Elbow Pain
The elbow is the joint that bends your arm. It is a modified hinge joint made up of three bones, the Humerus, Radius and Ulna bones. The elbow allows for the flexion and extension of the forearm relative to the upper arm, as well as rotation of the forearm and wrist. All of the nerves that travel down the arm pass across the elbow. Three main nerves begin together at the shoulder the radial nerve, the ulnar nerve and the medial nerve.
Pain in the Elbow is often caused by overuse. Many sports, hobbies and jobs require repetitive hand, wrist or arm movements. Elbow pain may occasionally be due to arthritis, but in general, your elbow joint is much less prone to wear-and-tear damage than are many other joints.
Common causes of elbow pain include:
- Bursitis (joint inflammation)
- Dislocated elbow
- Trapped nerves
- Osteoarthritis (disease causing the breakdown of joints)
- Rheumatoid arthritis (inflammatory joint disease)
- Sprains and strains
- Tendinitis
- Tennis elbow
- Golfer’s elbow
- Throwing injuries
- Stress fractures
How can Dr. Anden diagnose your Elbow pain?
- Physical Examination And Medical History
- X-ray, MRI and/or CT Scan
- EMG/NCS testing (Done by Dr. Anden)
- Ultrasound Guided Examination (Done in Dr Anden’s Office)
How can we treat your Elbow pain?
The treatments for elbow disorders depend on the underlying cause. Treatment varies depending on the disorder and symptoms you experience. Most elbow disorders require conservative treatment. Surgery is a last resort if your symptoms don’t improve.
Your treatment options include:
- Physical Therapy or at-home exercises
- NSAIDS and ice to reduce inflammation
- Regenerative Injection Therapies
- Ultrasound Guided Corticosteroid Injections
- braces or immobilization
Hand And Wrist Pain
Pain in the fingers, hand, or wrist is usually caused by overuse, repetitive motion, or underlying conditions like arthritis organglion cysts. Hand, finger and wrist injuries such as fractures, dislocations, or torn ligaments are often caused by falls or blows during sports or work activities. Injuries can also occur during accidents or activities.
Common Causes
Carpal tunnel syndrome
Carpal tunnel syndrome is caused by pressure on a nerve (median nerve) in the wrist. The symptoms include tingling, numbness, weakness, or pain of the fingers and hand. This can be a result of constant and repetitive motions with the hands. This can be diagnosed with an EMG/NCS Test on your hands. Dr. Corey Anden board certified in Electrodiagnostic Medicine and can perform this test and diagnose your problem.
Ganglion cysts
Ganglion cystsare small sacs filled with clear, jellylike fluid that often appear as bumps on the hands and wrists.
Diabetes
May change how the hands normally feel or sense touch. Decreased feeling in the hands is common because of decreased blood flow to the hands or damage tonerves of the hand.
Trigger Finger
Trigger finger is a “snapping” or “locking” condition of any of the fingers of the hand when opened or closed. Trigger finger is caused by local swelling from inflammation or scarring of the tendon sheath around the flexor tendons. This can be improved with at-home stretching and exercises or can be injected by a corticosteroid to reduce inflammation.
Pregnancy
May cause redness, itching, swelling, numbness, or tingling that often goes away after delivery.
Osteoarthritis
Osteoarthritis is the progressive breakdown of the tissue that protects and cushions joints (cartilage). It may cause stiffness and pain with movement. Stretching can improve symptoms. Regenerative medicine and corticosteroid injections can be helpful for improvement.
Treatments For Wrist/Hand Pain
Treatment for wrist pain depends on the cause of the pain and its severity. The least invasive treatment is given first before treatments are recommended. They include:
- Exercises and physical therapy – Depending on your type of pain, exercises may work. Certain exercises can be prescribed to stretch and lengthen muscles and tendons. When it comes to which exercises to do, patients should get recommendations from your doctor or physical therapist.
- NSAIDS and ice may also be helpful to reduce inflammation.
- Brace – in some cases, wearing a wrist brace can help. Splinting may prevent certain wrist movements that cause irritation. A splint might also reduce squeezing of the nerve.
