Insite Injury Management Group - Injuries Explained

Sprains and Strains

What is the difference between a sprain and a strain?

The difference between a strain and a sprain is that a strain is an injury to a muscle or tendon and a sprain has affected ligament tissue. Both occur at joints where ligaments connect bone to bone and tendons connect bone to muscles. They are usually temporary, mild injuries that get treated similarly and heal quickly. The severity of the injury will depend on the extent of the injury. This can vary from a simple overstretch to a partial or complete tear.

What is a Sprain?

A sprain is a stretch and/or tear of a ligament (a band of fibrous tissue that connects two or more bones at a joint). One or more ligaments can be injured at the same time.

How does a sprain occur?

A sprain can result from a fall, a sudden twist, or a blow to the body that forces a joint out of its normal position and stretches or tears the ligament supporting that joint. Typically, sprains occur when people fall and land on an outstretched limb.

What are the signs and symptoms?

The usual signs and symptoms include pain, swelling, bruising, instability, and loss of the ability to move and use the joint (called functional ability). However, these signs and symptoms can vary in intensity, depending on the severity of the sprain. Sometimes people feel a pop or tear when the injury happens.

What is a Strain?

A strain is an injury to either a muscle or a tendon (fibrous cords of tissue that connect muscle to bone).

How does a strain occur?

A strain is caused by twisting or pulling a muscle or tendon. Strains can be acute or chronic. An acute strain is associated with a recent trauma or injury; it also can occur after improperly lifting heavy objects or overstressing the muscles. Chronic strains are usually the result of overuse: prolonged, repetitive movement of the muscles and tendons.

What are the signs and symptoms of a strain?

Typically, people with a strain experience pain, limited motion, muscle spasms, and possibly muscle weakness. They can also have localized swelling, cramping, or inflammation and, with a minor or moderate strain, usually some loss of muscle function. Injured workers typically have pain in the injured area and general weakness of the muscle when they attempt to move it. Severe strains that partially or completely tear the muscle or tendon are often very painful and disabling.

When to see a Doctor for a Sprain or Strain?

You have severe pain and cannot put any weight on the injured joint.
The injured area looks crooked or has lumps and bumps (other than swelling)
that you do not see on the uninjured joint.
You cannot move the injured joint.
You cannot walk more than four steps without significant pain.
Your limb buckles or gives way when you try to use the joint.
You have numbness in any part of the injured area.
You see redness or red streaks spreading out from the injury.
You injure an area that has been injured several times before.
You have pain, swelling, or redness over a bony part of your foot.
You are in doubt about the seriousness of the injury or how to care for it.

Treatment

Treatments for sprains and strains are similar and can be in two stages concluding with a final stage of full return to normal activity.

Stage 1: Reduce swelling and pain.

Best treated in the first 72 hours by RICE, meaning rest, ice, compress, and elevate.
After 72 hours, heat can be used in conjunction with gentle massage to loosen the surrounding muscles.
If there is a lot of pain, an anti-inflammatory tablet, topical anti-inflammatory cream or gel or pain reducer may be prescribed by the Medical Provider.
In extreme injuries, an x-ray may be required to make sure there is no bone damage.
A splint or brace might be used to keep from aggravating the sensitive joint.
Sometimes, in repeated injuries, physical rehabilitation strengthens the adjacent muscles to prevent re-injury.

Stage 2: Physical Rehabilitation

Overall goal is to improve the condition of the injured area and restore its function.
The health care provider will prescribe an exercise program designed to prevent stiffness, improve range of motion, and restore the joint's normal flexibility and strength and pain free range of movement.
Some injured workers may need physiotherapy during this stage.
The provider can recommend many different types of exercises, depending on the injury. A person with an injured knee or foot will work on weight-bearing and balancing exercises. The duration of the program depends on the extent of the injury, but the regimen commonly lasts for several weeks.
Another goal of rehabilitation is to increase strength and regain flexibility. Depending on the patient's rate of recovery, this process begins about the second week after the injury. The physio will instruct the patient to do a series of exercises designed to meet these goals. During this phase of rehabilitation, injured workers progress to more demanding exercises as pain decreases and function improves.

Final Stage: Return to full daily activities, including work and sports when appropriate.

