discs also prevent bone-on-bone friction. If you were to look downward at a disc, it looks like a slice of a tree trunk, with many rings. There is a nucleus (NU-klee-us) is the center of the disc and is surrounded by the annulus (ANN-ul-us), which is comprised by rings. In the case of a disc bulge, the bulge may or may not impinge on the nerve root. Sometimes there are small “annular (ANN-ul-ar) tears” when the disc bulges. A tear of the rings can releases chemicals that are also a source of pain. If the disc ruptures, the pain can be unbearable, but is dependent on how much material ruptures out of the disc, and precisely where the rupture takes place.

Diagnosis of lumbar spine pain consists of a history, orthopaedic physical examination, x-rays to determine if there is a SPONDYLOSIS (spon-dill-OH-sis) or SPONDYLOLISTHESIS (spon-dill-OH-lis-THE-sis) which is a condition when the lamina of the vertebra breaks, causing one vertebra to slide forward onto the other. MRI will also determine whether or not there are disc herniations, and if so, the size of the herniation(s), what levels, and which nerves are being impinged, if any.

The “recipe” for a disc injury is to bend, lift something heavy and twist the torso. This sounds complicated, but if you think about it, people do it all the time without knowing it. Think about lifting groceries off the ground and placing them in the trunk of your car.

Treatment for a disc bulge, depending on the size and severity, may start with a course of physical therapy for gentle chiropractic flexion/distraction, along with pain medication. This treatment may be joined by a series of EPIDURAL (ep-ih-DUR-al) INJECTIONS, in which a steroid is injected at the sight of the disc to shrink the bulge.

When all else fails, a DISCOGRAM (DIS-ko-gram) is performed to determine which levels are the cause of pain. This procedure is performed by a pain specialist or an orthopaedic surgeon in which dye is injected into the “epidural space” and the effects are viewed under radiographically.

As a last resort, a MICRODISCECTOMY (mik-ro-disk-EK-to-mee) may be performed by an orthopaedic spine surgeon or neurosurgeon, who will surgically drill a hole into the “lamina” (LAM-in-ah) of the vertebra to open the spinal canal.

Then the surgeon will use an illuminated microscope to carefully visualize all the structures in the spine. The surgeon will then remove all loose disc material away from the nerve root and disc. After the surgery, it will take approximately two to three months for the disc to regenerate. Recovery can take several weeks, utilizing pain medication and physical therapy, but the success rate is high.
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SACRUM

The SACRUM (SAKE-rum) is the “upside down” triangular shaped portion of the spine. It is attached to the lumbar spine on the top, the “Illium” (ILL-ee-um) are on either side, and the “coccyx” (KOKS-iks) on the bottom.

In a small child, the sacrum is comprised of five levels, S1, S2, S3, S4 and S5. Gradually, these levels come together, and by the age of twenty-five, the sacrum is fused, and is considered to be one bone. The small notches you feel in your low back, right above your buttocks are called the “SACROILIAC (SAK-roh-IL-ee-ak) JOINTS”. Sometimes you may have low back pain that doesnt radiate into the hips or legs, but stays in on sacroiliac joint of the other. Sometimes the pain radiates between joints. This condition is commonly known as SACROILITIS (SAK-roh-ill-ee-EYE-tiss). Sacroilitis occurs when the ligaments of the joint are strained, usually from prolonged use of a treadmill, constant walking up hill or repetitively climbing many stairs while carrying heavy loads. The cure for sacroilitis begins with non-steroidal anti-inflammatory medication, rest, ice when the pain is acute, and a short course of chiropractic manipulation or physical therapy. If the symptoms persist, then a cortisone injection may be administered. Home exercises and chiropractic manipulation or physical therapy are very effective treatments during times of flare-ups.
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COCCYX