- Regenerative Injection Therapies
- Ultrasound Guided Cortisone injections – in some cases, a cortisone injection can be helpful to reduce inflammation. Dr. Anden uses an ultrasound to guide the injection.
- Surgery – only used if less invasive treatments have not worked. The type of surgery performed depends on the cause of the pain.
Head – Migraine Pain
Tension headaches, migraines and other chronic headaches like cluster headaches and can take a toll on everyday life. The factors that trigger headaches vary widely from person to person and headaches can be accompanied by a variety of migraine symptoms. The first step to identifying headaches is getting a detailed history of your headache experience. Expect questions about the frequency, location, and severity of your headaches. You’ll be asked what works to ease the pain of your headaches and what does not. Keeping a headache diary can help to better diagnose your symptoms.
Tension-type headache
The most common headache type in the world.
Tension-type headaches are often described as pain that feels like a tight band around your head or a weight on top of it. Your neck or shoulder muscles may also hurt along with the headache. If you have tension-type it will produce a mild to moderate pain whereas the pain of migraine can reach disabling severity.
Treatments for Tension-Type Headaches Include:
- Massage Therapy
- Trigger Point Injection Therapy
- Chiropractic Care
- OTC Medications
- Acupuncture
Migraine Pain
While it is commonly believed that migraine is a one-sided headache, many migraine sufferers have pain on both sides of their head. The pain of migraine is usually throbbing or pulsating and can last for hours to days. Associated features include nausea, vomiting, and sensitivity to light and sound. Some people have migraines several times a week, while others get them only several times throughout their lives.
There is no cure for migraine headaches. The focus of pain management for migraines is to reduce the severity, duration, and frequency of the migraine.
Treatment options for migraine pain include:
- Physical Therapy
- Medications
- Epidural injections
- Botox for Migraines
Leg and Foot Pain
What is foot and leg pain?
Pain in the feet or legs is common. It can be caused by a number of different conditions. The most common conditions that cause pain in the feet and/or legs are the following:
- Sciatica
- Neuropathy
- Plantar fasciitis
- Arthritis
Some of these conditions are commonly short-lived, while others are chronic.
Sciatica
Sciatica is a common pain condition marked by pain, numbness and/or tingling, beginning in the buttock and extending down the leg, all the way to the foot and toes.
The vast majority of acute cases of sciatica resolve on their own within a few weeks to months. Sometimes, it continues and becomes chronic. It’s considered chronic when lasting longer than six months.
Sciatica is the result of inflammation or irritation of the sciatic nerve. The sciatic nerve starts at the spinal cord in the low back, extends through the piriformis muscle in the buttock, and branches down the back of the leg, and into the foot.
Common Treatments for Sciatica include:
- Spinal injections: Epidural steroid injections, Nerve blocks, Rhizotomy and/or Spinal Cord Stimulator
- Physical therapies: stretching and strengthening exercises, mild aerobic exercises
Plantar fasciitis
Plantar fasciitis causes pain in the heel and bottom of the foot. It is due to inflammation of the plantar fascia. The plantar fascia is a muscle-like connective tissue at the bottom of the foot.
Plantar fasciitis is associated with overuse, such as with runners, or in cases of obesity.
Treatments are anti-inflammatory medications, heel stretches, supportive footwear, and weight loss.
Arthritis
Arthritis is a common pain condition marked by inflammation of the joints. The inflammation causes pain, swelling, and stiffness. Arthritis can occur in any joint of the body.
Neuropathy
Neuropathy is damage to nerves and causes pain, numbness and/or tingling.
Peripheral neuropathy is nerve damage in the peripheral nerves. This usually starts in the hands or feet as numbness or tingling. Over time, these symptoms can progress to pain. Patients often describe the pain as a burning type of pain.
Diabetic Neuropathy is the most common cause of peripheral neuropathy in the hands or feet. Nerves can be damaged from high blood sugar levels.
Other causes can be kidney disease, HIV, or alcohol dependence. It can also occur for unknown reasons. In the latter case, it is called ‘idiopathic peripheral neuropathy.’
If the cause of neuropathy is diabetes, therapy involves aggressive treatment of diabetes. In such cases, treatment consists of medications to control glucose, dietary changes, exercise, and weight loss.
