Should I Go To The Er For Severe Upper Arm Pain
You should go to the emergency department if you have any of these signs of a more serious problem:
- Severe pain with any attempt to move the shoulder or upper arm.
- Upper arm or shoulder pain associated with fevers, chills, or redness.
- Difficulty walking, loss of balance, and loss of bowel/bladder control associated with severe neck and shoulder pain.
Relationship Between Sciatica And Arthritis
My husband has been diagnosed with sciatica. Is there a relationship with arthritis? Because he also has osteoarthritis in the knees, hands, and hips as well as the back. Physical therapy does not seem to work. Many of my friends swear by chiropractors. My husband is also a heart patient who has had six bypasses, a valve replacement, and wears a pacemaker. Would any of these conditions limit what the therapist can accomplish or recommend? Anastasia, Illinois
I will address your specific questions about your husband’s situation after I give general information on sciatica, an important and common problem.
The sciatic nerve is the biggest and longest nerve of the body, originating from lumbar nerve roots in the lower spine, coursing under buttock muscles and down the back of the thigh and leg. Sciatica is the irritation and inflammation of the sciatic nerve, which has several causes. Sciatica tends to happen in our later years, 50 plus, and these are the years when osteoarthritis occurs. You are correct some causes of sciatica are related to OA. These are:
- Narrowing of the canal inside the lumbar spine
- Disc herniation or prolapse
- Slippage of vertebra in the lumbar spine
- Piriformis syndrome
- Injury of the lumbar spine or the sciatic nerve
- Tumor in the lumbar spinal canal or the sciatic nerve
- At times no obvious cause can be found
Injuries and tumors of the lumbar spine, the sciatic nerve, and its vicinity can cause sciatica, too.
Referred Pain In Arthritis
Referred pain in arthritis is a complex neurological process caused by the interconnected and sometimes scattered network of nerves. Based on how a nerve is compressed, the location of the pain can often shift by location or sensation. While referred pain most often vague and non-specific, it can sometimes be sharp and clearly defined.
Examples of this include:
- Arthritis in the small joints of the neck can refer pain to the outer arm or shoulder blade.
- Osteoarthritis in the hip can refer pain to the groin, lower thigh, or below the knee.
- Arthritis in the spine can refer pain to the buttocks and thigh, where it can often be mistaken for sciatica.
If the doctor is unable to make the connection between the referred pain and arthritis, a person may end up being X-rayed on the knee for a hip problem or given cortisone shots that have no effect.
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How Sciatica Is Treated
At-home treatment for sciatica consists of over-the-counter anti-inflammatories, icing and/or applying heat to the afflicted area, and some patience. For many people, that is enough to help them heal within a few weeks.
If your pain is bad enough that youve sought professional help, however, you likely need extra help. Treatment options for sciatica include:
This is the most common and generally most effective treatment for sciatica, says Dr. Huffstutter. The main goal is to take pressure off the sciatic nerve by strengthening and stretching the surrounding muscles. Physical therapy can be invaluable its really hard to learn how to do the right exercise without it, he says.
Epidural steroid injections
Physical therapy is very helpful, but sometimes the pain is too severe, and the patient feels they cant do it, says Dr. Barsoum. In that case, the first step might be to inject inflammation-reducing medication directly into the epidural space that surrounds the nerves in the spine.
Your doctor might suggest using anti-inflammatories, muscle relaxants, or even a narcotic medication if the pain is very severe. These drugs can make you feel a lot better and give your body a chance to heal.
Neuropathic Pain Common In End
Patients with end-stage knee or hip osteoarthritis often experience possible neuropathic pain particularly pain at rest vs on activity, and especially in men, according to a retrospective analysis published in Osteoarthritis Cartilage.
Individuals with knee or hip OA who were scheduled to undergo total joint arthroplasty were included in this study.
Before surgery, patients filled out questionnaires that gathered sociodemographic data as well as information on medication use, health status, depression, pain catastrophizing, and pain at rest and on activity and neuropathic pain. Questionnaires were evaluated using painDETECT.
In this cohort, neuropathic pain was found to be higher in women vs men . The percentage of patients meeting cut-offs for potential or likely neuropathic pain were 35.6% for women and 27.7% for men. In addition, women with knee OA vs women with hip OA reported greater neuropathic pain scores .
The variance in neuropathic pain scores was not accounted for by the combination of age, education, body mass index, surgical joint, number of comorbidities, and neuropathic comorbidities in a regression analysis. The addition of pain at rest raised the correlation in both men and women .
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Contextual Aspects Of Pain
Numerous studies have confirmed a role for multiple psychosocial factors, such as anxiety, distress and environment, as contributing to the chronic pain experience . In addition to the neurophysiological processes described thus far, pain is also defined as a multidimensional and dynamic interaction among physiological, psychological and social factors known as the biopsychosocial model of pain . Racial/ethnic background, sleep, fatigue, obesity/BMI, psychological distress, beliefs and weather are all well-studied factors that can influence OA pain . Many of these factors, such as depression and catastrophizing, can alter pain perception and enhance the overall pain experience . Psychosocial interventions such as self-management and group support are worthwhile considerations for the effective treatment of OA pain.
