What are rotator cuff disorders?

Rotator Cuff Tear

The rotator cuff is a group of tough, flexible fibers (tendons) and muscles in the shoulder. Rotator cuff disorders occur when tissues in the shoulder get irritated or damaged. Rotator cuff disorders include:

  • Inflammation of the tendons (tendinitis) or of a bursa (bursitis). In the shoulder, a bursa is a small, fluid-filled sac that serves as a cushion between the tendons and the bones.
  • Impingement, in which a tendon is squeezed and rubs against bone.
  • Calcium buildup in the tendons, which causes a painful condition called calcific tendinitis.
  • Partial or complete tears of the rotator cuff tendons.

How does the shoulder work, and what does the rotator cuff do?

The shoulder is a joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). The bones are held together by muscles, tendons, and ligaments. The rotator cuff keeps the upper arm bone in the shoulder socket and lets you raise and twist your arm.

The shoulder is a ball-and-socket joint. The ball at the top of the upper arm bone fits into the socket of the shoulder blade. This socket is shallow, which lets you move your arm in a wide range of motion. But it also means that the muscles and tendons of the rotator cuff have to work hard to hold the bones in place. As a result, they are easy to injure and are prone to wear and tear.

What causes rotator cuff disorders?

Most rotator cuff disorders are caused by a combination of:

  • Normal wear and tear. Using your shoulder for many years slowly damages the rotator cuff. As you age, everyday activities can lead to changes in the rotator cuff, such as thinning and fraying of the tendons and reduced blood supply.
  • Overuse. Activities in which you use your arms above your head a lot—such as tennis, swimming, or house painting—can lead to rotator cuff problems. Even normal motions made often over a long period can stress or injure the rotator cuff.

Both normal wear and tear and overuse can lead to impingement, when a tendon rubs against bone. This damages and irritates the tendon, which causes bleeding and inflammation. Over time, damage to the tendon may build up, so the tendon is more easily injured.

It takes great force to tear a healthy rotator cuff tendon. This can happen during sports, an accident, or a severe fall. But even a simple movement like lifting a suitcase can cause a rotator cuff tear in an older adult or someone whose shoulder is already damaged.

What are the symptoms for rotator cuff disorder?

Symptoms of a rotator cuff disorder include pain and weakness in the shoulder. Most often, the pain is on the side and front of the upper arm and shoulder. It may hurt or be impossible to do everyday things, such as comb your hair, tuck in your shirt, or reach for something. You may have pain during the night and trouble sleeping.

Symptoms of rotator cuff tendinitis

In tendinitis (inflammation in the tendon), the pain usually starts gradually, over the side of the shoulder and the upper arm.

  • Your shoulder and arm aren’t particularly weak but it hurts to use them.
  • The pain may spread down the outside of the upper arm, even to the elbow.
  • The pain may be worse at night and may keep you awake, especially if you lie on that side.
  • Lifting the arm to the side or to the front makes the pain worse.

Over time, the pain may get worse or you may have constant pain. In some cases, this is because you actually have one or more small tendon tears.

Some people also have tendinitis in other parts of the shoulder. And some people have neck pain from using other muscles to help move the shoulder.

Symptoms of rotator cuff tears

The most common symptoms of a tear are:

  • Pain when you move your arm, especially overhead or against resistance.
  • Pain at night.
  • Weakness in your shoulder, although some people don’t notice any weakness if the tear is small.

Symptoms of a sudden, severe tear include:

  • A popping sound or tearing sensation in your shoulder.
  • Immediate pain in your shoulder.
  • Weakness and pain when you lift or rotate your arm.
  • Limited range of motion and inability to raise your arm because of pain or weakness.
  • Possibly, bruising in your shoulder or upper arm.

You can have a complete tear without symptoms, especially if you are an older adult who is not very active.

How are rotator cuff disorders diagnosed?

To diagnose a rotator cuff disorder, doctors ask about any shoulder injuries or past shoulder pain. They also do a physical exam to see how well the shoulder works and to find painful areas or activities. Moving your arm in certain ways can help a doctor learn about the condition of the rotator cuff.

