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Conditions Treated

Arthritis

Arthritis


Arthritis is inflammation of one or more joints, which results in pain, swelling, stiffness, and limited movement. There are over 100 different types of arthritis.

Causes


Arthritis involves the breakdown of cartilage. Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when you walk. Without the usual amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.

You may have joint inflammation for a variety of reasons, including:

  • Broken bone
  • Infection (usually caused by bacteria or viruses)
  • An autoimmune disease (the body attacks itself because the immune system believes a body part is foreign)
  • General "wear and tear" on joints

Often, the inflammation goes away after the injury has healed, the disease is treated, or the infection has been cleared.

With some injuries and diseases, the inflammation does not go away or destruction results in long-term pain and deformity. When this happens, you have chronic arthritis. Osteoarthritis is the most common type and is more likely to occur as you age. You may feel it in any of your joints, but most commonly in your hips, knees or fingers. Risk factors for osteoarthritis include:

  • Being overweight
  • Previously injuring the affected joint
  • Using the affected joint in a repetitive action that puts stress on the joint (baseball players, ballet dancers, and construction workers are all at risk)

Arthritis can occur in men and women of all ages. About 37 million people in America have arthritis of some kind, which is almost 1 out of every 7 people.

Other types or cause of arthritis include:

  • Rheumatoid arthritis (in adults)
  • Juvenile rheumatoid arthritis (in children)
  • Systemic lupus erythematosus (SLE)
  • Gout
  • Scleroderma
  • Psoriatic arthritis
  • Ankylosing spondylitis
  • Reiter's syndrome (reactive arthritis)
  • Adult Still's disease
  • Viral arthritis
  • Gonococcal arthritis
  • Other bacterial infections (non-gonococcal bacterial arthritis )
  • Tertiary Lyme disease (the late stage)
  • Tuberculous arthritis
  • Fungal infections such as blastomycosis

Symptoms


If you have arthritis, you may experience:

  • Joint pain
  • Joint swelling
  • Stiffness, especially in the morning
  • Warmth around a joint
  • Redness of the skin around a joint
  • Reduced ability to move the joint

Exams and Tests


First, your doctor will take a detailed medical history to see if arthritis or another musculoskeletal problem is the likely cause of your symptoms.

Next, a thorough physical examination may show that fluid is collecting around the joint. (This is called an "effusion.") The joint may be tender when it is gently pressed, and may be warm and red (especially in infectious arthritis and autoimmune arthritis). It may be painful or difficult to rotate the joints in some directions. This is known as "limited range-of-motion."

In some autoimmune forms of arthritis, the joints may become deformed if the disease is not treated. Such joint deformities are the hallmarks of severe, untreated rheumatoid arthritis.

Tests vary depending on the suspected cause. They often include blood tests and joint x-rays. To check for infection and other causes of arthritis (like gout caused by crystals), joint fluid is removed from the joint with a needle and examined under a microscope. See the specific types of arthritis for further information.

Treatment


Treatment of arthritis depends on the particular cause, which joints are affected, severity, and how the condition affects your daily activities. Your age and occupation will also be taken into consideration when your doctor works with you to create a treatment plan.

If possible, treatment will focus on eliminating the underlying cause of the arthritis. However, the cause is NOT necessarily curable, as with osteoarthritis and rheumatoid arthritis. Treatment, therefore, aims at reducing your pain and discomfort and preventing further disability.

It is possible to greatly improve your symptoms from osteoarthritis and other long-term types of arthritis without medications. In fact, making lifestyle changes without medications is preferable for osteoarthritis and other forms of joint inflammation. If needed, medications should be used in addition to lifestyle changes.

Exercise for arthritis is necessary to maintain healthy joints, relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your exercise program should be tailored to you as an individual. Work with a physical therapist to design an individualized program, which should include:

  • Range of motion exercises for flexibility
  • Strength training for muscle tone
  • Low-impact aerobic activity (also called endurance exercise)

A physical therapist can apply heat and cold treatments as needed and fit you for splints or orthotic (straightening) devices to support and align joints. This may be particularly necessary for rheumatoid arthritis. Your physical therapist may also consider water therapy, ice massage, or transcutaneous nerve stimulation (TENS).