Nerve Pain Vs Joint Pain: What Do They Feel Like
All types of pain hurt but in different ways. Here are some of the signs to look for:
- Nerve pain. Nerve pain is often described as feeling like a burning, tingling or pins-and-needles sensation. It tends to be chronic, lasting six months or longer and typically exists in the hands, feet, arms and legs.
- Joint pain. Joint pain results in swelling, redness, tenderness, warmth and stiffness on the joints. Its common for people with arthritis, but it can also happen from other diseases like lupus. Oftentimes, joint pain is chronic and widespread.
- Muscular pain. We also want to point out muscular pain, because this, too, is common. Muscle pain is generally short-term and affects athletes, fitness enthusiasts or people sitting at a computer. It usually presents itself as tenderness, stiffness and throbbing in the muscles.
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Coping With Low Mood And Sleep Problems
Living with pain can affect your mood and sleep, and its normal to feel low from time to time. If this is something that affects you, try going along to a pain clinic, where you can learn how to manage your pain. Theyll usually take place at outpatient clinics, and you can be referred to them by whoever is treating you.
Pain can be affected by different things, including feeling low or stressed. There are a number of talking therapies and techniques you can learn, which can help you manage your pain, support your emotional wellbeing, and deal with any low feelings you might have. Mindfulness and cognitive behavioural therapy can help with osteoarthritis.
Learning to relax your muscles can also help, particularly if you have neck pain and are feeling stressed, as this can cause your muscles to become more tense.
A pillow thats too firm or thick can make neck pain worse. Try to sleep with your head level to the rest of your body. Its important to have a mattress that gives your head and spine proper support.
Try having a hot bath, reading a book, or listening to the radio or a relaxation CD to wind down before bed. If pain is waking you during the night, try taking paracetamol or another painkiller before bed. Talk to your doctor or a sleep expert for more advice.
Carpal Tunnel Versus Arthritis
If you have ever had a hand or leg go to sleep because of pressure that temporarily cuts off the blood supply, you can get an idea of what carpal tunnel can feel like. The prickling, burning sensation can be similar to the numbness caused by compressing the median nerve, which runs in a narrow tunnel like structure formed by the bones and connective tissues from the elbow to the hand. The tendons and median nerve allow the fingers of your hand to flex and extend.
The median nerve carries impulses to and from the palm side of your hand to the index, middle, and ring fingers, as well as your thumb. If the tissues of the tunnel are irritated , they can swell and place pressure on the nerve.
Arthritis of the hand, however, is caused by a different mechanism, often showing up with a specific pattern in the way it attacks the joints. In the case of arthritis, the lining of the joint itself becomes inflamed. This can occur because of osteoarthritis , or other inflammatory processes caused by a defect in the immune response, in which the body attacks otherwise healthy tissue. The symptoms of arthritis include stiffness and soreness of the joint, and frequently starts with the smaller joints of the hands.
If you, or a loved one has carpal tunnel syndrome or any form of arthritis, or you would like more information about treatments for carpal tunnel or arthritis, or to schedule an appointment, please contact Orthopaedic Associates at 892-1440 today.
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Arthritis Of The Foot And Ankle
Several types of arthritis can affect the ankle and foot joints osteoarthritis, rheumatoid arthritis and arthritis caused by fracture, dislocation, inflammatory disease or congenital deformity.
- Osteoarthritis occurs when the cartilage of the joints becomes worn or frayed from wear and tear as patients age.
- Arthritis due to injury and other causes is similar to osteoarthritis. Symptoms include pain, stiffness, swelling and diminished or loss of motion through the joints.
- Rheumatoid arthritis creates inflammation of the synovium, a thin layer of tissue that lines the joint space. There may be weakening of the supporting structures of the joints, and bunions, claw toes, hammer toes or rheumatoid nodules may develop. Patients may feel like they are walking on marbles.
Common arthritis treatments are medications, bracing and shoe modification or surgery. Surgical options for ankle arthritis may be ankle fusion or total ankle replacement.
Exercises Routines To Ease Numbness And Tingling
The general feeling of numbness can be relieved by taking some time out for reflexology massage therapy which has been shown to alleviate these sensations by increasing blood flow to muscles and joints. It would be best if you also tried exercise routines depending on what condition is causing them. These exercises include:
- Arthritis: tightening and releasing the muscles of your hands, arms and shoulders. Invest time into stretching or yoga exercises – they are good for your body and great for stress relief.
- Diabetic nerve pain: gently pressing on pressure points behind your knees or outside of elbows. Be careful not to press too hard as this may aggravate symptoms such as numbness in the fingers or toes .
Avoid activities that cause you pain, make sure you’re getting enough sleep, and stay hydrated throughout the day with water or other non-caffeinated drinks like herbal tea.
