Causes of Elbow or Arm Pain

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Article features on News Medical Life Sciences

There are various possible causes of elbow pain or arm pain. These include injury to the arm, compression of the nerves that serve the arm, arthritis, and various other health conditions.

elbow pain

Injury

A sprain can occur when a movement of the arm has caused damage to the connective tissues in the area. This can present as arm or elbow pain. This damage is usually acute and temporary, and the pain will improve with time as the tissues are repaired.

A fracture or dislocation of a bone in the arm or elbow may also be responsible for causing elbow pain. Most patients are able to pinpoint the cause of the pain or trace it to a certain incident that caused the damage.

Repetitive strain injury (RSI) can also cause elbow pain. It is due to the performance of repetitive tasks that involve movements of the elbows. As such, it commonly affects office workers who use computers frequently throughout the day, and other individuals whose job comprises repetitive manual work.

Tennis elbow or golfer’s elbow can cause elbow pain, and occurs due to the overuse of the muscles and tendons in the joint. It is so named because it is most common in individuals who plan tennis or golf, due to the arm movements that are involved in these sports.

Nerve compression

The joints and bones of an individual show wear and tear as part of the natural aging process. This can lead to the squashing or trapping of nerves, which in turn can cause pain in various areas of the body. In this case, the nerves around the elbow may be pinched, causing pain. Other sensations, such as numbness or tingling, may also be experienced.

cubital tunnel syndrome

Cervical spondylosis is a condition that involves compression of the spinal nerves in the neck region. Some of these nerves are responsible for the sensory messages of pain carried to and from the arm. Damage to them can hence lead to arm pain. Sometimes the compressed nerve may be located in the arm.

A cervical rib is a musculoskeletal abnormality that involves the presence of an additional rib above the normal first rib. This extra bone can interfere with the free passage of nerves in the region, which may lead to elbow pain.

Arthritis

Osteoarthritis or rheumatoid arthritis that affects the elbow joint can lead to stiffness, pain and inflammation of the elbow and arm.

Osteoarthritis involves damage to the cartilage at the ends of the bones that help to prevent friction between the bones that take part in the joint, often due to overuse of or injury to the joint. This leads to rubbing of the bones against each other, which provokes the symptoms of arthritis.

Rheumatoid arthritis involves an autoimmune response of the body that leads to damage to the synovial membrane that lines the joints in the body, including the elbow. In this condition, both elbows are usually affected.

Other health conditions that cause elbow pain

Angina is a health condition that involves reduced blood flow to the heart muscles as a result of narrowing of the blood vessels. Individuals with angina may experience a dull, throbbing pain in the chest, neck, and left arm as a symptom of the condition, particularly during physical activity or when they undergo stress.

Gout is another health condition characterized by the formation of sharp crystals at various locations around the body, including inside the elbow joints. This is due to a high concentration of uric acid in the body. This can cause severe elbow pain during a gout attack.

Olecranon bursitis is the build up of fluid inside the fold of smooth synovial membrane that cushions the olecranon (the bony tip of the elbow joint). This can cause pain and inflammation.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Why are arthritis symptoms worse at night?

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Article featured on Medical News Today

Many people notice that their arthritis symptoms get worse at night. When this occurs, it can be hard for people to sleep, leaving them exhausted in the morning and potentially contributing to daytime pain or fatigue.

It is common for pain to get worse at night. A 2020 study found that online searches for information about pain management peaked between 11:00 p.m. and 4:00 a.m.

Doctors do not fully understand why arthritis pain often worsens at night, but possible causes involve changes in the levels of hormones and cytokines, which are cell-signaling proteins, in the body. Daytime arthritis medication, which some people take during the morning, may also wear off by the evening.

In this article, we examine why arthritis pain gets worse at night and how it disrupts sleep. We also provide tips on ways to improve sleep.

Why arthritis symptoms get worse at night

Researchers have several theories to explain why many people with arthritis experience worse pain at night.

One theory is that the body’s circadian rhythm may play a role. In people with rheumatoid arthritis (RA), the body releases less of the anti-inflammatory chemical cortisol at night, increasing inflammation-related pain.

Other processes may also intensify RA pain, including the nighttime release of pro-inflammatory cytokines, an increased number of cells traveling to inflamed tissue, and changes in the body’s immune response.

Additionally, the body releases higher levels of melatonin and prolactin at night, both of which can cause an increase in inflammatory cytokines.

A person’s arthritis inflammation and pain may worsen if:

  • they are already in pain when they go to bed
  • their mattress or pillow puts pressure on their joints and irritates their arthritis
  • they have other risk factors for insomnia, such as high stress levels or drinking caffeine before bed

How arthritis disrupts sleep

Many studies show a link between arthritis and sleep deprivation. People with arthritis may have trouble falling asleep and staying asleep. They may also report lower quality sleep due to the pain that the condition causes.

