Separated Shoulder

A shoulder separation is an injury to the acromioclavicular joint on the top of the shoulder. The shoulder joint is formed at the junction of three bones: the collarbone (clavicle), the shoulder blade (scapula), and the arm bone (humerus). The scapula and clavicle form the socket of the joint, and the humerus has a round head that fits within this socket.

A shoulder separation occurs where the clavicle and the scapula come together. The end of the scapula is called the acromion, and the joint between this part of the scapula and clavicle is called the acromioclavicular joint. When this joint is disrupted, it is called a shoulder separation. Another name for this injury is an acromioclavicular joint separation, or AC separation.

Is a shoulder separation the same as a shoulder dislocation?
No! These two injuries are commonly confused, but they are very different conditions. As described above, the shoulder joint is located at the junction of three different bones: the clavicle, the scapula, and the humerus. In a shoulder separation, the junction of the clavicle and scapula is disrupted. In a shoulder dislocation, the humerus (arm bone) is displaced from the socket. Not only are the injuries different in anatomic terms, but the implications for treatment, recovery, and complications are also different.

How does a shoulder separation occur?
A shoulder separation is almost always the result of a sudden, traumatic event that can be attributed to a specific incident or action. The two most common descriptions of a shoulder separation are either a direct blow to the shoulder (often seen in football, rugby, or hockey), or a fall on to an outstretched hand (commonly seen after falling off a bicycle or horse).

What are the symptoms of a shoulder separation?
Pain is the most common symptom of a separated shoulder, and is usually severe at the time of injury. Evidence of traumatic injury to the shoulder, such as swelling and bruising, are also commonly found.

The diagnosis of shoulder separation is often quite apparent from hearing a story that is typical of this injury, and a simple physical examination. An x-ray should be performed to ensure there is no fracture of these bones. If the diagnosis is unclear, an x-ray while holding a weight in your hand may be helpful. When this type of x-ray is performed, the force of the weight will accentuate any shoulder joint instability and better show the effects of the separated shoulder.

Are all separated shoulders the same?
No. Separated shoulders are graded according to the severity of the injury and the position of the displaced bones. Shoulder separations are graded from type I to VI:

· Type I Shoulder Separation:
A type I shoulder separation is an injury to the capsule that surrounds the AC joint. The bones are not out of position and the primary symptom is pain.

· Type II Shoulder Separation:
A type II shoulder separation involves an injury to the AC joint capsule as well as one of the important ligaments that stabilizes the clavicle. This ligament, the coracoclavicular ligament, is partially torn. Patients with a type II separated shoulder may have a small bump over the injury.

· Type III Shoulder Separation:
A type III shoulder separation involves the same type of injury as a type II separated shoulder, but the injury is more significant. These patients usually have a large bump over the injured AC joint.

· Type IV Shoulder Separation:
A type IV shoulder separation is an unusual injury where the clavicle is pushed behind the AC joint.

· Type V Shoulder Separation:
A type V shoulder separation is an exaggerated type III injury. In this type of separated shoulder, the muscle above the AC joint is punctured by the end of the clavicle causing a significant bump over the injury.

· Type VI Shoulder Separation:
A type VI shoulder separation is also exceedingly rare. In this type of injury the clavicle is pushed downwards, and becomes lodged below the corocoid (part of the scapula)

The (In) Flexible Shoulder

The shoulder is one of the most flexible joints in the human body. We can move our shoulders in directions like no other joint. Owing to it's flexibility, we can do things like paoint a ceiling or pitch a baseball.

This flexiibility comes at the price of stability. Since the shulder is held together by ligamnets and muschles, and has a lot of mobility, it is on the th most unstable joints in the body.

What's your risk?

If you have a job or play a sport that requires a lof shoulder mobility and flexibility, you may be at rick for shoulder injuries.

The following individuals, for example, are highly susceptible:

• Overhead athlets, like tennis players, swimmers, basebal pitchers


• Painters


• Construction workers


• Movers
  

Commom Injuries Of The Shoulder

Common symptoms include:

• Pain when raising the arm


• Pain that persists beyond a few days


• Swelling or bruising around the arm


• Pain when leaning on, or sleeping on the afected shoulder


• Weakness in the arm that stops you from lifting a grocery bay, reaching up, or pushing opena heavy door


• Having difficulty or being unable to carry your child


• Inability to use the arm

1. 
   Overuse and trauma are the most common reson the shoulder is prone to injury. The muscles that support the shoulder - the rotator cuff muscles - can suffer from wear and tear trauma. In some cases, where there is no known cause for shoulder pain. Years of poor posture or improper movement patterns can play a role.
   