Rest is just as important as exercise. Sleeping 8 to 10 hours per night and taking naps during the day can help you recover from a flare-up more quickly and may even help prevent exacerbations. You should also:

  • Avoid positions or movements that place extra stress on your affected joints.
  • Avoid holding one position for too long.
  • Reduce stress, which can aggravate your symptoms. Try meditation or guided imagery. And talk to your physical therapist about yoga or tai chi.
  • Modify your home to make activities easier. For example, have grab bars in the shower, the tub, and near the toilet.

Other measures to try include:

  • Taking glucosamine and chondroitin -- these form the building blocks of cartilage, the substance that lines joints. These supplements are available at health food stores or supermarkets. While some studies show such supplements may reduce osteoarthritis symptoms, others show no benefit. However, since these products are regarded as safe, they are reasonable to try and many patients find their symptoms improve.
  • Eat a diet rich in vitamins and minerals, especially antioxidants like vitamin E. These are found in fruits and vegetables. Get selenium from Brewer's yeast, wheat germ, garlic, whole grains, sunflower seeds, and Brazil nuts. Get omega-3 fatty acids from cold water fish (like salmon, mackerel, and herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin seeds, and walnuts.
  • Apply capsaicin cream (derived from hot chili peppers) to the skin over your painful joints. You may feel improvement after applying the cream for 3-7 days.

MEDICATIONS

Your doctor will choose from a variety of medications as needed. Generally, the first drugs to try are available without a prescription. These include:

  • Acetaminophen (Tylenol) -- recommended by the American College of Rheumatology and the American Geriatrics Society as first-line treatment for osteoarthritis. Take up to 4 grams a day (2 extra-strength Tylenol every 6 hours). This can provide significant relief of arthritis pain without many of the side effects of prescription drugs. DO NOT exceed the recommended doses of acetaminophen or take the drug in combination with large amounts of alcohol. These actions may damage your liver.
  • Aspirin, ibuprofen, or naproxen -- these nonsteroidal anti-inflammatory (NSAID) drugs are often effective in combating arthritis pain. However, they have many potential risks, especially if used for a long time. They should not be taken in any amount without consulting your doctor. Potential side effects include heart attack, stroke, stomach ulcers, bleeding from the digestive tract, and kidney damage. In 2005, the U.S. Food and Drug Administration (FDA) asked makers of NSAIDs to include a warning label on their product that alerts users of an increased risk for heart attack, stroke, and gastrointestinal bleeding. If you have kidney or liver disease, or a history of gastrointestinal bleeding, you should not take these medicines unless your doctor specifically recommends them.

Prescription medicines include:

  • Cyclooxygenase-2 (COX-2) inhibitors -- These drugs block an inflammation-promoting enzyme called COX-2. This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach problems. However, numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s. Celecoxib (Celebrex) is still available, but labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest duration possible. Talk to your doctor about whether COX-2s are right for you.
  • Corticosteroids ("steroids") -- these are medications that suppress the immune system and symptoms of inflammation. They are commonly used in severe cases of osteoarthritis, and they can be given orally or by injection. Steroids are used to treat autoimmune forms of arthritis but should be avoided in infectious arthritis. Steroids have multiple side effects, including upset stomach and gastrointestinal bleeding, high blood pressure, thinning of bones, cataracts, and increased infections. The risks are most pronounced when steroids are taken for long periods of time or at high doses. Close supervision by a physician is essential.
  • Disease-modifying anti-rheumatic drugs -- these have been used traditionally to treat rheumatoid arthritis and other autoimmune causes of arthritis. These drugs include gold salts, penicillamine, sulfasalazine, and hydroxychloroquine. More recently, methotrexate has been shown to slow the progression of rheumatoid arthritis and improve your quality of life. Methotrexate itself can be highly toxic and requires frequent blood tests for patients on the medication.
  • Biologics-- these are the most recent breakthrough for the treatment of rheumatoid arthritis. Such medications, including etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira), are administered by injection and can dramatically improve your quality of life. Newer biologics include Orencia (abatacept) and Rituxan (rituximab).
  • Immunosuppressants -- these drugs, like azathioprine or cyclophosphamide, are used for serious cases of rheumatoid arthritis when other medications have failed.