Injured workers and the Rehabilitation Provider must work closely with their health care provider or physiotherapist to determine their readiness to return to full activity. Sometimes people are tempted to resume full activity or play sports despite pain or muscle soreness.
Returning to full activity before regaining normal range of motion, flexibility, and strength increases the chance of re injury and may lead to a chronic problem.
This is why the Rehabilitation Provider may discuss a structured gradual return to normal activity or duties. This will nearly always begin from the day the injury occurs. They will negotiate with the Employer the importance of providing suitable duties to assist with this process and with the Medical Provider to ensure all considerations are addressed.

Recovery Time:

Depend on the severity of the injury and individual rates of healing, a mild sprain may require up to 3 to 6 weeks of rehabilitation; a moderate sprain could require 2 to 3 months. With a severe sprain or strain, it can take up to 8 to 12 months to return to full activities and even surgery if there has been a significant tear.

Back Strain or Lumbar Pain

What is a Lower Back Strain or Lumbar Sprain?

Muscle strains and lumbar sprains are the most common causes of low back pain. A low back muscle strain occurs when the muscle fibers are abnormally stretched or torn. A lumbar sprain occurs when the ligaments, the tough bands of tissue that hold bones together, are torn from their attachments.

Differentiating a strain from a sprain can be difficult, as both injuries will show similar symptoms. Many doctors refer to both injuries as a category called "musculoligamentous injuries" of the lumbar spine.

In general, it doesn't matter what you call the problem because the treatment and prognosis for both back strains and sprains nearly always the same.

What causes a Lower Back Strain or Lumbar Sprain?

Most lower back pain is caused by a strain or sprain. Most commonly, injured workers who develop a lumbar strain or sprain are doing an activity that places their back at risk. This may be a sudden forceful movement, lifting a heavy object, or twisting the back in an unusual manner. Knowing how to properly lift can help to prevent many back injuries.

What are the symptoms of a low back injury?

Most lumbar muscle strains and sprains cause symptoms isolated to the low back. The most common symptoms of a lumbar strain or sprain are:

Pain around the low back and upper buttocks
Low back muscle spasm
Pain associated with activities, and generally relieved with rest

There are more serious conditions that require more immediate treatment. If you are unsure of the cause of your symptoms, you should be evaluated by a Medical Provider. Some warning signs of a serious injury to the spine include:

Loss of control of bladder or bowels
Progressive lower extremity weakness
Severe, constant pain

What causes these symptoms of low back pain and spasm?

When the lumbar spine is strained or sprained, inflammation of the soft-tissues results. This inflammation causes pain and can cause muscle spasm. People are often surprised at how painful and debilitating a lumbar strain or sprain can be... These are not small injuries.

Why do some injured workers tend to have low back strains and sprains more often?

We do know some factors that tend to influence the development of this type of problem, but often these symptoms strike in unexpected situations. Most commonly, injured workers who develop a lumbar strain or sprain are doing an activity that places their back at risk. This may be a sudden forceful movement, lifting a heavy object, or twisting the back in an unusual manner. Knowing how to properly lift can help to prevent many back injuries. Some well known factors that contribute to low back pain include:

Poor conditioning
Obesity
Smoking
Improper use/lifting technique

What is the treatment?

Some common treatments for low back pain are listed here. Not all of these treatments are appropriate for every condition, but they may be applied in your situation.

Stage 1: Reduce Inflammation and control symptoms

The first step in the treatment of a lumbar muscle strain is to allow the inflammation to subside and control the symptoms of muscle spasm. While it is important to rest the injured muscles, it is just as important to not allow the muscle to become weak and stiff. As the acute inflammation has subsided, some simple stretches and exercises should begin.

Step 2: Medications

Two groups of medications are especially helpful in treating the acute symptoms of a lumbar back strain:

Anti-inflammatory medication. These medications help control the inflammation caused by the injury, and also help to reduce pain.
The second group of medications commonly prescribed for the treatment of lumbar strains are muscle relaxing medications. These medications are often sedating, so they need to be used with care.

Stage 3: Physical Therapy/Exercises

Proper conditioning is important to both avoid this type of problem and recover from this injury. By stretching and strengthening the back muscles, you will help control the inflammation and better condition the lumbar back muscles. The exercises should not be painful. Without some simple exercises, the low back muscles can become "deconditioned," or weak. When the low back muscles are deconditioned, it is very difficult to fully recover from low back injuries.

Stage 4: Further Evaluation

If your symptoms continue to persist despite treatment, it is appropriate to return to your Medical Provider for further evaluation. Other causes of back pain may be investigated. An x-ray CT Scan, Bone Scan or MRI scan may be needed to make an accurate diagnosis.