   Repetitive activities lead to repetitive stress injuries. Also, too much wear and tear of the shoulder muscles and the joint capsue, or even UNDERUSE of the arm itself, can lead to frozen shoulder.
   
   If you suffer from any ofht he symptoms mentioned above, call our office today. Relief is just a phone call away!
   
   Your Physical Therapist - A Shoulder To Lean On
   
   Stress on your shoulder is one of the most common causes of shoulder injury, but one of themost overlooked reasons for shoulder injury is inactivity. When you don't use the muscles regularly, theny become weaker. The phrase "If you don't use it, you lose it" is applicable to muscles.
   
   If you don't exercise the full range of your shoulder throught moderate-intesisity esericws, the risk of hurting your shoulder increases. Legaments tighten, muscles weaken, and blood flow becomes inhibited. Over time, this can accelerate joint degeneratuon and trigger shoulder pain.
   
   We have the solution.
   
   Regular exercise (power walking with good arm movement, swimming, golf, tennis) may minimize the onset of severety of shoulder pain.
2. Proper body mecnaniscs- this can be counter-intuitive. Ask your therapist if your body mechanics need to be corrected.
3. 
   Strength and Flexibility - balanced muscles of the shoulder, chest, upper back, and abdominals help keep your shoulder joints well-aligned and pain free.
   

Remember, common sense is the best line of defense against hurting your shoulder. It is important to not push yourself too much, especially if there is discomfort. Don't do too much activity too soon. If you expereince ANY pain in your shoulder with any activity, stop! If it is MILD call your doctor of physical therapist. Don't ignore the pain.

The quicker the problems is addressed, the sooner your can begin healing and returning to your favorite activities.

We are here to serve you and help you achieve a speedy recovery as quickly as possible. We'll give yor a shoulder to lean on, so you have a healthy, pain free shoulder.

Could Physical Therapy Provide Fibromyalgia Relief

If you have fibromyalgia, simple movement may be the last thing you want to do. But simple movements through physical therapy may be just the right treatment for you. How does physical therapy provide fibromyalgia relief? The answer: With a hands-on approach to reduce fatigue, pain, stiffness and loss of strength that accompanies fibromyalgia.

Fibromyalgia is a syndrome estimated to affect 5 million Americans (mostly women) with widespread aches and pains, fatigue, sleep difficulties, anxiety, and depression. Doctors don't know what causes fibromyalgia and there's currently no known cure. There are a variety of treatment options however that relieve patients' symptoms. Standard treatments include painkillers, antidepressants, cognitive-behavioral therapy, exercise and physical therapy.

Physical therapy and exercise address the physical problems caused by fibromyalgia such as pain, fatigue, de-conditioning, muscle weakness, and sleep disturbances. Patrice Winter PTMS, physical therapist and spokesperson for the American Physical Therapy Association says, "Fibromyalgia syndrome (FMS) can be very debilitating. The fatigue associated with it varies from mild to overwhelming. Some patients can't get even out of bed. By the time many patients come to a physical therapist, they're often severely de-conditioned from lack of activity due and this compounds their fatigue."

How can physical therapy relieve fibromyalgia? Physical therapists design individual treatment plans that use a variety of passive and active treatments.

Passive treatments may include:

• Deep tissue massage to relieve muscle tension and spasms and improve muscular and joint range of motion.
• Soft Tissue Mobilization to treat muscle spasms, trigger points and improve range of motion.
• Heat Therapy to relax muscles, improve circulation to affected areas, and improve the body's natural healing processes.
• Ice Therapy to reduce inflammation.
• Hydrotherapy (hot baths and whirlpools) to relax muscles, improve circulation and allow for gentle no-stress exercise.
• Electric Muscle Stimulation (don't worry, it's painless) to reduce pain by increasing endorphins.
• Ultrasound therapy (sound waves) to create heat, improve range of motion, relax muscles and improve circulation

Active Treatment may include a variety of exercises to strengthen core (abdominal), back, arm and leg muscles and increase flexibility.

Winter says, "Our best results come from addressing individual patients at the physical state they present in and working very gradually. We've seen a lot of success with developmental sequencing work, similar to the process a baby goes through in normal development.... rolling, crawling, balancing, sitting, standing. This helps reorganize the neurologic system to return it to more normal function. We address body pain and trigger points with soft tissue mobilization and manual stretching."