Tendonitis
One of the first warning signs you have an inflamed Achilles tendon is pain in your lower calf, near the back of your heel. It’s a common injury that makes the tendon swell, stretch, or tear. You can get it from overworking the calf muscle or climbing the stairs.
Shoulder Pain
The shoulder is one of the most sophisticated and complicated joints of the body. Because the shoulder is the most mobile joint in the human body it is prone to unique and complex problems.
Shoulder problems occur when any one of these components starts to degenerate or is in some way compromised or irritated. The root cause is often overuse (which often comes with age), dislocation, or an accident, such as using the arms to break a fall, impacting the shoulder joint.
Shoulder Anatomy
- The shoulder is located where the humerus (upper arm), clavicle (collarbone), and scapula (shoulder blade) meet. The Glenohumeral joint is the major shoulder joint. Ball-and-socket socket construction allows for circular movement of the arm. he acromioclavicular joint (AC Joint) is on top of the shoulder, where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion).
- The Rotator Cuff is a group of four muscles (Supraspinatus, subscapularis, infraspinatus, teres minor) that come together as tendons to form a covering around the head of the humerus. These muslces are what keep your shoulder in your socket.
- The Glenoid Labrum is a fibrous ring of tissue which attaches to the rim of the glenoid which is the shallow depression of the scapula or shoulder blade where the ball of the humerus sits.
- A bursa is a synovial fluid filled sac, which acts as a cushion between tendons and other joint structures. The major bursae in the shoulder include the subacromial bursa, the subdeltoid bursa and the subscapular bursa. The bursa can commonly become inflamed and cause pain (bursitis).
Common Problems Include:
- Sprains and strains
- Dislocations
- Separations
- Tendinitis
- Bursitis
- Torn rotator cuffs
- Frozen shoulder
- Fractures
- Arthritis
Common treatments for shoulder pain include:
- Regenerative Medicine
- Physical therapy
- Corticosteroid Injection of an anti-inflammatory medicine
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Surgery if all other treatments do not work
Hip Pain
Hip pain or hip joint pain often develops gradually and can be from a number of causes. The pain can be debilitating. Hip pain will affect everything you do and rob you of your ability to do the everyday things you love. And it can keep you awake late at night, because you can’t get comfortable enough to sleep
The hip is a ball and socket joint that attaches the leg to the torso of the body. In the hip joint, the head of the femur (thighbone) swivels within the acetabulum, the socket, made up of pelvic bones. While many causes of hip pain can arise from the joint itself, there are numerous structures surrounding the hip that can also be the source of pain.
Common Causes Of Hip Pain
Pain my arise from structures that are within the hip joint or from structures surrounding the hip.
- Bursitis – Sometimes small lubricating sacs near tendons become inflamed and fill with fluid. This is called bursitis and can be very uncomfortable
- Osteoarthritis
- Wear and tear degeneration
- Sports related injuries
- Groin strain
- Hip fracture
- Labral Tear
- Pregnancy
- Pain you feel in the hip may reflect a problem in your back, rather than in the hip itself.
Dr. Anden will perform a physical exam with careful attention to your hips, thighs, back, and the way you walk. To help diagnose the cause of the problem we will ask questions regarding your pain and how it feels. We will view your hip under ultrasound, but you may be referred for additional imaging.
Treatments
- Regenerative Injection Therapies – Regenerative medicine is expanding rapidly in the area of joint pain treatment. Through the use of harvested growth factors and stem cells from the patient’s own blood and bone marrow, regenerative medicine assists the body’s healing process.
- NSAIDS and ice to reduce inflammation
- At home exercises and physical therapy – Exercise for the hip is one of the best things to do to maintain range of motion & strengthening the muscles that support the hip.
- Ultrasound Guided Cortisone Injections – if inflammation is causing pain in your hip joint or hip bursa, Dr. Anden can inject a corticosteroid injection under ultrasound guidance
- Hip surgery – Surgery should only be considered when your pain is not helped by other treatments. Dr. Anden can refer you to the appropriate surgeon if this treatment is deemed medically necessary.
Joint Pain and Arthritis
What is Arthritis?
The word “arthritis” means “joint inflammation.” Arthritis is inflammation in and around the body’s joints. It can affect one joint or multiple joints. There are more than 100 different types of arthritis, with different causes and treatment methods. The most common symptom of arthritis is joint pain, and this is the reason people seek medical care for their arthritis. .
Two of the most common types are osteoarthritis (OA) and rheumatoid arthritis (RA).
Osteoarthritis (OA) is one of the most common forms of arthritis, stemming from normal wear and tear of life. An infection or injury to the joints can exacerbate this natural breakdown of cartilage tissue. Your risk of developing OA may be higher if you have a family history of the disease or are overweight.
Rheumatoid Arthritis (RA) is an autoimmune disorder. It occurs when your body’s immune system attacks the tissues of the body. These attacks affect the synovium, a soft tissue in your joints that produces a fluid that nourishes the cartilage and lubricates the joints. RA is a disease of the synovium that will invade and destroy a joint. It can eventually lead to the destruction of both bone and cartilage inside the joint.
What causes Arthritis?
Although the exact causes of arthritis might not be known, there are several risk factors. A risk factor is a something that increases a person’s chance of developing a disease or condition. Risk factors for arthritis include:
- Age — the risk of developing arthritis, especially osteoarthritis, increases with age.
- Gender — In general, arthritis occurs more often in women than in men.
- Weight — being overweight puts extra stress on the joints that support a person’s weight. This increases wear and tear, and the risk of arthritis.
- Work factors — Jobs in which the worker has to keep doing the same movements over and over, or does a great deal of heavy lifting, can cause stress in the joints and/or an injury, which can lead to arthritis.
How is Arthritis treated?
Unfortunately arthritis cannot be reversed. There is no cure for arthritis, but symptoms can be effectively managed with lifestyle changes, physical and other therapies, medications, and injections.
Exercising and achieving a healthy weight are generally the most important ways to treat osteoarthritis.
Lifestyle treatments for Arthritis
Many people can help control their arthritis symptoms with basic lifestyle changes. Talk to Dr. Anden about whether these options may be right for you.
Exercise
Exercise can play a major role in reducing the pain that comes with arthritis. An active lifestyle can help you:
- maintain healthy joints
- relieve stiffness
- reduce pain and fatigue
- increase muscle and bone strength
Diet
Maintaining a healthy weight can reduce stress on joints. Weight loss can help with the pain of arthritis. It may also reduce systemic inflammation.
Cold and heat
Both cold and heat can help treat arthritis symptoms. Applying ice to an area for 20 minutes can help to reduce fluid in the tissue and decrease swelling. You can repeat the treatment two or three times a day. You can do the same 20-minute treatment pattern with a heating pad.
Medications
Osteoarthritis symptoms, primarily pain, may be helped by certain medications, including:
- Acetaminophen.
- Nonsteroidal anti-inflammatory drugs (NSAIDs).
Medical treatments for Arthritis
Cortisone Injections
These injections reduce inflammation which decreases swelling and pain in arthritic joints.
Physical therapy
A physical therapist can help you develop an exercise regimen suited to your needs.
- improve muscle strength
- increase the range of motion of stiff joints
- reduce pain
Surgery for Arthritis
Severe cases of Osteoarthritis may require surgery to replace or repair damaged joints. There are several types of surgery used to treat OA. Please discuss with your doctor to determine if you are a candidate.
Knee Pain
The knee is a “hinge” type joint that allows the leg to bend and straighten. Your knees are the largest joints in your body and you need them for practically everything you do. As a result, your knees take quite the beating throughout your life. Knee pain is common among older people; however people of all ages can have knee pain and injuries. Knee pain can stem from a degenerative (arthritic) condition, a systemic condition, or from an injury. Chronic knee pain is long-term pain, swelling, or sensitivity in one or both knees. Whether it’s due to arthritis or an injury, it is important to know what has caused the knee pain in order to properly diagnose the problem
Common Causes of Knee pain
Sprains and Strains
Injury – Sad, but true: sometimes, an active lifestyle can backfire if you fail to safeguard your knees. Skiers, cyclists, runners, and people who participate in jumping sports (tennis, basketball) are prone to knee pain and injuries.
Patellofemoral Pain – Patellofemoral pain syndrome is pain in the front of the knee and around the patella, or kneecap. It is sometimes called “runner’s knee” or “jumper’s knee”.
Tendinitis – Tendinitis is pain in the front of the knee that is made worse when climbing, taking stairs, or walking up an incline
Bursitis — Inflammation of a bursa is called bursitis. The knee is lubricated by joint fluid that is produced by the lining of the joint and by six lubricating “bursa” sacs. The bursa sacs can become irritated as a result of injury, excessive pressure, or overuse.
Osteoarthritis — Osteoarthritis is caused by degeneration (or age related changes) of the articular cartilage.
Muscle strain — the quadriceps muscles and the hamstring muscles straighten and bend the knee and are susceptible to strain (“pulled muscles”). Such strains occur most often in sports requiring rapid acceleration and deceleration (basketball, softball, football, soccer).
Meniscus tear — the meniscus is a specialized “shock absorber” cartilage located in the knee joint between the thigh and shin bones. There are two menisci in the knee, one on the inside (medial meniscus) and one of the outside (lateral meniscus). Traumatic tears occur when a sudden, twisting force tears an otherwise healthy meniscus.
Knee Pain Diagnosis
To diagnose you with a specific type of knee pain, Dr. Anden will need to perform a physical exam and check to see how you respond to different movements using your legs. If your pain increases when the knee is moved in one specific direction, or when performing a movement like standing up, it can point to which exact part of the knee is damaged or inflamed. You may also be referred for additional testing such as an x-ray or MRI.
Conventional Treatments for Knee Pain
Dr. Anden feels that an often overlooked aspect of treating knee pain is the need for different interventions depending on someone’s current fitness level. For example, a young woman who experiences knee pain after running for several months will benefit from a much different treatment approach than an older man with osteoarthritis of the knees. When treating knee pain injuries, Dr. Anden first looks at your symptoms and then discusses your lifestyle and exercise habits.
Non-Surgical treatments for knee pain:
- Rest
- Regenerative Medicine – This would involve injecting different growth factors into the damaged area to reduce inflammation and promote natural healing processes. Clink the link to read more about this!
- Compression, icing and elevation of the affected knee
- Physical therapy and at-home exercises
- Use of a knee brace
- Ultrasound Guided Cortisone Injection used to reduce inflammation, lubricate the knee and treat swelling.
- Rarely, Surgery may is recommended as a last resort option. This would be considered only after other treatments have failed.
Soft Tissue Pain
Soft tissues (muscles, ligaments, and tendons) may display abnormal tension from poor posture, traumatic injury, strain or sprain from activity. This tension may produce pain and tenderness and cause movement dysfunctions. Soft tissue pain can manifest in many ways, including trigger points.
We often refer to a trigger point as a taut band of muscle that can be painful upon compression and can give rise to referred pain and motor dysfunction, sometimes referred to as a knot or “kink.”Soft tissue pain can be a chronic condition that affects the fascia (connective tissue that covers the muscles).
What is a Trigger Point?
Trigger Points are extremely irritable knots in taut bands of muscle and connective tissue that can produce tenderness, a “twitch response” in part of the soft tissue, and a neurological phenomenon of referred pain to different locations of the body when external pressure is placed upon them, hence the term “Trigger Point”.
What Causes Soft Tissue Pain?
Myofascial pain may develop from a muscle injury or from excessive strain on a particular muscle or muscle group, ligament or tendon. Other causes include:
- Poor Posture
- Injury to muscle fibers
- Repetitive motions
- Lack of activity (such as having a broken arm in a sling)
Treatments for Soft Tissue Pain?
- Ice
- Heat
- Physical Therapy
- Massage Therapy
- Trigger Point Injections
Spine Pain
The spine is composed of many vertebrae stacked on top of each other. Between these bones are discs, which act as shock absorbers. As we age, the discs naturally become less flexible and more brittle. Disc degeneration which naturally occurs with old age, can also cause pain.