The COCCYX (KOKS-iks), also called the “tailbone” is a group of small bones. Like the sacrum, it usually fuses by adulthood. As small as the coccyx is, landing on that bone during a fall can cause extreme pain and discomfort. Sometimes the coccyx is displaced traumatically or during childbirth. 90 percent of the time, the coccyx returns to its normal position and the symptoms disappear within two to four weeks. However, in extreme cases, the coccyx has to be manipulated back into place.
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SHOULDER

The shoulder joint, or “glenohumeral” (glen-oh-HUME-oral) joint is a ball-and-socket joint, known as a multi-axial joint because it can rotate in multiple directions. The “humerus”, (HUME-er-us) is the long bone at the top of the arm, and the humeral head, located at the top of the humerus, interfaces with the “glenoid fossa” (GLEN-oid FAH-sah), which brings together the clavicle, humerus and scapula, all of which comprises the shoulder joint, which depends on the rotator cuff muscles rather than bones or ligaments for support and structural integrity. The rotator cuff consists of four tendons that surround the front, back and side of the shoulder. These tendons are called the S.I.T.S. muscles, for Supraspinatus, Infraspinatus, Teres Minor and Subscapularis (see diagram). Injury to one of these tnedons causes pain and instability to the shoulder joint.

A torn rotator cuff tendon, known as a rotator cuff tear, is caused by heavy lifting, a sudden jerk or pull to the shoulder joint. The pain is a dull, achy pain in the shoulder and the top of the arm. It is usually worse late at night. A physical examination and MRI of the shoulder is the best way to obtain a correct diagnosis.

A lesser tear can be alleviated or cured by careful use of the shoulder joint, i.e., no heavy lifting, pushing or pulling, as well as ice, rest use of non-steroidal anti-inflammatory medication (NSAIDS). However a more serious tear, which is usually to the supraspinatus tendon, may require surgical intervention.

The good news is that most patients who undergo arthroscopic rotator cuff repair suffer minimal pain and side effects and recuperate within two to three weeks.

A BICEPS TENDON TEAR is a tear to the “biceps” (BYE-ceps) tendon, which originates at the top, front part of the shoulder and incerts into the middle of the humerus, which comprises the bicep muscle. Too little exercise, (making it too lax and weak), or extremely strenuous lifting can cause a tear of this tendon. As with rotator cuff tears, treatment usually consists of ice, rest and non-steriodal anti-inflammatory (NSAIDS) medication. A more serious tear may require surgical intervention, followed by a course of physical therapy. Unlike surgical repair of a rotator cuff tear, there may be more pain, before and after surgery. The recuperation time may be as long as two to three months.

TENDONITIS (ten-don-EYE-tiss) of the shoulder is an inflammation of one or more tendons of the rotator cuff muscles. It is painful, and limits the shoulders range of motion. Rest, anti-inflammatory medication (NSAIDS) and perhaps a short course of physical therapy can alleviate or cure tendonitis, which is more of an effect than a condition or disease.

FROZEN SHOULDER, also known as ADHESIVE CAPSULITIS (ad-HEE-siv CAP-sole-EYE-tiss), is a painful condition that severely limits the movement of the shoulder. Adhesive Capsulitis occurs when the capsule that surrounds the shoulder is inflamed and the attempt to move the shoulder joint in any direction can cause severe pain. The condition is diagnosed via orthopaedic physical examination and MRI or arthrogram studies of the shoulder. Frozen shoulder usually improves over time. Treatment consists of pain medication and physical therapy in order to regain movement.
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ELBOW

The elbow is known as a “hinge joint” because it looks so much like the hinge of a door. The elbow is made up of the humerus (the bone at the top of the arm), and the radius and ulna bones from the forearm. The elbow is held together by the medial or “ulnar” (uhl-NAR) collateral ligament and the lateral or “radial” collateral ligament.