Once patients have improved their overall physical condition, therapists help them keep their fitness plan in motion. They might recommend yoga, Pilates, cardiovascular and strength training options. They'll also work on fundamental body issues like posture, work-related body mechanics and sleep positions to help fibromyalgia patients function at their best.

Does it Work?

In the face of a potentially disabling condition, physical therapists may get fibromyalgia patients back on their feet and moving in the right direction.

Studies show many patients report improvement in their symptoms and sense of well-being.

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Sources:

Physical therapy in the treatment of fibromyalgia.
Offenbächer M, Stucki G.
Department of Physical Medicine and Rehabilitation, University of Munich, Germany.
http://www.ncbi.nlm.nih.gov/pubmed/11028838

Move Forward - the website of the American Physical Therapy Association
Fibromyalgia
http://www.moveforwardpt.com/find-your-condition/fibromyalgia/

Spine Universe
Physical Therapy for Fibromyalgia, author Kelly Rehan (3/09) for Spine Universe
http://www.spineuniverse.com/conditions/fibromyalgia/physical-therapy-fibromyalgia

Understanding Breast Cancer - Symptoms

What Are the Symptoms of Breast Cancer?

In its early stages, breast cancer usually has no symptoms. As a tumor develops, you may note the following signs:

• A lump in the breast or underarm that persists after your menstrual cycle; often the first apparent symptom of breast cancer, breast lumps are painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt.
• Swelling in the armpit.
• Although lumps are usually painless, pain or tenderness in the breast can be a sign of breast cancer.
• A noticeable flattening or indentation on the breast, which may indicate a tumor that cannot be seen or felt.
• Any change in the size, contour, texture, or temperature of the breast; a reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer.
• A change in the nipple, such as an indrawn or dimpled look, itching or burning sensation, or ulceration; scaling of the nipple is symptomatic of Paget's disease, a localized cancer.
• Unusual discharge from the nipple that may be clear, bloody, or another color. It's usually caused by benign conditions but could be due to cancer in some cases.
• A marble-like area under the skin.
• An area that is distinctly different from any other area on either breast.

Want to keep the weight off? Get on your bike...

WASHINGTON (Reuters) - Just five minutes of riding a bicycle each day can help a younger woman keep the pounds off, U.S. researchers reported on Monday in a study offering one potentially easy way to help Americans slim down.

"Small daily increments in bicycling helped women control their weight. But the more time women spent bicycling, the better," said Rania Mekary, of the Harvard School of Public Health in Boston, who worked on the study.

"Women with excess weight appeared to benefit the most. This is encouraging for women with weight problems because they could substitute bicycling for slow walking or car driving."

The research could help public policymakers trying to find ways to slow the U.S. obesity epidemic, the researchers wrote in the Archives of Internal Medicine.

Two-thirds of U.S. adults are overweight or obese and 16 percent of children and adolescents are overweight.

The accompanying disease burden costs billions and President Barack Obama has assigned his wife Michelle Obama and cabinet secretaries to find ways to counter this trend.

Their plan includes changes to neighborhoods and cities to make it easier for Americans to exercise.
Mekary and colleagues studied 18,414 healthy women who had not yet gone through menopause taking part in the Brigham and Women's Hospital-based Nurses' Health Study, an ongoing study of women's health over time.

On average, the nurses gained about 20 pounds (9.3 kilograms) over the 16-year period.

The women who did not bicycle in 1989 who had started by 2005 were a quarter less likely to have gained weight, even if they rode for just five minutes a day, the researchers found.

Comparatively, women who started out exercising on bikes for more than 15 minutes day in 1989 but who slacked off over time gained weight.

Overweight and obese women who were bicycling just two or three hours a week were 56 percent less likely to gain weight.

Brisk walking, but not slower strolling, was also helpful in keeping weight off, the study found. Actually, "if women walked slowly, not only did they not control weight, they gained weight," Harvard's Dr. Anne Lusk, who was involved in the study, told Reuters Health.

This finding, Lusk said, contradicts the conventional wisdom that has driven physician recommendations for decades that any kind of walking is better than no walking at all.

SOURCE: http://link.reuters.com/qec84m Archives of Internal Medicine, June 28, 2010.