You may have an X-ray to check the bones of the shoulder. If the diagnosis is still unclear, the doctor may order an imaging test, such as an MRI or an ultrasound.

How are rotator cuff disorders treated?

Treatment of rotator cuff disorders should begin soon after an injury or soon after symptoms develop, to give you the best chance of restoring flexibility and strength to your shoulder. Without treatment, inflammation and tears can build up, causing pain, weakness, and loss of function.

Treatment depends on your symptoms, age, and activity level, and on whether your symptoms appear to be related to a rotator cuff injury.

Nonsurgical treatment

Most rotator cuff disorders are treated without surgery. Your treatment may include:

If symptoms don’t improve after a few months of nonsurgical treatment, you and your doctor may consider testing (such as X-rays or an MRI) to find out if you have a rotator cuff tear.

Surgery

Surgery often is used to repair a torn rotator cuff. Nowadays, surgery is done arthroscopically using keyhole.

Surgery may be considered if:

  • You have a rotator cuff tear caused by a sudden injury.
  • Your shoulder doesn’t get better after 3 to 6 months of other treatment.

Call (+65) 6471 2674 (24 hour) to fix an appointment with our specialist to treat your rotator cuff today.

What is tennis elbow?

Tennis elbow is soreness or pain on the outer part of the elbow. It happens when you damage the tendons that connect the muscles of your forearm to your elbow. The pain may spread down your arm to your wrist. If you don’t treat the injury, it may hurt to do simple things like turn a key or open a door.

Your doctor may call this condition lateral epicondylitis.

Tennis Elbow

What causes tennis elbow?

Most of the time tennis elbow is caused by overuse. You probably got it from doing activities where you twist your arm over and over. This can stress the tendon, causing tiny tears that in time lead to pain. A direct blow to the outer elbow can also cause tendon damage.

Tennis elbow injuries can result from:

  • Overuse. Repeated movements that involve twisting of the elbow cause small tears in the tendon, weakening it. Overuse depends on how hard or how long you do something.
  • Technique, or the way you do an activity. This includes holding equipment or a tool in a awkward position while you use it.
  • Equipment. This can happen, for example, if you use a tool or sports equipment that is too heavy for you or that has a grip that is the wrong size for your hand.
  • A single accident, such as a direct hit to the side of the elbow (lateral epicondyle), or falling on an outstretched arm.

Anyone can get tennis elbow, but it usually occurs in people in their 40s.

How is tennis elbow diagnosed?

To diagnose tennis elbow, a doctor will examine your elbow and ask questions about the elbow problem, your daily activities, and past injuries. You probably won’t need to have an X-ray, but you might have one to help rule out other things that could be causing the pain.

Symptoms of tennis elbow

Tennis elbow symptoms usually begin gradually. The main symptom is pain, which may begin with a dull aching or soreness on the outer part of the elbow that goes away within 24 hours after an activity. As time goes on, it may take longer for the pain to go away. The condition may further progress to pain with any movement, even during everyday activities, such as lifting a jug of milk. Pain may spread to the hand, wrist, other parts of the arm, shoulder, or neck.

Tennis elbow pain:

  • Usually occurs in the dominant arm (your right arm if you are right-handed, or left arm if you are left-handed).
  • Affects the outside of the elbow (the side away from your body). Pain increases when that area is pressed or when you are grasping or twisting objects.
  • May increase in the evening and make sleep difficult. The elbow might be stiff in the morning.
  • Over time may occur with mild activity, such as picking up a coffee cup, turning a jar lid or doorknob or key, or shaking hands. Simply starting your car could hurt. You may even have pain when you aren’t using your elbow.

Other parts of the arm, shoulder, and neck may also become sore or painful as the body tries to make up for the loss of elbow movement and strength.

Swelling rarely occurs with tennis elbow. If your elbow is swollen, you may have another type of condition, such as arthritis.

Radial tunnel syndrome is an unusual type of nerve entrapment that is sometimes confused with or can develop at the same time as tennis elbow.