A 2021 study involving 133 people with arthritis and 76 matched controls found that 54.1% of people with arthritis reported poor sleep quality. The issues included:

  • greater difficulty falling asleep
  • shorter periods of sleep
  • poor sleep quality
  • more daytime problems related to poor quality sleep

A 2018 study reached a similar conclusion. The researchers compared 178 people with arthritis — 120 with RA and 58 with osteoarthritis (OA) — with 51 people with no arthritis. The rate of insomnia was comparable between the OA and control groups, at 32% and 33%, respectively. However, insomnia was significantly more prevalent among the RA group, affecting 71% of these participants.

Both studies also found a link between arthritis and mental health. People with arthritis were more likely to report marital problems and experience depression, suggesting that insomnia may be a reaction not only to arthritis but also to stress.

The link between arthritis pain and sleep goes in both directions. For example, arthritis can make it difficult to sleep, but sleep deprivation can also worsen arthritis pain. A 2018 study found that pain intensified as sleep worsened. In addition, a 2017 study found that people with knee OA who had poor quality sleep were more likely to ruminate on their pain.

Tips to get better sleep with arthritis

As insomnia can make pain worse, it is important that people with arthritis take steps to improve their sleep, as well as treating their pain.

Practice better sleep hygiene

Tossing and turning at night when unable to sleep may cause a person to notice and fixate on their pain. Good sleep hygiene may help a person fall asleep faster and remain asleep longer. People can try the following:

  • going to bed at the same time each night and establishing a bedtime ritual, such as taking a bath, meditating, or doing another calming activity
  • avoiding daytime naps
  • exercising during the day to ease arthritis symptoms and support better health, but avoiding exercise for 4 hours before bed
  • avoiding stimulants such as caffeine and nicotine, especially in the afternoon and evening
  • refraining from drinking alcohol or only drinking it in moderation
  • developing strategies for managing daytime stress to prevent negative thoughts from keeping a person awake or triggering joint pain
  • eating a balanced meal a few hours before bed and trying a light snack just before bed if nighttime hunger is a problem
  • using the bed only for sleeping and sex and not for watching television or doing work
  • keeping the bedroom cool and dark, potentially by using blackout curtains
  • investing in a comfortable, supportive mattress and quality pillows
  • trying different pillow positioning, such as putting a pillow between the knees or under the hips, to ease joint pain

While they are working on improving their sleep hygiene, a person may find it helpful to get back up if they cannot fall asleep. Doing this helps the association between bed and sleep remain strong.

Develop an arthritis pain management strategy

A person can work with a doctor to develop a plan for managing arthritis pain.

Where possible, it is important to avoid going to bed in pain. A doctor can recommend an appropriate pain relief medication to prevent pain before bedtime. They might suggest:

  • nighttime release arthritis drugs
  • drugs that work for 24 hours
  • an evening dose of pain medication

Identifying and managing arthritis triggers can also be helpful. A person can try keeping a pain and sleep log to determine and address any patterns that seem to worsen sleep or pain.

Consider psychotherapy

Being in pain night after night can affect a person’s emotional well-being and cause them to experience more pain. A 2017 study of people with knee OA found that people with sleep issues tend to catastrophize and focus on their pain, intensifying both pain and insomnia.

Therapy can help a person better cope with their pain and deal with daytime stressors that undermine sleep. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based intervention that assists a person with learning new skills for sleeping better.

Summary

Nighttime arthritis pain is common. However, having arthritis does not mean that a person has to live with chronic sleep deprivation. The right combination of medications, sleep hygiene practices, and lifestyle adjustments may help a person sleep better and for longer.

People with arthritis should be aware that while pain can make sleep worse, low quality sleep can also intensify pain and increase stress. This can create a vicious cycle that arthritis medication alone may not be sufficient to break.

The best path to complete relief is to treat both insomnia and arthritis. A person can work with their doctor to create a treatment plan that addresses the two conditions.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Swollen Knee Causes and Treatments

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Article featured on the Mayo Clinic

Overview

A swollen knee occurs when excess fluid accumulates in or around your knee joint. Your doctor might refer to this condition as an effusion (ih-FYU-zhen) in your knee joint. Some people call this condition “water on the knee.”

A swollen knee may be the result of trauma, overuse injuries, or an underlying disease or condition. To determine the cause of the swelling, your doctor might need to obtain a sample of the fluid to test for infection, disease or injury.

Removing some of the fluid also helps reduce the pain and stiffness associated with the swelling. Once your doctor determines the underlying cause of your swollen knee, appropriate treatment can begin.

Symptoms

Signs and symptoms typically include:

  • Swelling. The skin around your kneecap can puff up noticeably, especially when you compare the affected knee to the normal one.
  • Stiffness. When your knee joint contains excess fluid, you might not be able to bend or straighten your leg completely.
  • Pain. Depending on the cause of the fluid buildup, the knee might be very painful — to the point that it’s difficult or impossible to bear weight on it.

When to see a doctor

See your doctor if:

  • Self-care measures or prescribed medications don’t relieve the pain and swelling
  • One knee becomes red and feels warm to the touch compared to your other knee

Causes

Many types of problems, ranging from traumatic injuries to diseases and other conditions, can cause a swollen knee.