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Other Factors With Effects On Pain
In addition to metabolic factors numerous other general factors may play a role in OA and OA pain. These factors can only be briefly addressed in this review.
Psychological and Socioeconomic Factors
As in all chronic pain conditions, psychological factors including pain catastrophizing were also found to be important in OA pain . In a study on 194 patients with knee OA psychological profiles and pain characteristics were assessed. Cluster 1 patients had high optimism with low negative affect, pain vigilance, anger, and depression along with the lowest self-reported pain/disability and the lowest sensitivity to mechanical, pressure, thermal pain. Patients of cluster 4, the other extreme, exhibited the highest pain vigilance, reactivity, negative effect, anger, and depression, and these patients were most sensitive to mechanical, pressure, and thermal stimuli, and showed significant central sensitization to mechanical and thermal stimuli . Individuals with knee OA who are at the highest risk of developing disability and pain are those who have a lower socioeconomic status .
Miller R. E. et al. reported that DAMPs generated in murine OA directly excite murine nociceptive neurons through Toll-like receptor 4 . This points to an involvement of innate immunity in OA pain mechanisms, showing an additional dimension of OA pain so far barely investigated.
Reduction Of Descending Inhibition
Descending pathways from the brainstem mediate inhibition and facilitation of nociceptive spinal cord neurons. While descending inhibition is mainly observed in inflammatory pain states, neuropathic pain is often characterized by descending facilitation . One form of descending inhibition, namely conditioning pain modulation , is out of order in patients with severe OA pain, but importantly, it is restored under pain-free conditions after joint replacement , combined with a reduction of widespread mechanical hyperalgesia .
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How Is Osteoarthritis Of The Spine Treated
In most cases, treatment of spinal osteoarthritis is geared toward relieving the symptoms of pain and increasing a person’s ability to function. The goal is to have a healthy lifestyle.
Initial treatment may include losing weight if needed and then, for everyone, maintaining a healthy weight. It may also include exercise. Besides helping with weight management, exercise can also help:
- increase flexibility
- improve blood flow
- make it easier to do daily tasks
- Strengthening exercises. These exercises seek to make muscles that support the joints stronger. They work through resistance with the use of weights or rubber bands.
- Aerobic exercises. These are exercises that make the heart and circulatory system stronger.
- Range-of-motion exercises. These exercises increase the bodyâs flexibility.
Including rest periods in the overall treatment plan is necessary. But bed rest, splints, bracing, or traction for long periods of time is not recommended.
There are non-drug treatments available for osteoarthritis, including:
- heat or cold compresses, which refers to placing ice or heated compresses onto the affected joint
- transcutaneous electrical nerve stimulation using a small device that emits electrical pulses onto the affected area
- nutritional supplements
Clinical Appearance Of Oa Pain
Initially, pain in OA joints occurs episodically during movements and loading of the joint , and this pain may be evoked by specific activities . These are typical features of nociceptive pain. At later stages, constant pain may occur, even at rest and at night . Thus, there seems to be a gradual increase of pain with OA progression. However, it is unclear at which time point or at which stage of the OA process the pain starts.
Figure 2. Assessment of pain at the knee with the Knee injury and Osteoarthritis Outcome score at the end stage of knee OA. The graph shows the severity of pain in patients with lower synovitis scores and in patients with higher synovitis scores . Synovitis was scored using the histopathological scoring system of Krenn et al. . It quantifies in points the enlargement of the lining cell layer , the cellular density of synovial stroma and pannus formation and leukocytic infiltrate . The total score ranges from 0 to 9 . The pain intensity had to be classified as either none, mild, moderate, severe or extreme . Reproduced from Eitner et al. with permission.
Figure 3. Neuronal changes in animal models of OA and in humans with OA. Findings from studies on experimental OA models in rodents. Findings in humans suffering from OA pain.
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Should You Be Concerned About Nerve Pain In Your Knee
Nerve pain symptoms of numbness, tingling, and/or weakness going all the way to the foot are abnormal and should be evaluated by a board-certified physician. Some intermittent clicking or a little bit of grinding around the kneecap walking downstairs or hiking in Colorado is typically mild to moderate arthritis and typically does not denote significant nerve-related problems in the knee.
Complementary And Alternative Therapies
Some people with osteoarthritis try complementary or alternative therapies such as acupuncture and aromatherapy and find them helpful.
However, there’s a lack of medical evidence to suggest they’re effective and they generally are not recommended by the National Institute for Health and Care Excellence .
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General Factors Which May Play A Role In Oa Pain
OA is a disease which may result from numerous pathogenic factors . It is not the aim of this article to address the pathophysiological role of individual factors to the generation or progression of the disease OA. However, we believe that some of the risk factors may represent cofactors or comorbidities which have a direct or an indirect impact on the sensation of pain. According to common clinical experience, many patients with OA are elder persons, exhibit obesity, and suffer from a metabolic syndrome or diabetes mellitus . This raises the question whether such comorbidities have a significant role in pain sensation . So far this area of pain research is not well defined and therefore firm data are sparse.