When To Call a Doctor

Call your doctor immediately if you had an injury to your elbow and:

  • You have severe elbow pain.
  • You cannot move your elbow normally.
  • Your elbow looks deformed.
  • Your elbow begins to swell within 30 minutes of the injury.
  • You have signs of damage to the nerves or blood vessels. These include:
    • Numbness, tingling, or a “pins-and-needles” sensation below the injury.
    • Pale or bluish skin.
    • The injured arm feeling colder to the touch than the uninjured one.

Call your doctor if you have:

  • Pain when grasping, twisting, or lifting objects.
  • Work-related problems caused by your elbow pain.
  • Elbow pain after 2 weeks of home treatment or if treatment is making your elbow pain worse.

How is tennis elbow treated?

You can start treating tennis elbow at home right away.

  • Rest your arm, and avoid any activity that makes the pain worse.
  • As soon as you notice pain, use ice or cold packs for 10 to 15 minutes at a time, several times a day. Always put a thin cloth between the ice and your skin. Keep using ice as long as it relieves pain. Or use a warm, moist cloth or take hot baths if they feel good. Do what works for you.
  • Take over-the-counter pain relievers such as ibuprofen or naproxen (NSAIDs) or acetaminophen if you need them. Or try an NSAID cream that you rub over the sore area. Be safe with medicines. Read and follow all instructions on the label.
  • Wear a counterforce brace when you need to grasp or twist something. This is a strap around your forearm placed about an inch below your elbow. It may ease the pressure on the tendon and spread force throughout your arm.

Our specialist treats tennis elbow using:

  • Anti-inflammatory injections to reduce the inflammation at the tendon. This is a direct delivery of the medicine to the area.
  • Shockwave therapy. This is a high energy soundwave that transmits to your tendon. It will stimulate our body’s self healing mechanism.
  • Platelet rich plasma therapy. This is using the platelet of your blood sample and using the platelets self healing power to heal your tendon.

How to prevent tennis elbow?

The best way to prevent tennis elbow is to stretch and strengthen your arm muscles so that they are flexible and strong enough for your activities.

Surgery for tennis elbow

Most cases of tennis elbow are treated without surgery. You and your doctor might consider surgery if you have exhausted the conservative treatment and the pain is still bothering you.

Consider surgery if:

  • Your elbow is still sore and painful after more than 6 to 12 months of trying conservative treatment.
  • Your doctor has ruled out other possible causes of elbow pain, such as nerve problems, arthritis, muscle injury, or injury to another tendon.
  • Your conservative treatment have given good short-term pain relief, but the pain has returned.
  • You can’t do normal daily activities and job tasks because of elbow pain.

During surgery, a doctor will most likely cut (release) the tendon, remove damaged tissue from the tendon, or both. In some cases, tendon tears can be repaired.

After surgery, rehab is needed to restore flexibility and strength in the forearm.

Call (+65) 6471 2674 (24 Hours) to make an appointment to see our elbow specialist to treat your tennis elbow today.

What is patellar tracking disorder?

Patellar tracking disorder means that the kneecap (patella) shifts out of place as the leg bends or straightens. In most cases, the kneecap shifts too far toward the outside of the leg. In a few people, it shifts toward the inside.

Patellar Tracking Disorder

Your knee joint is a complex hinge that joins the two bones of the lower leg with the thighbone.

  • The kneecap sits in a groove at the end of the thighbone. It is held in place by tendons on the top and bottom and by ligaments on the sides.
  • A layer of cartilage lines the underside of the kneecap. This helps it glide along the groove in the thighbone.

A problem with any of these parts in or around the knee can lead to patellar tracking disorder.

What causes patellar tracking disorder?

Patellar tracking disorder is usually caused by several problems combined, such as:

  • The way your knee is formed. Things that can lead to a knee problem include having a small or flat kneecap, knock-knees, a very long patellar tendon, or a shallow groove in the end of the thighbone.
  • Muscles in the front of your thigh (quadriceps) that are weak or out of balance. Strong quadriceps help hold your kneecap in place. But your kneecap can be pulled off track if the outer quadriceps muscle is stronger or contracts more quickly than the inner muscle.
  • Ligaments, tendons, or muscles that are too loose or too tight.
  • Damaged cartilage in your kneecap.