Vocational Rehabilitation: This should begin as soon as possible after the injury. The Rehabilitation Provider will assist to identify suitable duties with the employer and in consultation with the treating medical provider, the injured worker, their supervisor and any other key person. The Rehabilitation Provider will prepare a return to work plan of action with the aim being a gradual and safe return to normal work duties. This plan will always include considerations directed by the Medical Provider and may include identifying any other requirements or services needed.

Recovery Time for Lower Back Sprain or Lumbar Strain:

Over 90% of injured workers are completely recovered from an episode of lumbar muscle strain or sprain within one month. Having said this, there is the % of injured workers with a more sever condition may take longer.
Depending on the severity of the injury and individual rates of healing, a mild sprain may require up to 3 to 6 weeks of rehabilitation; a moderate sprain could require 2 to 3 months. With a severe sprain or strain, it can take up to 8 to 12 months to return to full activities and even surgery if there has been a more serious condition diagnosed.

Sciatica

What is sciatica?

Sciatica means that there is inflammation of the sciatic nerve. The sciatic nerve supplies information about movements to the leg, and sends information about sensations back to the brain. The sciatic nerve is quite large. It is the largest peripheral nerve in the body. The sciatic nerve exits the lower part of the spinal cord (lumbosacral region), passes behind the hip joint, and runs down the back of the thigh.

How does this nerve normally function?

The sciatic nerve, like most other nerves, performs two basic functions: first, it sends signals to your muscles from the brain; and second, it collects sensory information from the legs and passes this back to your brain. Conditions such as sciatica that affect the nerve will alter these normal functions. This usually manifests as either weakness of these leg muscles, pain in the legs and thighs, or both.

What causes sciatica?

The most common cause of sciatica is a herniated spinal disc. When this happens, the normal cushion between the vertebra of your spine ruptures. This causes the disc to push out into areas normally occupied by these nerves. The nerves are compressed and people then experience the symptoms of pain, weakness, and numbness. Other conditions, such as spinal stenosis, spondylolisthesis, or piriformis syndrome can also cause sciatica symptoms by irritating the nerve.

What are the signs and symptoms of sciatica?

As stated above, sciatica can cause both sensory and muscular abnormalities in the legs and thighs. Often there is a sudden onset that may be attributed to over-exertion or a back injury. Common symptoms of sciatica include:

cramping sensation of the thigh
Shooting pains from the buttock, down the leg
Tingling, or pins-and-needles sensations in the legs and thighs
A burning sensation in the thigh

In addition, injured workers with sciatica may notice a worsening of their symptoms with manoeuvre such as squatting, coughing or sneezing. These manoeuvres can increase pressure around the nerve and magnify the symptoms of sciatica.

What treatments are available for sciatica?

Treatment is initially aimed at addressing the inflammation associated with sciatica. Rest, anti-inflammatory medications, and muscle relaxants are often used. Some injured workers require a more powerful anti-inflammatory treatment and are given oral steroids. These steroids do have potential side-effects, but the powerful anti-inflammatory effect can be helpful in the treatment of sciatica.

As the pain subsides, exercises and physiotherapy are helpful. Many people find that heat packs and ice packs soothe the muscles that are painful in sciatica. Some doctors may prescribe an epidural steroid injection that can deliver anti-inflammatory medication directly to the inflamed area around the nerves.

Surgical treatment of sciatica is not usually needed, but in individuals who undergo the above treatments for a minimum of three months, and still have symptoms, a referral to a surgeon may be considered. The surgical procedure is one that allows more room for the nerve in the area being compressed. This may mean removing the ruptured disc, opening up the bone around the nerve, or a combination of both.

Recovery Time:

This is the good news. Most people (80-90%) fully recover from sciatica without surgery. In most cases the nerve is not permanently damaged, and individuals recover in the 3-week to 3-month time frame.

Sciatica is not a medical emergency. However, if you experience difficulty with bowel or bladder function, decreased sensation around the genitals, or progressive leg weakness, this may be the sign of cauda equina syndrome, a medical emergency. If you have these symptoms, contact your doctor or go to the emergency room immediately.

Herniated or Ruptured Disc

What is a Herniated Disc?

The cushion (disc) that sits between the spinal vertebra (bones) is pushed outside its normal position. A herniated disc would not be a problem so often if it weren't for the spinal nerves that are very close to the edge of the intervertebral disc.