Injuries

Damage to any part of your knee can cause excess joint fluid to accumulate. Injuries that can cause fluid buildup in and around the knee joint include:

  • Torn ligament, particularly the anterior cruciate ligament (ACL)
  • Cartilage (meniscus) tear
  • Irritation from overuse
  • Broken bones

Diseases and conditions

Underlying diseases and conditions that can produce fluid buildup in and around the knee joint include:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Infection
  • Gout
  • Pseudogout
  • Bursitis
  • Cysts
  • Tumors

Risk factors

  • Age. Your likelihood of developing a swollen knee related to arthritis increases as you age.
  • Sports. People who participate in sports that involve twisting the knee, such as basketball, are more likely to experience the types of knee injuries that cause swelling.
  • Obesity. Excess weight puts added stress on the knee joint, contributing to the tissue and joint overload and knee degeneration that can lead to a swollen knee. Obesity increases your risk of osteoarthritis, one of the more frequent causes of knee swelling.

Complications

Complications of a swollen knee can include:

  • Muscle loss. Fluid in the knee can harm the working of your muscles and cause thigh muscles to weaken and atrophy.
  • Fluid-filled sac (Baker’s cyst). The buildup of fluid in your knee can lead to the formation of a Baker’s cyst in the back of your knee. A swollen Baker’s cyst can be painful, but usually improves with icing and compression. If the swelling is severe, you might need to have fluid removed (cyst aspiration).

Prevention

A swollen knee is typically the result of an injury or chronic health condition. To manage your overall health and prevent injuries:

  • Strengthen the muscles around your knee. Strong muscles around a joint can help ease pressure on the joint itself.
  • Choose low-impact exercise. Certain activities, such as water aerobics and swimming, don’t place continuous weight-bearing stress on your knee joints.
  • Maintain a healthy weight. Excess weight contributes to the wear-and-tear damage that can lead to a swollen knee.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Common Heel Pain

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This article is featured on Humpal Physical Therapy & Sports Medicine Centers

Plantar fasciitis is a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes called a heel spur. Plantar fasciitis is the correct term to use when there is active inflammation. Plantar fasciosis is more accurate when there is no inflammation but chronic degeneration instead. Acute plantar fasciitis is defined as inflammation of the origin of the plantar fascia and fascial structures around the area. Plantar fasciitis or fasciosis is usually just on one side. In about 30 per cent of all cases, both feet are affected.

ANATOMY

Where is the plantar fascia, and what does it do?

The plantar fascia (also known as the plantar aponeurosis) is a thick band of connective tissue. It runs from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps support the arch of the foot by acting something like the string on an archer’s bow. It is the source of the painful condition plantar fasciitis.

The plantar fascia is made up of collagen fibers oriented in a lengthwise direction from toes to heel (or heel to toes). There are three separate parts: the medial component (closest to the big toe), the central component, and the lateral component (on the little toe side). The central portion is the largest and most prominent.

Both the plantar fascia and the Achilles’ tendon attach to the calcaneus. The connections are separate in the adult foot. Although they function separately, there is an indirect relationship. If the toes are pulled back toward the face, the plantar fascia tightens up. This position is very painful for someone with plantar fasciitis. Force generated in the Achilles’ tendon increases the strain on the plantar fascia. This is called the windlass mechanism. Later, we’ll discuss how this mechanism is used to treat plantar fasciitis with stretching and night splints.

CAUSES

How does plantar fasciitis develop?

Plantar fasciitis can come from a number of underlying causes. Finding the precise reason for the heel pain is sometimes difficult.

As you can imagine, when the foot is on the ground a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This is just how the string on a bow is stretched by the force of the bow trying to straighten. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can result. These tears are normally repaired by the body.

As this process of injury and repair repeats itself over and over again, bone spur (a pointed outgrowth of the bone) sometimes forms as the body’s response to try to firmly attach the fascia to the heel bone. This appears on an X-ray of the foot as a heel spur. Bone spurs occur along with plantar fasciitis but they are not the cause of the problem.

As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates (starts to break down). This can lead to inadequate padding on the heel. With less of a protective pad on the heel, there is a reduced amount of shock absorption. These are additional factors that might lead to plantar fasciitis.

Fat Pad

Some physicians feel that the small nerves that travel under the plantar fascia on their way to the forefoot become irritated and may contribute to the pain. But some studies have been able to show that pain from compression of the nerve is different from plantar fasciitis pain. In many cases, the actual source of the painful heel may not be defined clearly.

SYMPTOMS

What does plantar fasciitis feel like?

The symptoms of plantar fasciitis include pain along the inside edge of the heel near the arch of the foot. The pain is worse when weight is placed on the foot. This is usually most pronounced in the morning when the foot is first placed on the floor.