There are three main types of injuries to the elbow. The most common injury is called “LATERAL EPICONDYLITIS” (LAT-er-all epi-con-dill-EYE-tiss), and is also known as “tennis elbow”, is an inflammation of the extensor carpi radialis brevis (ex-TEN-sor CAR-pee rade-ee-AL-iss BRE-viss) tendon, which is caused by repetitive use of the elbow, as in when one plays a lot of tennis. It is diagnosed by orthopaedic physical examination, electrodiagnostic testing and occasionally MRI studies. Often treatment consists of non-steroidal anti-inflammatory medication, an elbow brace and physical therapy. More chronic cases are treated with steroid injections to the elbow. In extreme cases, surgerical arthroscopic joint resection is indicated to repair the tendon, followed by bracing, medication and a short course of physical therapy.

MEDIAL EPICONDYLITIS (MEDE-ee-AL Epi-con-dill-EYE-tiss), also known as “golfers elbow” or “baseballers elbow” is an inflammation of the of tendon of the “flexor pronator” (FLEX-or pro-NAY-tor) muscles. These are a group of muscles in the front of the forearm that pull the hand downard.

These muscles come together and meet at the tendon, which attaches to the bone on the inside of the elbow. This is also diagnosed via orthopaedic physical examination, electrodiagnostic testing, and in rare cases, MRI studies of the elbow. As with lateral epicondyltis, MEDIAL EPCONDYLITIS is initially treated with a brace, ice, non-steroidal anti-inflammatory medication and a course of physical therapy. In rare cases (about 10%), surgical intervention is needed, which would be followed up by pain medication, a brace and physical therapy.

CUBITAL TUNNEL SYNDROME occurs when the nerve that runs through the back of the elbow becomes irritated, and is usually the result of constant bending of the elbow, which cases stretching and sometimes displacement of the nerve. This condition is diagnosed by orthopaedic physical examination and electrodiagnostic testing. This is treated with pain medication and splinting of the elbow, which can be difficult, because the splint forces the arm to be in a straight position at all times. In rare, but extreme cases, surgically moving the nerve, or shaving the medial epicondyle is necessary to alleviate the pain.
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WRIST & HAND

The two bones in the forearm, the “radius” (RADE-ee-us) and the “ulna” (UHL-na), lead to the “carpal bones” in the hand. The long thin bones in the hand that lead to the fingers are called “metacarpal (meh-te-CAR-pal) bones”. The fingers are called “phlanges” (fuh-LANG-eez). Two main nerves run into the hand and fingers. The “median” (MEDE-ee-an) nerve runs from the radius and into the thumb and first two fingers. It is the larger of the two nerves and is the nerve affected in a condition called “CARPAL TUNNEL SYNDROME”, which is a debilitating disorder, that effects women more than men at a 4:1 ratio, but has become increasingly more common in men. Carpal Tunnel Syndrome (CTS) occurs when the median nerve literally gets pinched or compressed while passing through the carpal tunnel, which is a canal within the metacarpal bones on the palm side of the wrist. CTS is common in pregnant women or obese people because water gain impinges on the nerve within the carpal tunnel.

However, CTS can also occur as a result of repetitive wrist motion, as in when using the computer keyboard or mouse. From a work injury point of view, the most likely suffers are graphic artists, supermarket checkers, reporters, secretaries, accountants and court reporters, amongst others. CTS is diagnosed via orthopaedic physical examination, as well as electrodiagnostic studies and sometimes MRI studies of the wrist. Treatment should also be conservative to start: Non-steroidal anti-inflammatory medication hand exercises are the first stages of treatment. If the symptoms do not decrease, then cortisone injections may be administered. As a last resort, an orthopaedic hand surgeon will perform surgical carpal tunnel release, which is a simple surgery in which a small incision is made in the transverse carpal ligament of the hand and pressure is taken off of the median nerve. This procedure has a high rate of effectiveness.

DeQUERVAINS TENOSYNOVITIS (dee-cuh-AIR-VANEZ ten-oh-sin-oh-VYE-tiss) is also known as “Mothers Wrist” or “Washerwomans Wrist”. The two muscles that run at the back of the arm are called the “Extensor Pollicis Brevis” (ex-TEN-sor Pol-ISS-iss BRE-viss) and the and the “Abductor Pollicis Longus” (AB-duc-tor Pol-ISS-iss LONG-us) muscles. They attach at the back of the hand undernearth a sheath that wraps around the hand like an Ace Bandage. When the tendons and the sheath are inflamed, there is pain in the back of the hand, particularly below the thumb. This is an overuse-type syndrome and is diagnosed via orthopaedic physical examination and sometimes electrodiagnostic studies. People who get DeQuervains Tenosynovitis are usually typists, stenographers, hair stylists, accountants, reporters, supermarket checkers, etc. The good news is that with rest, it resolves on its own.

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HIP

The HIP JOINT, like the shoulder joint, is a ball-and-socket joint. The hip joint is quite stable because of the deep insertion of the head of the femur into the pelvis. The head of the femur (FEE-mer) fits into the pelvis bone. It is held together by the Y ligament of Bigelow, which is the strongest ligament of the human body. Many of the bodys largest muscles surround this joint that is designed for stability and to hold the human body in an erect position.

There are a few congenital deformities that may make the hip joints less stable. Malnutrition may also make the hip joints week. Diseases such as Muscular Dystrophy or Multiple Sclerosis will also make the hip joint week, but because the muscles surrounding the hip joint are attacked.

Injuries to the hip are painful, debilitating and can be serious. It is extremely important, when the hip is fractured that the patient is monitored for blood clots. (A fractured or broken hip is common in the elderly, especially elderly women because of their pre-disposition to osteoporosis).

TOTAL HIP REPLACEMENT is a procedure that has been performed for decades. Modern technology has made this procedure to become much less complicated and dangerous than in past decades. The need for additional surgical procedures has declined drastically over the years. X-ray diagnosis of a hip fracture, along with orthopaedic physical examination is the simplest and best course of diagnosis. Post operative physical therapy is necessary to speed up the recovery time.

DEGENERATIVE JOINT DISEASE of the hip comes from degeneration of the hip joint and the cartilage within the joint. It is mostly considered to be a form of osteoarthritis, although other auto-immune diseases can cause degeneration of the hip such as SLE, rheumatoid arthritis, peripheral vascular diseases or some sexually transmitted diseases.

In the case of HIP PAIN, the hip joint may not be the source of the pain. It is common to experience severe hip pain if you have suffered an injury to the lumbar spine, and is known as “referred pain” or “radiculopathy.”
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KNEE

The knee, like the elbow, is a hinge joint and is the largest joint in the human body, even larger than the hip joint. However, unlike the hip joint, the knee is a particularly vulnerable joint because it joins two long bones, the “femur” (FEE-mur) or thigh bone from the top, and the \“fibula” (FIB-ul-ah), on the leg. (There are two bones in the lower leg. The “tibia” (tib-EE-ah) is the shorter bone, located on the outside of the leg and is also considered the “weight bearing bone”, whereas the fibula is longer, skinnier and considered the “balancing bone” on the leg. The “patella”, also known as the “knee cap”, is the round cartilage in front of the knee and is meant to protect and prevent the knee from bending backwards. There is a lot of cartilage at the ends of the joining bones, (the femur and the fibula), as well as underneath the patella. Also located between the femur and fibula are two discs, called the “medial meniscus” (MEDE-ee-al Men-ISS-cuss) and the “lateral meniscus” (LAT-er-al Men-ISS-cuss).

The knee depends on ligaments and muscles that surround it for its stability and strength. These ligaments are easily injured. A sharp blow to the outside of the knee (something that often happens to football or soccer players) can cause damage to the “medial” and “lateral collateral ligaments” that are located on the inside and outside of the knee vertically from the femur to the fibula. The “Anterior Cruciate Ligament” (AN-tier-ee-or KRU-shee-it LIG-ah-ment) is a ligament that cris-crosses in front of your knee. When twisted too much, something easily done by skiing, or bending and twisting to lift heavy objects in order to place them on an assembly platform, this ligament can be damaged or torn. Usually, the medial meniscus is also torn.