When a herniated disc bulges out from between the vertebrae, the spinal nerves and spinal cord can become pinched. There is normally a little extra space around the spinal cord and spinal nerves, but if enough of the herniated disc is pushed out of place, then these structures may be compressed.

What causes symptoms of a herniated disc?

When the herniated disc ruptures and pushes out, the nerves may become trapped. A herniated disc may occur suddenly in an event such as a fall or an accident, or may occur gradually with repetitive straining of the lumbar spine. When a herniated disc occurs, the space for the nerve is diminished and irritation of the nerve results.
Evidence shows that in about 30% of people as young as 30, there is evidence of disc deterioration without them being aware of it. Common symptoms of a herniated disc include:

Leg Pain
Most commonly experienced over the outside of the thigh, the lower leg, or foot. Shooting pain may be experienced coming all the way down the leg; injured workers often describe an electric shock type of symptom.

Parasthesias
This is the medical word for abnormal sensations such as tingling, numbness, or pins and needles. These symptoms may be experienced in the same region as painful sensations.

Muscle Weakness
Because of the nerve irritation, signals from the brain may be interrupted causing muscle weakness, usually of the ankle. Nerve irritation can also be tested by examining the reflexes of the knee and ankle.

Bowel or Bladder Problems
These symptoms are important because it may be a sign of cauda equina syndrome, a possible condition resulting from a herniated disc. This is a medical emergency. Your should see your doctor immediately if you have problems urinating, having bowel movements, or if you have numbness around your genitals.

All of these symptoms are due to the irritation of the nerve from the herniated disc. By interfering with the pathway by which signals are sent from your brain out to your extremities and back to the brain, all of these symptoms can be caused by a herniated disc pressing against the spinal nerves.

How is the diagnosis of a herniated disc made?

Most often, your physician can make the diagnosis of a herniated disc by physical examination. By testing sensation, muscle strength, and reflexes, your physician can often establish the diagnosis of a herniated disc.

A CT scan or MRI is commonly used to aid in making the diagnosis of a herniated disc. It is very important that injured workers understand that the CT scan or MRI is only useful when used in conjunction with examination findings. It is normal for a MRI of the lumbar spine to have "abnormalities," especially as people age. Injured workers in their 20s may begin to have signs of disc wear, and this type of wear would be expected on MRIs of injured workers in their 40s and 50s. This is the reason that your physician may not be concerned with some MRI findings noted by the radiologist.

Making the diagnosis of a herniated disc, and coming up with a treatment plan depends on the symptoms experienced by the patient, the physical examination findings, and the x-ray and MRI results. Only once this information is put together can a reasonable treatment plan be considered.

Treatment for a herniated disc:

Treatment depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program and should seek medical advice before beginning any treatment plan. Some common treatments for herniated disc are listed here. Not all of these treatments are appropriate for every condition, but they may be applied in your situation.

Depending on the size of the herniated disc and the condition of the patient, treatments of a herniated disc may be conservative or aggressive. The usual treatment for a herniated disc is to proceed conservatively. After diagnosing the problem, usually a period of rest is advised. It is important that rest take place initially, but that gradually you return to activities.

Initial treatments are aimed at minimizing inflammation around the nerve with anti-inflammatory medications and possibly an epidural steroid injection, and stabilizing the lumbar spine with physiotherapy and strengthening exercises.

Because the nerve root is irritated, anti-inflammatory medications will help reduce the inflammation.

Non Steroid Anti-inflammatory Medications are relatively safe, taken by mouth, and have the benefit of also helping to alleviate pain. Oral steroid medications, are more powerful anti-inflammatory, but have more side-effects, and do not directly treat pain symptoms.

Injections of steroid medication (epidural steroid injections) are another consideration for more directed treatment. Injured workers also often use a muscle relaxant to help control muscle spasms in the early treatment of a herniated disc. If pain is severe, narcotic medications are prescribed. These medications have significant side-effects in some injured workers, and can become addictive; care must be taken if using these medications.

Physiotherapy and lumbar stabilization exercises do not directly affect the herniated disc, but they can stabilize the lumbar spine muscles. This has an effect of decreasing the load experienced by the disc and vertebrae. Stronger, well balanced muscles help control the lumbar spine and minimize the risk or injury to the nerves and the disc.