Prolonged standing can also increase the painful symptoms. It may feel better after activity but most patients report increased pain by the end of the day. Pressing on this part of the heel causes tenderness. Pulling the toes back toward the face can be very painful.

DIAGNOSIS

How do health care providers diagnose the condition?

When you first visit medical care, the doctor will typically examine your foot and speak with you about the history of your problem. Diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions.

Some patients may be referred to an additional doctor for further diagnosis. Once your diagnostic examination is complete, treatment options will be offered that will help speed your recovery, so that you can more quickly return to your active lifestyle.

TREATMENTS

Non-surgical Rehabilitation

Nonsurgical management of plantar fasciitis is successful in 90 per cent of all cases. When you begin physical therapy, Physical Therapists will design exercises to improve flexibility in the calf muscles, Achilles’ tendon, and the plantar fascia.

Treatments will be applied to the painful area to help control pain and swelling. Examples include ultrasound, ice packs, and soft-tissue massage. Physical Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine, prescribed by your doctor, into the sore area.

There may be customized arch support, or orthotic, designed to support the arch of your foot and to help cushion your heel. Supporting the arch with a well fitted orthotic may help reduce pressure on the plantar fascia. Alternatively, we may recommend placing a special type of insert into the shoe, called a heel cup. This device can also reduce the pressure on the sore area. Wearing a silicone heel pad adds cushion to a heel that has lost some of the fat pad through degeneration.

Your Physical Therapist will also provide ideas for therapies that you can perform at home, such as doing your stretches for the calf muscles and the plantar fascia. We may also have you fit with a night splint to wear while you sleep. The night splint keeps your foot from bending downward and places a mild stretch on the calf muscles and the plantar fascia. Some people seem to get better faster when using a night splint and report having less heel pain when placing the sore foot on the ground in the morning.

We find that many times it takes a combination of different approaches to get the best results for patients with plantar fasciitis. There isn’t a one-size-fits-all plan. Some patients do best with a combination of heel padding, medications, and stretching. If this doesn’t provide relief from symptoms within four to six weeks, then we may advise additional Physical Therapy and orthotics.

Finding the right combination for you may take some time. Don’t be discouraged if it takes a few weeks to a few months to find the right fit for you. Most of the time, the condition is self-limiting. This means it doesn’t last forever but does get better with a little time and attention. But in some cases, it can take up to a full year or more for the problem to be resolved.

Post-surgical Rehabilitation

Although recovery rates vary among patients, it generally takes several weeks before the tissues are well healed after surgery. The incision is protected with a bandage or dressing for about one week after surgery. You will probably use crutches briefly, and your Physical Therapist can help you learn to properly use your crutches to avoid placing weight of your foot while it heals.

The stitches are generally removed in 10 to 14 days. However, if your surgeon used sutures that dissolve, you won’t need to have the stitches taken out. You should be released to full activity in about six weeks.

Surgical release of the plantar fascia decreases stiffness in the arch. However, it can also lead to collapse of the longitudinal (lengthwise) arch of the foot. Releasing the fascia alters the biomechanics of the foot and may decrease stability of the foot arch. The result may be increased stress on the other plantar ligaments and bones. Fractures and instability have been reported in up to 40 per cent of patients who have a plantar fasciotomy.

Throughout your post-surgical recovery, your Physical Therapist will note your progress and be watchful for the development of fractures and instability.

PHYSICIAN REVIEW

Your doctor may order an X-ray to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation.

Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter’s syndrome, or ankylosing spondylitis. These are diseases that affect the entire body but may show up at first as pain in the heel.

A cortisone injection into the area of the fascia may be used but has not been proven effective. Studies show better results when ultrasound is used to improve the accuracy of needle placement. Cortisone should be used sparingly since it may cause rupture of the plantar fascia and fat pad degeneration and atrophy, making the problem worse.

Botulinum toxin A, otherwise known as BOTOX, has been used to treat plantar fasciitis. The chemical is injected into the area and causes paralysis of the muscles. BOTOX has direct analgesic (pain relieving) and anti inflammatory effects. In studies so far, there haven’t been any side effects of this treatment.

Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It’s possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells causes an increase in blood flow to the area. Recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function.

Clinical trials are underway investigating the use of radio frequency to treat plantar fasciitis. It is a simple, noninvasive form of treatment. It allows for rapid recovery and pain relief within seven to 10 days. The radio waves promote angiogenesis (formation of new blood vessels) in the area. Once again, increasing blood flow to the damaged tissue encourages a healing response.

SURGERY

Surgery is a last resort in the treatment of heel pain. Physicians have developed many procedures in the last 100 years to try to cure heel pain. Most procedures that are commonly used today focus on several areas:

  • remove the bone spur (if one is present)
  • release the plantar fascia (plantar fasciotomy)
  • release pressure on the small nerves in the area

Usually the procedure is done through a small incision on the inside edge of the foot, although some surgeons now perform this type of surgery using an endoscope. An endoscope is a tiny TV camera that can be inserted into a joint or under the skin to allow the surgeon to see the structures involved in the surgery. By using the endoscope, a surgeon can complete the surgery with a smaller incision and presumably less damage to normal tissues. It is unclear whether an endoscopic procedure for this condition is better than the traditional small incision.

Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present that is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done on an outpatient basis. This means you can leave the hospital the same day.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

What a Dislocated Elbow Means

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Article featured on the Cleveland Clinic.

The elbow is composed of three bones. A dislocation happens when any of these bones become separated or knocked out of place. If you think you have dislocated your elbow, you should get immediate medical help.

What is a dislocated elbow?

A dislocated elbow occurs when any of the three bones in the elbow joint become separated or knocked out of their normal positions.

Dislocation can be very painful, causing the elbow to become unstable and sometimes unable to move. Dislocation damages the ligaments of the elbow and can also damage the surrounding muscles, nerves and tendons (tissues that connect the bones at a joint).

You should seek immediate medical treatment if you think you have an elbow dislocation. Treatment reduces the risk of irreversible damage.

How common is a dislocated elbow?

The incidence of the injury has been estimated at 2.9 events per 100,000 people over the age of 16. In children, dislocations can happen when someone yanks on the child’s arm.

SYMPTOMS AND CAUSES

What causes a dislocated elbow?

There can be various causes of a dislocated elbow.

  • Most elbow dislocations occur when people try to stop a fall with their outstretched hand.
  • Car accidents can cause dislocated elbows when people reach out to brace themselves against impact.
  • Sports injuries can cause dislocations.
  • Overuse can also be a cause.
  • In some cases, a joint disorder such as Ehlers-Danlos syndrome causes dislocations. Ehlers-Danlos makes joints unusually loose and flexible.

What are the signs and symptoms of a dislocated elbow?

A dislocated elbow can be partial or complete. A complete elbow dislocation involves a total separation and is called a luxation. When the elbow joint is partially dislocated, it is called a subluxation.

Doctors also classify elbow dislocations according to the extent of the damage and where it occurs. The 3 types include:

  • Simple: No major injury to the bone
  • Complex: Severe injuries to the bone and ligament
  • Severe: Damage to the nerves and blood vessels around the elbow

The signs and symptoms of a dislocated elbow vary depending on the severity of the injury and the bones involved. They include:

  • Bruising
  • Deformed-looking arm (bone looks out of place)
  • Weakness in the joint
  • Loss of ability to move the elbow
  • Pain
  • Swelling

DIAGNOSIS AND TESTS

How is dislocated elbow diagnosed?

A doctor diagnoses a dislocated elbow by looking at the arm and moving the joint.

In many cases, doctors use an imaging test called an X-ray to see if the bone is injured. Occasionally, doctors use tests called MRI or CT scans to look for damage to the surrounding muscles and tendons.

MANAGEMENT AND TREATMENT

How is a dislocated elbow condition managed or treated?

Some dislocated elbows return to their usual position on their own. More severe cases need a doctor to return the bones to their proper position.

Treatment for a dislocated elbow varies according to the severity of the injury. Steps you can take to reduce pain while you wait to see a doctor include:

  • Rest
  • Apply ice
  • Keep the elbow elevated

Treatments for an elbow dislocation include:

  • Manipulation: A doctor returns the bones to their normal positions, called a joint reduction.
  • Medication: Your doctor may recommend over-the-counter medicine to reduce pain.
  • Rest: Once the joint is back in place, you may need to keep it immobile and protect it. Using a sling can help the elbow joint heal.
  • Physical therapy: You may need to do exercises to strengthen the muscles and tendons in the elbow to help support it after it heals.
  • Surgery: You may need surgery if:
    • Your doctor is unable to return the bones to their proper positions through manipulation.
    • Dislocation damaged nerves or blood vessels in the elbow.
    • Torn tendons or muscles need repair.

PREVENTION

Can dislocated elbow be prevented?

Caution can help reduce your risk of a dislocated elbow. Be careful on slippery surfaces and stairs to avoid falls. Avoid overtraining in sports to avoid overuse injuries.

What are the risk factors for dislocated elbow?

People at higher risk for a dislocated elbow include those who:

  • Are over age 65 (because they are more prone to falls)
  • Overtrain in sports, especially activities involving throwing
  • Have inherited joint disorders such as Ehlers-Danlos syndrome

OUTLOOK/PROGNOSIS

What is the prognosis (outlook) for people with dislocated elbow?

Recovery times vary according to the severity of the elbow dislocation. Many dislocated elbows do not cause any further problems once they heal. They usually feel better as soon as a doctor puts the joint back in place.

LIVING WITH

When should I call the doctor?

Contact your doctor if you have the symptoms of a dislocated elbow. Do not try to push a dislocated elbow back into place yourself. This effort could damage the surrounding tissue and tendons and lead to complications. If you have a dislocated elbow, let your doctor know if you think you are not healing correctly or continue to have problems.

What questions should I ask my doctor?