It is very important to take your medications as directed by your doctor. If you are having difficulty doing so (for example, due to intolerable side effects), you should talk to your doctor.

SURGERY AND OTHER APPROACHES

In some cases, surgery to rebuild the joint (arthroplasty) or to replace the joint (such as a total knee joint replacement) may help maintain a more normal lifestyle. The decision to perform joint replacement surgery is normally made when other alternatives, such as lifestyle changes and medications, are no longer effective.

Normal joints contain a lubricant called synovial fluid. In joints with arthritis, this fluid is not produced in adequate amounts. In some cases, a doctor may inject the arthritic joint with a manmade version of joint fluid. The synthetic fluid may postpone the need for surgery at least temporarily and improve the quality of life for persons with arthritis.

Outlook (Prognosis)


A few arthritis-related disorders can be completely cured with treatment. Most are chronic (long-term) conditions, however, and the goal of treatment is to control the pain and minimize joint damage. Chronic arthritis frequently goes in and out of remission.

Possible Complications


  • Chronic pain
  • Lifestyle restrictions or disability

When to Contact a Medical Professional


Call your doctor if:

  • Your joint pain persists beyond 3 days.
  • You have severe unexplained joint pain.
  • The affected joint is significantly swollen.
  • You have a hard time moving the joint.
  • Your skin around the joint is red or hot to the touch.
  • You have a fever or have lost weight unintentionally.

Prevention


If arthritis is diagnosed and treated early, you can prevent joint damage. Find out if you have a family history of arthritis and share this information with your doctor, even if you have no joint symptoms.

Osteoarthritis may be more likely to develop if you abuse your joints (injure them many times or over-use them while injured). Take care not to overwork a damaged or sore joint. Similarly, avoid excessive repetitive motions.

Excess weight also increases the risk for developing osteoarthritis in the knees, and possibly in the hips and hands. See the article on body mass index to learn whether your weight is healthy.

References


Krishnan E. Reduction in long-term functional disability in rheumatoid arthritis from 1977 to 1998: a longitudinal study of 3035 patients. Am J Med. 2003; 115(5): 371-376.

Maini SR. Infliximab treatment of rheumatoid arthritis. Rheum Dis Clin North Am. 2004; 30(2): 329-347.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:1583-1599.

Simon LS, Lipman AG, Jacox AK, etc. Pain in osteoarthritis, rheumatoid arthritis and juvenile chronic arthritis. 2nd ed. Glenview (IL): American Pain Society (APS); 2002.

 

Review Date: 7/27/2007
Reviewed By: Steve Lee, DO, Rheumatology Fellow, Loma Linda University Medical Center, Loma Linda, CA. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Osteoarthritis

Osteoarthritis


Osteoarthritis (OA) is the most common joint disorder.

Alternative Names


Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis - osteoarthritis

Causes


Most of the time, the cause of OA is unknown. It is mainly related to aging, but metabolic, genetic, chemical, and mechanical factors can also lead to OA.

The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in both sexes. However, after 55 it is more common in women.

The disease causes the cushioning (cartilage) between the bone joints to wear away, leading to pain and stiffness. As the disease gets worse, the cartilage disappears and the bone rubs on bone. Bony spurs usually form around the joint.

OA can be primary or secondary.

Primary OA occurs without any type of injury or obvious cause.

Secondary OA is osteoarthritis due to another disease or condition. The most common causes of secondary OA are metabolic conditions, such as acromegaly, problems with anatomy (for example, being bow-legged), injury, or inflammatory disorders such as septic arthritis.

Symptoms


The symptoms of osteoarthritis include:

  • Deep aching joint pain that gets worse after exercise or putting weight on it and is relieved by rest
  • Grating of the joint with motion
  • Joint pain in rainy weather
  • Joint swelling
  • Limited movement
  • Morning stiffness

Some people might not have symptoms.