Surgical treatment may be recommended soon after the injury if there is a significant neurological component (i.e. weakness or numbness) to the problem. Most often surgery is recommended if more conservative measures do not relieve your symptoms. Surgery is performed to remove the herniated disc, and free up space around the compressed nerve. Depending on the size and location of the herniated disc, and associated problems (such as spinal stenosis, arthritis, etc.), the surgery can be done by several techniques. In very straightforward cases, endoscopic or microscopic excision of the herniated disc may be possible. However, this is not always recommended, and in some cases, a more traditional surgery may need to be performed.

Spine surgery to remove a herniated disc...

What is a spinal discectomy?

A discectomy is a surgery done to remove a herniated disc from the spinal canal. When a disc hernia occurs, a fragment of the normal spinal disc is dislodged. This fragment may press against the spinal cord or the nerves that surround the spinal cord. This pressure causes the symptoms that are characteristic of herniated discs. The surgical treatment of a herniated disc is to remove the fragment of spinal disc that is causing the pressure.

What is the recovery from a discectomy?

Injured workers often awaken from surgery with complete resolution of their leg pain; however, it is not unusual for these symptoms to take several weeks to slowly dissipate. Pain around the incision is common, but usually well controlled with oral pain medications. Injured workers often spend one night in the hospital, but are usually then discharged the following day.

Gentle activities are encouraged after surgery, such as sitting upright and walking. Patient must avoid lifting heavy objects, and should try not to bend or twist the back excessively. Injured workers should avoid strenuous activity or exercise until cleared by their doctor.

What is endoscopic microdiscectomy?

The endoscopic microdiscectomy is a procedure that accomplishes the same goal as a traditional open discectomy, removing the herniated disc, but uses a smaller incision. Instead of actually looking at the herniated disc fragment and removing it, the surgeon uses a small camera to find the fragment and special instruments to remove it. The procedure may not require general anesthesia, and is done through a smaller incision with less tissue dissection. The surgeon uses x-ray and the camera to "see" where the disc hernia is, and special instruments to remove the fragment.

Shoulder Injuries

Shoulder Pain: Common conditions and treatment information

Shoulder pain is an extremely common complaint, and there are many common causes of this problem. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause. If you have shoulder pain, some common causes include:

Bursitis | Rotator Cuff Tendonitis
The most common diagnosis in injured workers with shoulder pain is bursitis or tendonitis of the rotator cuff. Bursitis is inflammation of a bursa. Bursae are small sacs located between two adjoining structures, usually muscles, tendons and bones. Rotator cuff tendonitis is inflammation or swelling of the three main tendons in the shoulder.

Rotator Cuff Tear
Rotator cuff tears occur when the tendons of the rotator cuff separate from the bone. Surgery is sometimes necessary for this condition.

Frozen Shoulder
Also called 'adhesive capsuliitis,' this is a common condition that leads to stiffness of the joint. Physical therapy and stretching are extremely important aspects of treatment.

Calcific Tendonitis
Calcific tendonitis is a condition of calcium deposits within a tendon; most commonly within the rotator cuff tendons. Treatment of calcific tendonitis depends on the extent of symptoms.

Shoulder Instability
Instability is a problem that causes a loose joint. Instability can be caused by a traumatic injury (dislocation), or may be a developed condition.

Shoulder Dislocation
A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula.

Shoulder Separation
Also called an AC separation, these injuries are the result of a disruption of the acromioclavicular joint. This is a very different injury from a dislocation!

Labral Tear
A Bankart lesion is a type of labral tear most commonly due to dislocation of the joint. Bankart lesions cause problems of persistent instability.

SLAP Lesion
The SLAP lesion is also a type of labral tear. The most common cause is a fall onto an outstretched hand.

Arthritis
Shoulder arthritis is less common than knee and hip arthritis, but when severe may require a joint replacement surgery.

Biceps Tendon Rupture
A proximal biceps tendon rupture occurs when the tendon of the biceps muscle ruptures near the joint.

When do you need to see your doctor about your shoulder pain?

If you are unsure of the cause of your shoulder pain, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of these conditions must be directed at the specific cause of your problem. Some signs that you should be seen by a doctor include:

Inability to carry objects or use the arm
Injury that causes deformity of the joint
Shoulder pain that occurs at night or while resting
Shoulder pain that persists beyond a few days
Inability to raise the arm
Swelling or significant bruising around the joint or arm
Signs of an infection, including fever, redness, warmth
Any other unusual symptoms

Treatments for shoulder pain?

Some common treatments for shoulder pain are listed here. Not all of these treatments are appropriate for every condition, but they may be applied in your situation.