If you have a dislocated elbow, you may want to ask your doctor:

  • How serious is the dislocation?
  • Will I need surgery or other treatment?
  • What signs of complications should I look out for?
  • Do I need a follow-up visit, and if so, when?

When can I go back to my regular activities?

Healing time for a dislocated elbow varies depending on the severity of the injury. Most people with a dislocated elbow can return to their usual activities once a doctor has returned the joint to its normal position.

A sling can help protect the elbow joint so you can return to your usual activities while the joint heals. Your doctor will let you know when you can resume more physical activities such as sports or lifting heavy objects.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Managing Neck and Lower Back Pain

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Article featured on Cone Health

According to Dahari Brooks, MD, neck and lower back pain is often caused by muscle strain, degenerative disc disease or arthritis.

“If the pain comes on suddenly and out of the blue, you may have pulled a muscle and can begin with at home treatments,” shares Dr. Brooks.

If you suspect a pulled muscle, Dr. Brooks suggests resting for a day. You can treat pain with over-the-counter anti-inflammatory medications. In the first 24 hours or so, cold therapy can help minimize pain and swelling. Place an ice pack on the painful area for 10 minutes followed by 20-minute breaks. Later, you can consider cold and/or heat therapy for relief. Ease back into exercising with walking and stretching.

“On the other hand, if your chronic pain has worsened over time or you experience a sudden onset of arm or leg weakness, pain or numbness, it is time to make an appointment,” adds Dr. Brooks. “A comprehensive physical examination will help determine the cause of your problem.”

During office visit, you will be examined for issues such as a pinched nerve. You may need to take an x-ray to rule out structural issues. Often, physical therapy or steroid injections can offer improvement. If not, soft tissue imaging can reveal bone spurs or discs that have herniated, degenerated or broken down over time.

“If you are experiencing horrific or radiating pain, weakness or numbness in the neck or limbs or lack of balance, make an appointment to be seen right away,” concludes Dr. Brooks. “These types of symptoms can signal a more serious issue and require more immediate attention.”

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Is It Time for a Pain Management Reboot?

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Article featured on WebMD

 

Now that we are entering a new phase in the COVID-19 pandemic where access to vaccines is high, infection rates are declining, and there is greater access to health-related services, this might be a time to reevaluate your pain management plan and consider what changes can make a positive impact.

Let’s start by taking a look at some of the ways the pandemic may have increased your pain problem:

  • Emotionally drained. Certainly life during COVID-19 has been a source of intense stress. Whether you’ve had COVID-19 or not, the pandemic has played a role in increasing mental health problems like anxiety and depression. For some, it has intensified already stressful home environments, while for others it has meant being apart from loved ones, creating emotional distress. A drop in income and the challenges of kids doing virtual schooling at home have become common sources of added stress in many households. But both depression and anxiety can impact how much we hurt and make it harder to manage our pain.
  • Weight gain. Studies show that the average person gained around 2 pounds per month during the height of the pandemic, which means that most of us are carrying around at least a few extra pounds or more. While this added weight gain can impact underlying health problems like diabetes and hypertension, it can also potentially increase pain, too. Even small bumps in body weight can significantly increase mechanical forces on parts of the body like our knees, hips, and spines.
  • Self-medicating. According to the CDC in June 2020, 13% of Americans reported starting or increasing substance use as a way of coping during the COVID-19 pandemic, and there was an 18% increase in overdoses during the early parts of the outbreak. The combination of all the added stress along with greater difficulty accessing medical and behavioral health help may have contributed to an increase in harmful activities like misusing prescription painkillers, increased alcohol use, or using illicit substances in the hopes of finding relief.
  • Less active. In many areas, access to places like swimming pools, health clubs, gyms, and indoor exercise classes were very limited for a number of months. So if you relied on those types of places for exercise, you may have had to make do without them. Out of caution, many of my patients preferred to avoid leaving their homes as much as possible, which also cut back on their level of activity. But many patients with pain problems like back pain and arthritis rely on programs like water aerobics and yoga classes or working out in a gym, and not having access to exercise venues that they depended on made managing their pain more challenging.
  • More isolated. Most of my patients experienced a dramatic decrease in social interactions over the last year, leaving some feeling lonely and isolated. Loneliness is now considered a significant health problem and is associated with a greater risk for heart disease, strokes, depression, anxiety, suicide, and premature death.

Now that access to resources has likely improved in many of your communities, here are some thoughts to help you navigate your next steps:

  • Ease into it. If you haven’t gone for a swim or worked out in your local gym for a year, start slowly as your time away has likely left you deconditioned and with some muscle atrophy. Pare back your exercise program or activity regimen to give yourself time to build back up your strength and endurance, while minimizing pain flare-ups that can slow down your progress. Now is a good time to be patient with your body.
  • Ask for help. Making changes can be difficult, but there are people who can help. If you would like a little guidance on how to recharge and get more active, talk to your doctor for recommendations or a referral to a physical therapist. If you have developed an addiction problem during the pandemic or relapsed into an old one, please ask for help and look for resources. And if the pandemic has left you feeling more down or dampened your relationship with your significant other, look for a counselor that can help you and your family get back on track.
  • Baby steps. There may be a lot of pent-up anxiety about doing things again, like leaving the house more, mingling with others, or going to that water aerobics class. This is to be expected.  Start small and build your confidence gradually, and don’t forget to breathe!