Why you should use exercise balls

By Jeanne Faulkner
Reviewed by QualityHealth's Medical Advisory Board

In the past few years, exercise balls have become all the rage as they've encouraged us to get fit in fun, new ways. Here, the top five reasons to bring balls into your workout routine.
1. Balancing Act. Balls are unstable, and sitting on one requires more balance than you'd expect. It contracts the small muscles in your abdomen, back, and spine into the most physically correct alignment. Exercising on the ball means you get a double whammy from your work out-the muscles the exercise intends to target plus the ones that keep you from falling off. Over time, you'll find your balance and your posture will improve.
2. Core Work. According to the American Council on Exercise, think of your core as a strong column that links the upper and lower body together. Having a solid core creates a foundation for all activities, and is especially important when you add a heavy load, such as weights to your workout. Exercising with stability balls helps to develop and strengthen those muscles. Try doing crunches "on the ball," and feel the difference between those on the ground and those done while trying to balance. It's a whole different ball game.
3. Office Equipment. Using your exercise ball as your office chair provides an all day workout with proper spinal alignment during what would otherwise be "sitting around time." Every movement, like turning to answer the phone, requires subtle adjustments using your core muscles. Traditional office chairs are hard on the butt and back and can impede circulation between the upper and lower body. Exercise balls, however, require low-level exertion that improves circulation.
Updated: August 24, 2009

Sciatica: What a Pain in the Behind!

Hip Arthritis: There's Nothing Hip About It

Hip arthritis generally results from osteoarthritis, or “wear-and-tear” arthritis. In a nutshell, osteoarthritis progressively wears away the cartilage of the joint it affects. Without cartilage in the joint to make movements smoother, the hip bones begin to grind and cause pain. Hip arthritis is typically found in individuals who are:

· Over 50 years old

· Overweight – in fact, weight loss has a tendency to lessen the symptoms of hip arthritis.

· Genetics - if the condition runs in your family, your chances of developing it are much greater.

· Trauma – injuries to the hip, including fractures, can increase risk.

There’s no way to tell for sure who will develop hip arthritis, but there are a few measures you can take to avoid this debilitating condition:

• Lose weight. More weight = more compression on all joints. Weight loss can dramatically decrease symptoms.Seek the help of your physical therapist or exercise professional. We can teach you exercises to better distribute the pressure on your joints from everyday movements.
• Modify your activities. Limit activities that are painful. Continue with ones that are not. Aquatic exercise is a great option to perform exercises without increasing joint compression. Use walking aids. We can show you the right way to use a cane/crutch to help alleviate your pain.
• Ask your doctor about trying anti-inflammatory medications.
• In severe cases, you may need to talk to your doctor about hip replacement surgery.

· As soon as you start feeling the symptoms of hip arthritis, including limited range of motion, joint stiffness, and pain in the hip area, see your doctor. If you receive a diagnosis of hip arthritis, following the steps outlined above. The goal is to avoid a hip replacement surgery, which should always be your last resort. Our well trained staff will help you make the most of your condition so you can carry out your day to day activities with less pain.

Becoming a Couch Potato Won’t Save Your Hip

It's a common misconception that less activity (being sedentary) will “save” your hip from further decay. On the contrary, medical experts recommend that you remain as active as your comfort level will allow. You certainly don’t want to force activities that will result in more pain down the road.

If you or a loved one have any hip discomfort, it is IMPERATIVE that you consult our staff right away for recommendations on exercises and activities that will be right for your condition.

The Importance of Heat and Stretching

Before exercising, use heat to loosen the muscles in preparation for stretching exercises. The best method is a warm shower or bath for 10-15 minutes. You can also use a heating pad or a towel warmed in the microwave, but remember, warm heat gets into the joint better than dry heat! Then, STRETCH daily!. Some common stretching we recommend include:

• Knee-to-chest pulls. Start in a comfortable position lying on your back with knees bent and feet flat on the floor. Bring one knee to your chest and hold it with your hands for 10 seconds. Do not bounce. Lower your leg and repeat the process with the other leg. Repeat the sequence 5 times.

• Hamstring stretch. Lie on your back in a doorway, with one leg through the open door. Slide your leg up the wall to straighten your knee. You should feel a gentle stretch down the back of your leg. Hold it for 10 seconds. Be careful to not arch your back, or bend either knee. Remember to keep one heel touching the floor and the other heel touching the wall. Do not point your toes. Repeat with your other leg.
• .

Physical therapy is a critical step in the management of pain associated with hip arthritis. We will work with you to create a treatment plan that includes exercise and other specialized techniques to relieve your pain.