The way to appropriately diagnose a knee injury is via history, careful orthopaedic physical examination, an x-ray of the knee, (if the injury is not too acute), and MRI studies of the knee. Because the knee is so complex, there may be damage to more than one part of the knee.

The Medial Meniscus, the Medial Collateral Ligament and the Anterior Cruciate Ligament are known as the “Terrible Triad of the Knee”, because those are the three parts usually involved in a knee injury, especially in a “clipping”-type injury, such as what may happen to a football player. The good news is that with the advent of the most up to date procedures and surgical equipment, repair of the knee is often quick and without serious side effects. Post operative pain medication and physical therapy usually lead to recovery for the patient and quick return to activities of daily living.
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ANKLE & FOOT

The ankle is a thee bone joint. On the inside, the “tibia” (tib-EE-ah) is the shorter bone on the inside of the leg and is considered the “weight bearing bone” of the lower leg. The “fibula” (FIB-ul-ah) is the longer, thinner bone on the outside of the leg, articulates with the “femur” (FEE-mur) to form the knee, and is considered the “balancing bone” of the lower leg. It forms the outside part of the ankle. Both the tibia and fibula articulate with the “talus” bone, underneath the foot and form the ankle joint, which moves the foot up and down.

Underneath that joint the talus articulates with the “calcaneus” (kal-KANE-ee-us) or “heel bone”, which moves the foot from right to left and visa versa.

There are multiple ligaments that attach the ankle to the foot and provide stability to the foot. Damage to these ligaments can be as simple as an ankle sprain, or as severe as damage requiring surgical intervention to repair the torn ligaments. Obviously damage to the ankle and foot can cause inability for the patient to stand, walk or run properly.

The correct diagnosis is performed by history, orthopaedic physical examination, x-rays and sometimes MRI studies of the ankle or foot may be necessary to assess how much damage was done to the ligaments.
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CHRONIC PAIN

Chronic pain is technically pain that lasts for more than four months. Traumatic injury may exacerbate or aggravate the pain. Other health conditions such as arthritis or auto-immune disorders may be factors in determining the overall treatment plan. Furthermore, if you notice that your pain has exceeded what you have been told is the normal recovery time after an injury, there may or may not be an underlying health issue, which should be discussed and investigated by your doctor.
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FIBROMYALGIA

FIBROMYALGIA (FYE-broh-my-AL-gah) is a condition that has been suffered by patients, mostly women, since the dawn of time. Until recently, patients who suffered from Fibromyalgia have been dismissed by many physicians as hypochondriacs with underlying emotional or psychological issues. Interestingly, with the advent of certain types of medication that has been effective in relieving the symptoms of Fibromyalgia, came a new age of consciousness and Fibromyalgia has been newly recognized as a true illness amongst healthcare professionals.

Part of the reason why Fibromyalgia was not being recognized is due to the fact that this condition is difficult to diagnose. There are no blood tests, urine tests, MRI studies, CT scans, x-rays or diagnostic studies that can confirm or deny that a patient has Fibromyalgia. But then again, that was the case with clinical depression and pre-menstrual syndrome until the advent of anti-depressants and Midol, respectively.

Fibromyalgia is characterized by overall global muscular pain that lasts more than three months. It is associated with other symptoms such as exhaustion, loss of appetite, and depression. Fibromyalgia is a progressive disease and without treatment can become extremely painful and debilitating. Treatment is a multi-specialty plan that may include a combination of specialists such as a rheumatologist, pain management specialist, psychological support, medication, chiropractic manipulation, physical therapy and acupuncture.
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Temporomandibular Joint Syndrome Shoulder Hip Knee Ankle Headaches Spine Thoracic Spine Lumbar Spine Sacrum Coccyx Elbow Wrist