You are more likely to have patellar tracking disorder if you have any of the above problems and you are overweight, run, or play sports that require repeated jumping, knee bending, or squatting.

What are the symptoms?

If you have a patellar tracking problem, you may have:

  • Pain in the front of the knee, especially when you squat, jump, kneel, or use stairs (most often when going down stairs).
  • A feeling of popping, grinding, slipping, or catching in your kneecap when you bend or straighten your leg.
  • A feeling that your knee is buckling or giving way, as though all of a sudden your knee can’t support your weight.

If your kneecap is completely dislocated, you may have severe pain and swelling. Your knee may look like a bone is out of place. And you may not be able to bend or straighten the knee. If you have these symptoms, be sure to see your doctor. A dislocated kneecap needs to be put back in place by a doctor right away.

How is patellar tracking disorder diagnosed?

It can be hard to tell the difference between patellar tracking disorder and some other knee problems. To find out what problem you have, your doctor will:

  • Ask questions about your past health, your activities, when the pain started, and whether it was caused by an injury, overuse, or something else.
  • Feel, move, and look at your knee as you sit, stand, and walk.

You may have an X-ray so your doctor can check the position and condition of your knee bones. If more information is needed, you may have an MRI.

How is patellar tracking disorder treated?

Patellar tracking disorder can be a frustrating problem, but be patient. Most people feel better after a few months of treatment. As a rule, the longer you have had this problem, the longer it will take to get better.

Treatment of patellar tracking disorder has two goals: to reduce your pain and to strengthen the muscles around your kneecap to help it stay in place. If you don’t have severe pain or other signs of a dislocated kneecap, you can try home treatment for a week or two to see if it will reduce your pain.

  • Take a break from activities that cause knee pain, like squatting, kneeling, running, and jumping.
  • Put ice on your knee, especially before and after activity. After 2 or 3 days, you can try heat to see if that helps.
  • Take an over-the-counter pain reliever to reduce pain and swelling. Read and follow all instructions on the label.

As your knee pain starts to decrease, do exercises to increase strength and flexibility in your leg and hip. Your doctor or a physical therapist can help you plan an exercise program that fits your condition. You will probably start with one or two exercises and add others over time. Make sure to closely follow the instructions you’re given.

Most people with patellar tracking disorder can slowly return to their previous activity level if they:

  • Avoid movements that make symptoms worse.
  • Keep doing their stretches and strength exercises.
  • Learn the best way to do their sport and use the right shoes or equipment.
  • Lose excess weight.

Surgery usually isn’t needed for patellar tracking disorder. You may need surgery if your kneecap dislocates many times or other treatments haven’t worked. There are several types of surgery that can correct a tracking problem. You and your doctor can decide which surgery is best for you.

Can patellar tracking disorder be prevented?

Sometimes knee problems run in the family. If a family member has knee pain, you may want to take steps to help prevent this problem.

  • Avoid activity that overloads and overuses the knee.
  • Keep the muscles around your knees and hips strong and flexible.
  • Stretch your legs and hips well, both before and after activity.
  • Do activities that work different parts of the leg, especially if you’re a runner. Cycling and swimming are good choices.
  • Stay at a healthy weight to reduce stress on your knees.

Call (+65) 6471 2674 (24 Hour) to see our knee specialist regarding your patellar tracking disorder today.

What is a tendon injury?

Tendons are the tough fibers that connect muscle to bone. For example, the Achilles tendon connects the calf muscle to the heel bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.

Doctors may use different terms to describe a tendon injury. You may hear:

  • Tendinitis. This means “inflammation of the tendon.”
  • Tendinosis. This refers to tiny tears in the tissue in and around the tendon caused by overuse.

Most experts now use the term tendinopathy to include both inflammation and microtears. But for many years most tendon problems were called “tendinitis.” Many doctors still use this familiar word to describe a tendon injury.

What causes a tendon injury?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or aging. Anyone can have a tendon injury. But people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened over time.

What are the symptoms?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

  • The pain may get worse when you use the tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be a lot like those caused by bursitis.

How is a tendon injury diagnosed?