Rest
The first treatment for many common conditions that cause shoulder pain is to rest the joint, and allow the acute inflammation to subside. It is important, however, to use caution when resting the joint, because prolonged immobilization can cause a frozen shoulder.

Ice and Heat Application
Ice packs and heat pads are among the most commonly used treatments for shoulder pain. So which one is the right one to use, ice or heat? And how long should the ice or heat treatments last? Read on for more information about ice and heat treatment.

Stretching
Stretching the muscles and tendons that surround the joint can help with some causes of shoulder pain. A good routine should be established, and following some specific suggestions will help you on your way.

Physiotherapy
Physical therapy is an important aspect of treatment of almost all orthopedic conditions. Physical therapists use different modalities to increase strength, regain mobility, and help return injured workers to their pre-injury level of activity. Some specific exercises may help you strengthen the muscles around the joint and relieve some of the pain associated with many conditions.

Anti-Inflammatory Medication
Non steroidal anti-inflammatory pain medications, commonly referred to as NSAIDs, are some of the most commonly prescribed medications, especially for injured workers with shoulder pain caused by problems such as arthritis, bursitis, and tendonitis.

Cortisone injections
Cortisone is a powerful medication that treats inflammation, and inflammation is a common problem in injured workers with shoulder pain. Discuss with your doctor the possible benefits of a cortisone injection for your shoulder pain condition.

Vocational Rehabilitation
This should begin as soon as possible after the injury. The Rehabilitation Provider will assist to identify suitable duties with the employer and in consultation with the treating medical provider, the injured worker, their supervisor and any other key person. The Rehabilitation Provider will prepare a return to work plan of action with the aim being a gradual and safe return to normal work duties. This plan will always include considerations directed by the Medical Provider and may include identifying any other requirements or services needed.

Elbow Pain

What are common conditions and treatments of Elbow Pain?

Elbow pain is an extremely common complaint, and there are many common causes of this problem. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause. If you have elbow pain, some common causes include:

Lateral Epicondylitis
The most common cause of elbow pain is lateral epicondylitis, also called tennis elbow. Injured workers with lateral epicondylitis have pain over the outside of the joint and difficulty gripping objects. Interestingly, most injured workers with lateral epicondylitis are not tennis players.

Medial Epicondylitis
Similar to lateral epicondylitis, medial epicondylitis, or golfer's elbow, causes discomfort around the joint. However, the symptoms of medial epicondylitis are on the inner side of the joint. Again, most injured workers with this condition are not golfers.

Olecranon Bursitis
Bursitis is most common behind the elbow joint. When a patient has olecranon bursitis, they usually have swelling and tenderness behind the joint over the bony prominence called the olecranon. Infections of the bursa can complicate the treatment of olecranon bursitis.

Tendonitis
Tendonitis can occur in any of the tendons that surround the joint. The most common types of tendonitis that cause elbow pain are biceps tendonitis (in front of the joint) and triceps tendonitis (in the back of the joint).

Cubital Tunnel Syndrome
Cubital tunnel syndrome occurs when there is compression of the ulnar nerve as is wraps around the inside of the joint causing elbow pain. Cubital tunnel syndrome can also cause shooting pains along the forearm and numbness and tingling of the fingers.

Radial Tunnel Syndrome
Radial tunnel syndrome is an uncommon condition that causes nerve compression of the radial nerve. Most often, this diagnosis is considered in injured workers who are thought to have lateral epicondylitis, but do not improve.

Elbow Fractures
Broken bones can occur abound the elbow after injuries such as falls, sports injuries, and car accidents. The most common elbow fractures are olecranon fractures and radial head fractures.

When do you need to call your doctor about your elbow pain?

If you are unsure of the cause of your elbow pain, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of these conditions must be directed at the specific cause of your problem. Some signs that you should be seen by a doctor include:

Inability to carry objects or use the arm
Injury that causes deformity of the joint
Elbow pain that occurs at night or while resting
Elbow pain that persists beyond a few days
Inability to straighten or flex the arm
Swelling or significant bruising around the joint or arm
Signs of an infection, including fever, redness, warmth
Any other unusual symptoms

What are the common treatments for elbow pain?

Some common treatments for elbow pain are listed here. Not all of these treatments are appropriate for every condition, but they may be applied in your situation.

Rest
The first treatment for many common conditions that cause elbow pain is to rest the joint, and allow the acute inflammation to subside. It is important, however, to use caution when resting the joint, because prolonged immobilization can cause a stiff joint.