Now might be the perfect time to consider what you can safely add or modify to your pain management plan. Before starting something new or restarting something that maybe you haven’t done in over a year, it is always a good idea to first talk with your doctor.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Cervical Disc Surgery: Disc Replacement or Fusion?

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Article featured on WebMD, medically reviewed by Sabrina Felson, MD

The vast majority of people — more than 90% — with pain from cervical disc disease will get better on their own over time with simple, conservative treatments. Surgery, however, may help if other treatments fail or if symptoms worsen to the point that weakness in your arms and or legs develop. This is called a cervical myelopathy and surgery is recommended.

Cervical disc disease is caused by an abnormality in one or more discs — the cushions — that lie between the neck bones (vertebrae). When a disc is damaged — due to degenerative disc disease (or DDD) or an unknown cause — it can lead to neck pain from inflammation or muscle spasm. In severe cases, pain and numbness can occur in the arms from pressure on the cervical nerve roots or spinal cord.

Surgery for cervical disc disease typically involves removing the disc that is pinching the nerve or pressing on the spinal cord. This surgery is called a discectomy. Depending on where the disc is located, the surgeon can remove it through a small incision either in the front (anterior discectomy) or back (posterior discectomy) of the neck while you are under anesthesia. A similar technique, microdiscectomy, removes the disc through a smaller incision using a microscope or other magnifying device.

Often, a procedure is performed to close the space that’s left when the disc is removed and restore the spine to its original length. Patients have two options:

  • Artificial cervical disc replacement
  • Cervical fusion

In 2007, the FDA approved the first artificial disc, the Prestige Cervical disc, which looks and moves much like the real thing but is made of metal. Since then, several artificial cervical discs have been developed and approved. Ongoing research has shown that the artificial disc can improve neck and arm pain as safely and effectively as cervical fusion while allowing for range of motion that is as good or better than with cervical fusion. People who get the artificial disc are often able to return to work more quickly as well. The surgery to replace the disc, however, does take longer and can lead to more blood loss than with cervical fusion. It’s also not known how the artificial discs will last over time. People who get an artificial disc can always opt for cervical fusion later. But if a patient has cervical fusion first, it’s not possible to later put an artificial disc in the same spot.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Why Do My Knees Pop?

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Article featured on Cone Health Medical Group

Have you ever bent down to pick up something and heard a loud pop or crack coming from your knees? This sound is called “crepitus,” which is defined as “joint noise.” Popping knees are not unusual. It happens when carbon dioxide builds up in the joint’s synovial fluid and is released as a gas bubble that bursts when the joint adjusts rapidly. It is the same process that causes knuckles to crack.

Most of the time, this noise should cause no concern. There has been a rumor circulating for years that popping joints are a sign of impending arthritis, but there has been no research that supports this.

Some folks may hear a grinding noise in the knee when they squat. This is another form of crepitus and is typically nothing to be concerned about. The sound is caused by the cartilage rubbing on the joint surface and other soft tissue when the knee moves.

Most people experience crepitus their entire lives with no problems.

What if it hurts when my joints pop or grind?

You should be concerned if you have joint noise that is accompanied by pain, discomfort or swelling. This could be a sign that medical attention is required. Two of the most common cause for knee pain are:

  1. Cartilage injury or wear. The underside of your kneecap can unevenly rub on the front of your femur (thigh bone) and cause the cartilage under your kneecap to soften and wear off. Once the cartilage wears off, it hangs around the joint and can irritate the surrounding area. This irritation can result in pain when squatting, climbing stairs or even sitting for an extended period.
  2. Meniscus tear. The rubbery disc that cushions your knee and absorbs shock is called the meniscus. It can tear when there is an unexpected twist or turn in the joint, usually when the knee moves and the foot stays stationary. With aging comes greater risk of a meniscus tear, even through everyday activities.

What are the treatment options for knee injuries?

  • Rest – Stay off your knee as much as possible.
  • R.I.C.E. – Rest, ice, compression and elevation will promote healing and reduce swelling.
  • Knee Brace – There are many kinds, so it is best to consult your care provider for advice.
  • Physical therapy – A physical therapist can help you learn techniques and exercises to strengthen your knee and allow it time to heal.
  • Surgery – Minimally invasive surgery, especially for meniscus tears, can repair the tear and clear out any tissue causing pain, swelling and irritation.  

To help protect the knees, try exercises that develop the quadriceps, which are the muscles in the front of the thigh. Exercises that benefit this muscle group are walking, cycling and swimming. Other effective ways of protecting the knees are wearing supportive shoes, warming up before and stretching after exercise, and maintaining a healthy body weight.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Back Strains and Sprains

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Article featured on Cleveland Clinic

A back strain is an injury to either a muscle or tendon, while a back sprain is the stretching or tearing of a ligament. The symptoms, causes and treatment of back strains and sprains are discussed.