To diagnose a tendon injury, a doctor will ask questions about your past health and your symptoms and will do a physical exam. If the injury is related to your use of a tool or sports equipment, the doctor may ask you to show how you use it.

If your symptoms are severe or do not improve with treatment, your doctor may want you to have a test, such as an X-ray, ultrasound, or MRI.

How is tendon injury treated?

In most cases, you can treat a tendon injury at home. To get the best results, start these steps right away:

  • Rest the painful area, and avoid any activity that makes the pain worse.
  • Apply ice or cold packs for 10 to 15 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
  • Take over-the-counter pain relievers such as acetaminophen or NSAIDs if you need them. Be sure to follow the nonprescription medicine precautions. Always take these medicines exactly as prescribed or according to the label.
  • Do gentle range-of-motion exercises and stretching to prevent stiffness.

If these steps do not help to relieve pain, other treatment may be considered. Your doctor may:

  • Prescribe physical therapy.
  • Use a corticosteroid injection to relieve pain and swelling.
  • Shockwave therapy
  • Platelet rich plasma therapy
  • Blood test if the doctor suspects a systemic problem

How to prevent tendon injury?

To keep from hurting your tendon again, you may need to make some long-term changes to your activities.

  • Try changing your activities or how you do them. For example, if running caused the injury, try swimming some days. If the way you use a tool is the problem, try switching hands or changing your grip.
  • If exercise caused the problem, take lessons or ask a trainer or pro to check your technique.
  • If your job caused the tendon injury, ask your human resource department if there are other ways to do your job.
  • Always take time to warm up before and stretch after you exercise.

Call (+65) 6471 2674 (24 Hour) to treat your tendon injury today.

What is whiplash?

Whiplash

Whiplash is pain and stiffness in the neck after an injury that has caused the neck to move suddenly or beyond its normal range.

It occurs when the head is suddenly forced backward or forward and is then snapped in the other direction. This kind of motion most often happens to people in a car that is hit from behind. Less commonly, it might happen in a fall, a sports injury, or if you are roughly shaken. The motion causes stretching or tears (sprains) of muscles and ligaments in the neck, and it may damage the nerves. In rare cases, it may cause broken bones.

What are the symptoms?

Symptoms of whiplash are pain and stiffness in the neck and sometimes in the muscles in your head, chest, shoulders, and arms. You also may have a headache, feel dizzy, and have pain in your back.

You may not have any symptoms until the day after your injury. Or your symptoms may go away but then return a few days later.

You may have a more serious injury if you have:

  • Severe pain in your neck.
  • Pain down one or both arms.
  • Pain that comes back after being gone for a few days.
  • Numbness or tingling in your hands, arms, chest, or legs.
  • Weakness in your arms, hands, or legs.
  • Inability to move your head.

How is whiplash diagnosed?

Your doctor will ask questions about your neck injury and past health, and he or she will carefully examine your head and neck. You may need X-rays to make sure there are no broken bones in your neck. You may also need an imaging test such as an MRI scan to look for other injuries.

How is Whiplash treated?

Most whiplash improves with conservative treatment.

  • Your doctor may prescribe pain medicines and muscle relaxers to help with continuing or severe pain.
  • Talk with your doctor about whether physical therapy could help you.
  • Anti-inflammatory injections.

What things can I do for Whiplash Injury?

  • Avoid activities such as lifting and sports that make pain and stiffness worse.
  • Place a special pillow or a tightly rolled-up towel under your neck while you sleep. Do not use your regular pillow at the same time.
  • You can try using a soft foam collar to support your neck for short periods of time. You can probably buy one at a drugstore. Do not wear the collar more than 2 or 3 days unless your doctor tells you to do so.
  • Return to your normal daily activities as soon as possible.

It takes up to 3 months for the neck to heal, even though most pain may be gone in less time. More severe whiplash may take longer, but it usually improves within 6 to 12 months.

After your neck pain is gone, do exercises to stretch your neck and back and make them stronger. Your doctor or physical therapist can tell you which exercises are best.

How can you prevent whiplash?

To help prevent whiplash when you drive, always wear your seat belt and adjust your headrest to the proper height.

Call (+65) 6471 2674 (24 hour) to treat your Whiplash Injury today.