Exams and Tests


A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness.

An x-ray of affected joints will show loss of the joint space, and in advanced cases, wearing down of the ends of the bone and bone spurs.

Treatment


The goals of treatment are to relieve pain, maintain or improve joint movement, increase the strength of the joints, and reduce the disabling affects of the disease. The treatment depends on which joints are involved.

MEDICATIONS

The most common medications used to treat osteoarthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). They are pain relievers that reduce pain and swelling. Types include aspirin, ibuprofen, and naproxen.

Although NSAIDs work well, long-term use of these drugs can cause stomach problems, such as ulcers and bleeding. Manufacturers of NSAIDs include a warning label on their products that alerts users to an increased risk for cardiovascular events (heart attacks and strokes) and gastrointestinal bleeding.

Other medications used to treat OA include:

  • COX-2 inhibitors (coxibs). Coxibs block a substance called COX-2 that causes swelling. This class of drugs was first thought to work as well as other NSAIDs, but with fewer stomach problems. However, reports of heart attacks and stroke have led the FDA to re-evaluate the risks and benefits of the COX-2s. Celecoxib (Celebrex) is still available at the time of this report, but labeled with strong warnings and a recommendation that it be prescribed at the lowest possible dose for the shortest possible period of time. Ask your doctor whether the drug is right and safe for you.
  • Steroids. These medications are injected right into the joint. They can also be used to reduce inflammation and pain.
  • Supplements. Many people are helped by over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage.
  • Artificial joint fluid (Synvisc, Hyalgan). These medications can be injected into the knee. They may relieve pain for up to 6 months.

LIFESTYLE CHANGES

Exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.

Applying heat and cold, protecting the joints, using self-help devices, and rest are all recommended.

Good nutrition and careful weight control are also important. If you're overweight, losing weight will reduce the strain on the knee and ankle joints.

PHYSICAL THERAPY

Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3-6 weeks, then it likely will not work at all.

BRACES

Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.

SURGERY

Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:

  • Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty, hip arthroplasty)
  • Arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
  • Cartilage restoration to replace the damaged or missing cartilage in some younger patents with arthritis
  • Change in the alignment of a bone to relieve stress on the bone or joint (osteotomy)
  • Surgical fusion of bones, usually in the spine (arthrodesis)

Support Groups

For more information and support, see arthritis resources.

Outlook (Prognosis)

Your movement may become very limited. Treatment generally improves function.

Possible Complications

  • Decreased ability to walk
  • Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking
  • Adverse reactions to drugs used for treatment
  • Surgical complications

When to Contact a Medical Professional

Call your health care provider if you have symptoms of osteoarthritis.

Prevention

Weight loss can reduce the risk of knee osteoarthritis in overweight women.

References

Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB, Kelley's Textbook of Rheumatology, 7th ed. St. Louis, MO; W.B. Saunders; 2005.

US Food and Drug Administration. FDA Announces Series of Changes to the Class of Marketed Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Rockville, MD: National Press Office; April 7, 2005. Press Release P05-16.

US Food and Drug Administration. FDA Issues Public Health Advisory Recommending Limited Use of Cox-2 Inhibitors. Rockville, MD: National Press Office; December 23, 2004. Talk Paper T04-61.

 

Review Date: 8/6/2007
Reviewed By: Thomas N. Joseph, MD, Private Practice specializing in Orthopaedics, subspecialty Foot and Ankle, Camden Bone Joint, Camden, SC. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Scoliosis

Scoliosis


Scoliosis is a curving of the spine. The spine curves away from the middle or sideways.

Alternative Names


Spinal curvature; Kyphoscoliosis

Causes


There are three general causes of scoliosis:

  • Congenital (present at birth) scoliosis is due to a problem with the formation of the spine bones (vertebrae) or fused ribs during development in the womb.
  • Neuromuscular scoliosis is caused by problems such as poor muscle control or muscle weakness, or paralysis due to diseases such as cerebral palsy, muscular dystrophy, spina bifida, and polio.
  • Idiopathic scoliosis is scoliosis of unknown cause. It appears in a previously straight spine.