Ice and Heat Application
Ice packs and heat pads are among the most commonly used treatments for elbow pain. So which one is the right one to use, ice or heat? And how long should the ice or heat treatments last?

Stretching
Stretching the muscles and tendons that surround the joint can help with some causes of elbow pain. A good routine should be established, and following some specific suggestions will help you on your way.

Physiotherapy
Physical therapy is an important aspect of treatment of almost all orthopedic conditions. Physiotherapists use different modalities to increase strength, regain mobility, and help return injured workers to their pre-injury level of activity.

Anti-Inflammatory Medication
No steroidal anti-inflammatory pain medications, commonly referred to as NSAIDs, are some of the most commonly prescribed medications, especially for injured workers with elbow pain caused by problems such as arthritis, bursitis, and tendonitis.

Cortisone injections
Cortisone is a powerful medication that treats inflammation, and inflammation is a common problem in injured workers with elbow pain. Discuss with your doctor the possible benefits of a cortisone injection for your elbow pain condition.

Wrist Pain

What are common conditions and treatment for Wrist Pain?

Wrist pain is an extremely common complaint, and there are many common causes of this problem. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause. If you have wrist pain, some common causes include:

Tendonitis
Tendonitis is a common problem that can cause wrist pain and swelling. Wrist tendonitis is due to inflammation of the tendon sheath. Treatment of wrist pain caused by tendonitis usually does not require surgery.

Sprain
Wrist sprains are common injuries to the ligaments around the wrist joint. Sprains can cause problems by limiting the use of our hands (see definition of sprains & strains).

Carpal Tunnel Syndrome
Carpal tunnel syndrome is the condition that results from dysfunction of one of the nerves in the wrist. In carpal tunnel syndrome the median nerve is compressed, or pinched off, as it passes through the wrist joint.

Arthritis

Arthritis is a problem that can cause wrist pain and difficulty performing normal activities. There are several causes of arthritis, and fortunately there are a number of treatments for wrist arthritis.

Ganglion Cyst
A ganglion cyst is a swelling that usually occurs over the back of the hand or wrist. These are benign, fluid-filled capsules. Ganglion cysts are not cancerous, will not spread, and while they may grow in size, they will not spread to other parts of your body.

Fractures
A wrist fracture is a common orthopedic injury. Injured workers who sustain a broken wrist may be treated in a cast, or they may need surgery for the fracture.

When do you need to call your doctor about your wrist pain?

If you are unsure of the cause of your wrist pain, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of these conditions must be directed at the specific cause of your problem. Some signs that you should be seen by a doctor include:

Inability to carry objects or use the arm
Injury that causes deformity of the joint
Wrist pain that occurs at night or while resting
Wrist pain that persists beyond a few days
Inability to straighten or flex the joint
Swelling or significant bruising around the joint or forearm
Signs of an infection, including fever, redness, warmth
Any other unusual symptoms

What are the common treatments for wrist pain?

Some common treatments for wrist pain are listed here. Not all of these treatments are appropriate for every condition, but they may be applied in your situation.

Rest & Activity Modification
The first treatment for many common conditions that cause wrist pain is to rest the joint, and allow the acute inflammation to subside. It is important, however, to use caution when resting the joint, because prolonged immobilization can cause a stiff joint. Adjusting your activities so as not to irritate the joint can help prevent worsening of wrist pain. You Rehabilitation Provider will assist in adjusting your work activities and negotiate the provision of suitable duties with the Employer.

Ice and Heat Application
Ice packs and heat pads are among the most commonly used treatments for wrist pain. So which one is the right one to use, ice or heat? And how long should the ice or heat treatments last?

Wrist Support
Support braces can help injured workers who have either had a recent wrist sprain injury or those who tend to injure their wrists easily. These braces act as a gentle support to wrist movements. They will not prevent severe injuries, but may help you perform simple activities while rehabilitating from a wrist sprain.

Anti-Inflammatory Medication
No steroidal anti-inflammatory pain medications, commonly referred to as NSAIDs, are some of the most commonly prescribed medications, especially for injured workers with wrist pain caused by problems such as arthritis and tendonitis.

Cortisone injections
Cortisone is a powerful medication that treats inflammation, and inflammation is a common problem in injured workers with wrist pain. Discuss with your doctor the possible benefits of a cortisone injection for your wrist pain condition.