Spine (neck, mid-back, low back) pain occurs for many reasons. The first step in treating neck and back pain of pain is to identify exactly what is causing it. Before we can diagnose your condition and design a treatment plan, a complete medical history and physical examination are necessary. We will determine if any additional diagnostic tests are needed.
Dr. Anden treats all different kinds of spine pain including:
- Neck pain
- Thoracic back pain
- Low back pain
- Degenerative disc changes
- Facet Pain Syndrome
- Spinal stenosis
- Scoliosis
- Spondylolisthesis
- Sciatica (Lumbar radiculopathy)
- Cervical radiculopathy
- Failed back surgery syndrome
- Compression fractures
- Sacroiliac pain
- Arthritis
- Peripheral neuropathy
- Sports injuries
- Work related injuries
- Complex regional pain syndrome/RSD
Treatments for spine pain include:
- Regenerative Medicine
- Physical Therapy
- Ultrasound Guided Injections
- Epidural Steroid Injections
- Facet Joint / Medial Branch Nerve Injections
- Rhizotomy / Radiofrequency Neurotomy
- Discograms
- Stellate ganglion blocks
- Selective nerve root blocks
- SI Joint Injections
- Trigger Point Injections
Herniated Disc
A herniated disc occurs when the outer ring becomes weak or torn and allows the inner portion to slip out. This can happen with age. Certain motions may also cause a herniation. A disc can slip out of place while you are twisting or turning to lift an object. If you have a physically demanding job that requires a lot of lifting, you may be at increased risk for herniated discs.
As you get older, you are more likely to experience a slipped disc. This is because your discs begin to lose some of their protective water content as you age. As a result, they can slip more easily out of place. Overweight individuals are also at increased risk for a herniated disc because their discs must support the additional weight. Weak muscles and a sedentary lifestyle may also contribute to the development of a herniated disc.
Treatments for a herniated disc range from conservative to surgical. The treatment typically depends on the level of discomfort you’re experiencing and how far the disc has slipped out of place.
Some people can relieve a herniated disc using an exercise program that strengthens the back and surrounding muscles. Other patients may need spinal injections to relieve inflammation and swelling around the pinched nerve. It may be tempting to refrain from all physical activity while you’re experiencing the discomfort of a herniated disc, but this can lead to muscle weakness and joint stiffness. Instead, try to remain as active as possible through stretching or low-impact activities such as walking.
Spinal Stenosis
Spinal stenosis (or narrowing) is a common condition that occurs when the small spinal canal, which contains the nerve roots and spinal cord, becomes compressed. This causes a “pinching” of the spinal cord and/or nerve roots, which leads to pain, cramping, weakness or numbness.
Some may not feel any effects of the narrowing, but as part of the aging process, most people will eventually notice radiating pain, weakness, and/or numbness secondary to the compression of the nerves or spinal cord.
Degenerative Disc Changes
Degenerative disc disease isn’t actually a disease per se, but rather a term used to describe normal age related changes in the spine. As you age, your discs, like other joints in the body, can degenerate (break down) and become problematic: That’s a natural part of growing older as your body deals with years of strain, overuse, and maybe even misuse. Degenerative changes can occur in people as young as 20..
Facet Joint Pain
Facet joints are the joints in your spine that make your back flexible and enable you to bend and twist. They are like any other joint in the body like the knee or elbow that enable the body to bend and twist. There is a left and a right facet joint in each spinal motion segment.
The facet joints can get inflamed secondary to injury or arthritis and cause pain and stiffness. When the facet joints are affected in the neck or cervical spine it typically causes pain in this area as well headaches and difficulty rotating the head.
Sciatica
Sciatica is pain that stems from the sciatic nerve. The sciatic nerve is the largest nerve in our body, branching out from the lower back, down the buttocks, and down the back of the legs.
Part of the sciatic nerve runs down the thigh, calf, foot and toes. The nerve runs through most of your lower body. The most common cause for sciatica is when a herniated disc in the spine presses against the nerve. Sciatica can also be the result of spinal canal narrowing (spinal stenosis), a pinched nerve, pregnancy or even an infection that affects the nerve.
Sciatic symptoms don’t always need surgery to be fixed. Majority of patients will treat their sciatica with non-invasive conservative options.