Idiopathic scoliosis in adolescents is the most common type. Some people may be prone to curving of the spine. Most cases occur in girls. Curves generally worsen during growth spurts. Scoliosis in infants and young children are less common, and commonly affect boys and girls equally.

Scoliosis may be suspected when one shoulder appears to be higher than the other, or the pelvis appears to be tilted. Untrained observers usually can't notice the curving.

Routine scoliosis screening is now done in middle and junior high schools. Many cases, which previously would have gone undetected until they were more advanced, are now being caught at an early stage.

There may be fatigue in the spine after prolonged sitting or standing. Pain will become persistent if irritation results. The greater the initial curve of the spine, the greater the chance the scoliosis will get worse after growth is complete. Severe scoliosis (curves in the spine greater than 100 degrees) can cause breathing problems.

Symptoms

  • Backache or low-back pain
  • Fatigue
  • Shoulders or hips appear uneven
  • Spine curves abnormally to the side (laterally)

Note: Kyphoscoliosis also involves abnormal front-to-back curvature, with a "rounded back" appearance. See kyphosis.

Exams and Tests


The health care provider will perform a physical exam, which includes a forward bending test that will help the doctor define the curve. The degree of curve seen on an exam may underestimate the actual curve seen on an x-ray, so any child found with a curve is likely to be referred for an x-ray. The health care provider will perform a neurologic exam to look for any changes in strength, sensation, or reflexes.

Tests may include:

  • Scoliometer measurements (a device for measuring the curvature of the spine)
  • Spine x-rays (taken from the front and the side)
  • MRI (if there are any neurologic changes noted on the exam or if there is something unusual in the x-ray )

Treatment


Treatment depends on the cause of the scoliosis, the size and location of the curve, and how much more growing the patient is expected to do. Most cases of adolescent idiopathic scoliosis (less than 20 degrees) require no treatment, but should be checked often, about every 6 months.

As curves get worse (above 25 to 30 degrees in a child who is still growing), bracing is usually recommended to help slow the progression of the curve. There are many different kinds of braces used. The Boston Brace, Wilmington Brace, Milwaukee Brace, and Charleston Brace are named for the centers where they were developed.

Each brace looks different. There are different ways of using each type properly. The selection of a brace and the manner in which it is used depends on many factors, including the specific characteristics of the curve. The exact brace will be decided on by the patient and health care provider.

A back brace does not reverse the curve. Instead, it uses pressure to help straighten the spine. The brace can be adjusted with growth. Bracing does not work in congenital or neuromuscular scoliosis, and is less effective in infantile and juvenile idiopathic scoliosis.

Curves of 40 degrees or greater usually require surgery because curves this large have a high risk of getting worse even after bone growth stops. Surgery involves correcting the curve (although not all the way) and fusing the bones in the curve together. The bones are held in place with one or two metal rods held down with hooks and screws until the bone heals together. Sometimes surgery is done through a cut in the back, on the abdomen, or beneath the ribs. A brace may be required to stabilize the spine after surgery.

The limitations imposed by the treatments are often emotionally difficult and may threaten self-image, especially of teenagers. Emotional support is important for adjustment to the limitations of treatment.

Physical therapists and orthotists (orthopedic appliance specialists) can help explain the treatments and make sure the brace fits comfortably.

Outlook (Prognosis)


The outcome depends on the cause, location, and severity of the curve. The greater the curve, the greater the chance the curve will get worse after growth has stopped.

Mild cases treated with bracing alone do very well. People with these kinds of conditions tend not to have long-term problems, except maybe an increased rate of low back pain when they get older. People with surgically corrected idiopathic scoliosis also do very well and can lead active, healthy lives.

Patients with neuromuscular scoliosis have another serious disorder (like cerebral palsy or muscular dystrophy) so their goals are much different. Often the goal of surgery is simply to allow a child to be able to sit upright in a wheelchair.

Babies with congenital scoliosis have a wide variety of underlying birth defects. Management of this disease is difficult and often requires many surgeries.

Possible Complications

  • Emotional problems or lowered self-esteem may occur as a result of the condition or its treatment (specifically, wearing a brace)
  • Failure of the bone to join together (very rare in idiopathic scoliosis)
  • Low back arthritis and pain as an adult
  • Low back arthritis and pain as an adult
  • Respiratory problems from severe curve
  • Spinal cord or nerve damage from surgery or severe, uncorrected curve
  • Spine infection after surgery

When to Contact a Medical Professional


Call your health care provider if you suspect your child may have scoliosis.

References

Hedequist DJ. Surgical treatment of congenital scoliosis. Orthop Clin North Am. 2007;38(4):497-509, vi.

 

Review Date: 2/27/2008
Reviewed By: Rachel A. Lewis, MD, FAAP, Columbia University Pediatric Faculty Practice, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Sprains

Sprains


A sprain is an injury to the ligaments around a joint. Ligaments are strong, flexible fibers that hold bones together. When a ligament is stretched too far or tears, the joint will become painful and swell.

Alternative Names


Joint sprain

Causes


Sprains are caused when a joint is forced to move into an unnatural position. For example, "twisting" one's ankle causes a sprain to the ligaments around the ankle.

Symptoms


  • Joint pain or muscle pain
  • Swelling
  • Joint stiffness
  • Discoloration of the skin, especially bruising

First Aid


  1. Apply ice immediately to help reduce swelling. Wrap the ice in cloth -- DO NOT place ice directly on the skin.
  2. Try NOT to move the affected area. To help you do this, bandage the affected area firmly, but not tightly. ACE bandages work well. Use a splint if necessary.
  3. Keep the swollen joint elevated above the level of the heart, even while sleeping.
  4. Rest the affected joint for several days.

Aspirin, ibuprofen, or other pain relievers can help. DO NOT give aspirin to children.

Keep pressure off the injured area until the pain subsides (usually 7-10 days for mild sprains and 3-5 weeks for severe sprains). You may require crutches when walking. Rehabilitation to regain the motion and strength of the joint should begin within one week.

When to Contact a Medical Professional


Go to the hospital right away or call 911 if:

  • You suspect a broken bone
  • The joint appears to be deformed
  • You have a serious injury or the pain is severe
  • There is an audible popping sound and immediate difficulty using the joint

Call your doctor if:

  • Swelling does not go down within 2 days
  • You have symptoms of infection -- the area becomes redder, more painful, or warm, or you have a fever over 100°F
  • The pain does not go away after several weeks

Prevention


  • Wear protective footwear for activities that place stress on your ankle and other joints.
  • Make sure that shoes fit your feet properly.
  • Avoid high-heeled shoes.
  • Always warm-up and stretch prior to exercise and sports.
  • Avoid sports and activities for which you are not conditioned.

References


DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 2nd ed. Philadelphia, Pa:Saunders; 2003.

Frontera, WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 1st ed. Philadelphia, Pa: Hanley & Belfus; 2002.

Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

Review Date: 5/6/2007
Reviewed By: Thomas N. Joseph, MD, Private Practice specializing in Orthopaedics, subspecialty Foot and Ankle, Camden Bone & Joint, Camden, SC. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com

Tennis Elbow

Tennis elbow


Definition


Tennis elbow is an inflammation, soreness, or pain on the outside (lateral) side of the upper arm near the elbow. There may be a partial tear of the tendon fibers, which connect muscle to bone, at or near their point of origin on the outside of the elbow.

Alternative Names


Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral

Causes


This injury is due to repeated motions of the wrist or forearm. The injury is typically associated with tennis playing, hence the name "tennis elbow." However, any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to this condition.

Symptoms


  • Elbow pain that gradually worsens
  • Pain radiating from the outside of the elbow to the forearm and back of the hand when grasping or twisting
  • Weak grasp

Exams and Tests


The diagnosis is made by clinical signs and symptoms, since x-rays are usually normal. Often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow

There is also pain near the elbow when the wrist is extended (bent backwards, like revving a motorcycle engine) against resistance.

Treatment


The goal of treatment is to relieve pain and swelling. Treatment may include:

  • Nonsteroidal anti-inflammatory medications (such as ibuprofen, naproxen or aspirin)
  • Local injection of cortisone and an numbing medicine
  • Using a splint to keep the forearm and elbow still for 2 to 3 weeks
  • Heat therapy
  • Physical therapy
  • Pulsed ultrasound to break up scar tissue, promote healing, and increase blood flow in the area

To prevent the injury from happening again, a splint may be worn during aggravating activities. Or, you may need to limit certain activities. If the pain persists despite non-surgical treatments, surgery may be necessary.

Outlook (Prognosis)

Most people improve with non-surgical treatment. The majority of those that do have surgery show an improvement in symptoms.

Possible Complications

  • Recurrence of the injury with overuse
  • Rupture of the tendon with repeated steroid injections
  • Failure to improve with nonoperative or operative treatment; these may be due to nerve entrapment in the forearm

When to Contact a Medical Professional


Apply home treatment (over-the-counter anti-inflammatory analgesics and immobilization) if symptoms are mild or if you have had this disorder before and you know this is what you have.

Call for an appointment with your health care provider if this is the first time you have had these symptoms, or if home treatment does not relieve the symptoms.

Prevention


Maintain good strength and flexibility in the arm muscles or avoid repetitive motions. Rest the elbow when flexion and extension is painful. An ice pack applied to the outside of the elbow after repetitive motion may help alleviate symptoms.

 

Review Date: 9/26/2006
Reviewed By: Andrew L. Chen, M.D., M.S., Orthopedist, The Alpine Clinic, Littleton, NH. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Plantar Fasciitis

Plantar fasciitis


Definition


Plantar fasciitis is irritation and swelling of the thick tissue on the bottom of the foot.

Causes


The plantar fascia is a very thick band of tissue that covers the bones on the bottom of the foot. This fascia can become inflamed and painful in some people, making walking more difficult.

Risk factors for plantar fasciitis include foot arch problems (both flat foot and high arches), obesity, sudden weight gain, running, and a tight Achilles tendon (the tendon connecting the calf muscles to the heel). A typical patient is an active man age 40-70.

This condition is one of the most common orthopedic complaints relating to the foot.

Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On x-ray, heel spurs are seen commonly both in people with and without plantar fasciitis.

Symptoms


The most common complaint is pain in the bottom of the heel, usually worst in the morning and improving throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest.

Exams and Tests


Typical physical exam findings include tenderness on the bottom of the heel, closer to the midline, and mild swelling and redness.

X-rays may be taken to rule out other problems, but the presence or absence of a heel spur is not significant.

Treatment


Conservative treatment is almost always successful, given enough time. Duration of treatment can be anywhere from several months to 2 years before symptoms resolve, although about 90% of patients will be better in 9 months.

Initial treatment usually consists of heel stretching exercises, shoe inserts, night splints, and anti-inflammatory medications. If these fail, casting the affected foot in a short leg cast (a cast up to but not above the knee) for 3-6 weeks is very often successful in reducing pain and inflammation. Alternatively, a cast boot (which looks like a ski boot) may be used. It is still worn full time, but can be removed for bathing.

Some physicians will offer steroid injections, which provide lasting relief in about 50% of people. However, this injection is very painful and not for everyone.

In a few patients, non-surgical treatment fails and surgery to release the tight, inflamed fascia becomes necessary.

Outlook (Prognosis)


Nearly all patients will improve within 1 year of beginning non-surgical therapy, with no long-term problems. In the few patients requiring surgery, over 95% have relief of their heel pain.

Possible Complications


A complication of non-operative therapy is continued pain. In surgical therapy, there is a risk of nerve injury, infection, rupture of the plantar fascia, and failure of the pain to improve.

When to Contact a Medical Professional


Contact your health care provider if you have symptoms of plantar fasciitis.

Prevention


Maintaining good flexibility around the ankle is probably the best way to prevent plantar fasciitis.

 

Review Date: 9/21/2006
Reviewed By: Jeffrey Kauffman, MD, Sacramento Knee and Sports Medicine, Sacramento, CA. Review provided by VeriMed Healthcare Network.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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