Knee Pain

Common conditions and treatment information

Knee pain is an extremely common complaint, and there are many common causes. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause. If you have knee pain, some common causes include:

Arthritis
Arthritis is among the most common causes of knee pain, and there are many treatments available.

Ligament Injuries
Ligament injuries commonly occur during athletic activities and can cause discomfort and instability.

Anterior Cruciate Ligament (ACL) Injury
The anterior cruciate ligament (also called the ACL) is one of four ligaments that are critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. Of the four major ligaments of the knee, the ACL injury is the most common.
Posterior Cruciate Ligament (PCL) Injury
The posterior cruciate ligament, or PCL, is one of four ligaments important to the stability of the knee joint. The PCL is the ligament that prevents the tibia (shinbone) from sliding too far backwards.
Medial Collateral Ligament (MCL) Injury
The medial collateral ligament is also is one of four ligaments that are critical to the stability of the knee joint. It spans the distance from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint.

Cartilage Injuries | Meniscal Tear
Cartilage tears are seen in young and old patients alike, and are also an extremely common cause of knee pain.

Patellar Tendonitis
Tendonitis around the joint is most commonly of the patellar tendon, the large tendon over the front of the knee. Tendonitis is an inflammation or swelling of this tendon.

Chondromalacia Patella
Chondromalacia causes knee pain under the kneecap and is due to softening of the cartilage. It is most common in younger patients (15-35 years old).

Dislocating Kneecap
A dislocating kneecap causes acute symptoms during the dislocation, but can also lead to chronic knee pain.

Baker's Cyst
A Baker's cyst is swelling in the back of the joint, and is usually a sign of another underlying problem such as a meniscus tear.

Bursitis
The most common bursa affected around the joint is just above the kneecap. This is most common in people who kneel for work, such as gardeners or carpetlayers. Bursitis is an inflammation or swelling of the bursa.

Plica Syndrome
Plica syndrome is an uncommon cause of knee pain, and can be difficult to diagnose. The diagnosis is usually made at the time of arthroscopy.

Osgood-Schlatter Disease
Osgood-Schlatter disease is a condition seen in adolescents and is due to irritation of the growth plate just at the front of the joint.

Gout
Gout is an uncommon cause of knee pain. However, in patients who have a diagnosis of gout, it must be considered as a cause for new onset knee pain.

When do you need to call your doctor about your knee pain?

If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of knee pain must be directed at the specific cause of your problem. Some signs that you should be seen by a doctor include:

Inability to walk comfortably on the affected side
Injury that causes deformity around the joint
Knee pain that occurs at night or while resting
Knee pain that persists beyond a few days
Locking (inability to bend) the knee
Swelling of the joint or the calf area
Signs of an infection, including fever, redness, warmth
Any other unusual symptoms

What are the best treatments for knee pain?

Some common treatments for knee pain are listed here. Not all of these treatments are appropriate for every condition, but they may be applied in your situation.

Rest & Activity Modification
The first treatment for many common conditions that cause wrist pain is to rest the joint, and allow the acute inflammation to subside. It is important, however, to use caution when resting the joint, because prolonged immobilization can cause a stiff joint. Adjusting your activities so as not to irritate the joint can help prevent worsening of knee pain. Your Rehabilitation Provider will assist in adjusting your work activities and negotiate the provision of suitable duties with the Employer.

Ice and Heat Application
Ice packs and heat pads are among the most commonly used treatments for knee pain. So which one is the right one to use, ice or heat? And how long should the ice or heat treatments last? Read on for more information about ice and heat treatment.

Stretching
Stretching the muscles and tendons that surround the joint can help with some causes of knee pain. A good routine should be established, and following some specific suggestions will help you on your way.

Physical Therapy
Physical therapy is an important aspect of treatment of almost all orthopedic conditions. Physical therapists use different modalities to increase strength, regain mobility, and help return patients to their pre-injury level of activity.

Anti-Inflammatory Medication
Non steroidal anti-inflammatory medications, commonly referred to as NSAIDs, are some of the most commonly prescribed medications, especially for patients with knee pain caused by problems such as arthritis, bursitis, and tendonitis.

Cortisone injections
Cortisone is a powerful medication that treats inflammation, and inflammation is a common problem in patients with knee pain. Discuss with your doctor the possible benefits of a cortisone injection for your condition.

References
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
American Academy of Orthopedic Surgeons
American Physical Therapy Association
Better Health www.betterhealth.vic.gov.au