Overview

The back is a complex structure of bone and muscle, supported by cartilage, tendons and ligaments, and fed by a network of blood vessels and nerves. The back—especially the lumbar, or lower back—bears much of the body’s weight during walking, running, lifting and other activities. It makes sense, then, that injuries to the lower back—such as strains and sprains—are common.

What is a strain?

A strain is an injury to either a muscle or tendon. Tendons are the tough, fibrous bands of tissue that connect muscle to bone. With a back strain, the muscles and tendons that support the spine are twisted, pulled or torn.

What is a sprain?

A sprain is the stretching or tearing of a ligament. Ligaments are the fibrous bands of tissue that connect two or more bones at a joint and prevent excessive movement of the joint.

How common are back strains and sprains?

Strains and sprains are very common injuries. Next to headaches, back problems are the most common complaint to healthcare professionals.

Symptoms and Causes

What causes a back strain or sprain?

Twisting or pulling a muscle or tendon can result in a strain. It can also be caused by a single instance of improper lifting or by overstressing the back muscles. A chronic (long-term) strain usually results from overuse after prolonged, repetitive movement of the muscles and tendons.

A sprain often occurs after a fall or sudden twist, or a blow to the body that forces a joint out of its normal position. All of these conditions stretch one or more ligaments beyond their normal range of movement, causing injury.

In addition, several factors can put a person at greater risk for a back strain or sprain, including:

  • Curving the lower back excessively
  • Being overweight
  • Having weak back or abdominal muscles, and/or tight hamstrings (muscles in the back of the thighs).

Playing sports that involve pushing and pulling—such as weightlifting and football—also increases the risk of a low back injury.

What are the symptoms of a back strain or sprain?

Symptoms of a strain or sprain include:

  • Pain that gets worse when you move
  • Muscle cramping or spasms (sudden uncontrollable muscle contractions)
  • Decreased function and/or range of motion of the joint (difficulty walking, bending forward or sideways, or standing straight)

In some cases, the person may feel a pop or tear at the time of the injury.

Diagnosis and Tests

How are back sprains and strains diagnosed?

Mild strains and sprains can usually be diagnosed based on a medical history—including a review of the symptoms and how the injury occurred—and a physical examination by a healthcare provider. In cases of more severe strains and sprains, especially when there is weakness or loss of function, an X-ray may be taken to rule out a fractured (broken) or herniated (bulging) disc as the cause of the back pain.

Management and Treatment

How are back strains and sprains treated?

The treatment for strains and sprains is similar, and often takes place in two phases.

The goal of the first phase is to reduce the pain and spasm. This may involve rest, and the use of ice packs and compression (pressure), especially for the first 24 to 48 hours after the injury. An over-the-counter nonsteroidal anti-inflammatory drug, may be recommended to help reduce pain and swelling.

After the first 24 to 48 hours, returning to normal activities, as tolerated, is advisable. Extended bed rest or immobility (nonmovement) simply prolongs symptoms and delays recovery.

Most people with lumbar strain/sprain symptoms improve in about 2 weeks. If symptoms continue for more than 2 weeks, additional treatment may be required.

What complications are associated with back strains and sprains?

The most common complication of a back strain or sprain is a reduction in activity, which can lead to weight gain, loss of bone density, and loss of muscle strength and flexibility in other areas of the body.

Prevention

How can back sprains and strains be prevented?

It is not possible to prevent all back injuries, but you can take some steps to help lower the risk of a sprain or strain:

  • Eat a healthy, well-balanced diet to keep your bones and muscles strong.
  • Maintain a healthy weight. Excess weight puts added stress on the structures of the lower back.
  • Exercise regularly, including stretching, to keep your joints flexible and your muscles in good condition.
  • Practice safety measures to help prevent falls, such as wearing shoes that fit properly, and keeping stairs and walkways free of clutter.
  • Use good body mechanics when sitting, standing and lifting. For example, try to keep your back straight and your shoulders back. When sitting, keep your knees bent and your feet flat on the floor. Don’t over-reach, and avoid twisting movements. When lifting, bend your knees and use your strong leg muscles to help balance the load.
  • Stop smoking. Nicotine interferes with blood flow to the muscles.

Outlook/Prognosis

What is the prognosis (outlook) for people with back strains and sprains?

Most people with back strains and sprains have a full recovery with treatment within 2 weeks.

Living With

When should I contact my healthcare provider about a back strain or sprain?

Call your healthcare provider if:

  • You have severe pain and cannot walk more than a few steps.
  • You have numbness in the area of injury or down your leg.
  • You have injured your lower back several times before.
  • You have a lump or area with an unusual shape.
  • You have pain that interferes with sleep.
  • You have obvious weakness in an extremity (hands or feet) after an injury.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm