muscle pains Archives - Amazing Health Advances

How Do You Treat Rotator-Cuff Tears?

The AHA! Team — Wed, 12 Mar 2025 05:14:33 +0000

Michigan Medicine – University of Michigan via Newswise – Shoulder symptoms led to an average of 9.6 million physician visits in 2015 and 2016 in the United States. The most common cause of those shoulder symptoms? Rotator-cuff disorders. Tears of the rotator cuff can result from a substantial traumatic injury or can occur slowly over time. Most degenerative tears occur in the dominant arm of adults over the age of 40, and their prevalence increases with as you age. Nonoperative treatment, such physical therapy, is the typical approach to treating rotator-cuff tears. However, surgery is considered in certain patients whose rotator-cuff tears don’t resolve with nonoperative treatments. When it comes to treatments for these tears, there are a variety of options to choose from and it’s important to know which one is best for your condition. In a recent publication in the New England Journal of Medicine, University of Michigan Health professor and chair of Physical Medicine and Rehabilitation, Nitin Jain, M.D., MSPH, talks through the different treatments available for rotator-cuff tears to help bring together a better understanding of how to treat the issue for patients and providers. Symptoms of rotator-cuff tears “Patients with nontraumatic or degenerative rotator-cuff tears typically experience an onset of shoulder pain that seems to have no cause,” said Jain. “However, it is not uncommon for tears to be asymptomatic and become slowly painful over time, or even cause no pain at all.” Jain says there are some activities that make the injury more painful as the tear worsens. This can include sleeping on your shoulder, overhead activities and/or lifting items above your shoulder level. “Rotator-cuff tears may also grow over time, but there’s a lack of correlation between patient symptoms and the size and thickness of the tear,” explained Jain. Your active range of motion and arm strength are usually affected by the tear, which gets assessed by using certain protocols when providers are searching for a diagnosis. Rehabilitation and physical therapy for rotator-cuff tears This is the most common form of treatment for rotator-cuff tears, says Jain. “It is recommended that as the first line of specialist referral, patients seek care from a physical medicine and rehabilitation doctor (physiatrist) or sports medicine doctor,” said Jain. “Rehabilitation and physical therapy routines address areas such as periscapular muscle weakness, correcting scapular posture and improve rotator cuff muscle strength and endurance.” In observational studies, more than 80% of patients who received supervised physical therapy reported reduced pain and improved function between 6 months to a year. However, the trial populations consisted of patients with various types of rotator-cuff injuries and had no requirement for advanced imaging to confirm their diagnosis. “One of the biggest factors in a successful rehabilitation was trust from patients that their physical therapy routine would improve their rotator-cuff condition,” said Jain. “The more patients leaned into the physical therapy routine, the better their outcomes were.” Other nonpharmacologic therapies for rotator-cuff tears Evidence suggests that psychosocial distress and depression are associated with shoulder pain and reduced function in patients with rotator-cuff tears. “Despite this, though, there isn’t much data supporting psychosocial interventions in the treatment of rotator-cuff disorders, even though they show benefit in the treatment of other musculoskeletal disorders such as lower back pain,” said Jain. In addition to the lack of data for psychological interventions for rotator-cuff repairs, there’s also a lack of high quality trials supporting the use of manual therapy, massage therapy, acupuncture, therapeutic ultrasonography, transcutaneous electrical nerve stimulation, shock-wave therapy or pulsed-electromagnetic-field therapy. Topical and oral medications and injections for rotator-cuff tears There isn’t a lot of evidence supporting the use of topical medications in treating rotator-cuff disorders. The topical treatment with the best outcomes so far has been glyceryl trinitrate. In a small, randomized trial it showed short term benefits in the treatment of rotator-cuff disorders, but it also found there was a considerably high bias towards this treatment from participants in the study. Topical nonsteroidal anti-inflammatory drugs such as diclofenac and ketoprofen have also been effective in providing pain relief in chronic musculoskeletal pain and tendinitis and have a better safety profile than oral, nonsteroidal anti-inflammatory drugs. “But high quality evidence supporting their use in rotator-cuff disorders is still lacking,” explained Jain. For oral medications, randomized research trials have shown that oral nonsteroidal anti-inflammatory drugs reduced pain, although modestly, in patients with rotator-cuff disorders. “Opioid drugs are generally not recommended due to risks associated with their use and lack of evidence of superiority to nonopioid therapy in a variety of musculoskeletal conditions,” said Jain. Jain says acetaminophen hasn’t been studied specifically in rotator-cuff disorders, but what has been studied has shown little or no benefit regarding pain or function. “Rigorous evidence is lacking to inform the use of pain-modulating drugs such as gabapentin, duloxetine, and pregabalin, specifically regarding the nonoperative treatment of rotator-cuff disorders,” said Jain. Injection of a glucocorticoid, together with a local anesthetic, has been reported to provide symptomatic pain relief in patients with rotator-cuff disorders. Small trials have shown short term benefit, about four weeks long, of pain relief through using this method. The injections are performed in the subacromial space of the rotator-cuff for those with subacromial impingement syndrome. Some centers use ultrasound guidance to administer this treatment, which can reduce the risk of an inadvertent injection into the tendon. Surgical interventions for rotator-cuff injuries “Surgical interventions are not the initial recommendation when it comes to rotator-cuff repairs. However, they may be considered in some patients whose condition does not improve with conservative treatment,” said Jain. Observational data supports that surgery is associated with better function and reduced pain in patients who are under 65 years of age and have smaller tears. Surgical repairs are mostly performed arthroscopically, involving the repair of the torn tendon and resecuring it to the humerus to allow for tendon-to-bone healing as well as a low incidence of complications, explains Jain. The hypothesis that surgical intervention can reduce the progression of muscle degradation has led some experts to recommend early surgical intervention, but data is still lacking on outcomes of early surgery compared to surgery later. Each rotator-cuff case is different, meaning each treatment style will be different. Before starting any treatments, review your options and talk with your provider about which option may be best for you. Additional authors: Michael S. Khazzam, M.D., University of Texas Southwestern Funding/disclosures: Jain is supported by the National Institutes of Health under award number 1R01AR074989. Paper cited: “Degenerative Rotator-Cuff Disorders,” The New England Journal of Medicine. DOI: 10.1056/NEJMcp1909797 To read the original article click here.

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Chest Pain in Children and Adolescents

The AHA! Team — Wed, 26 Feb 2025 06:11:28 +0000

Jennifer S. Li, MD via Duke Health – Chest pain is a common complaint in children and adolescents. Chest pain is often perceived as “heart pain” both to children and their parents, and it can cause a lot of distress. However, chest pain in children is very rarely due to a heart problem and most often arises from a less worrisome source. Jennifer S. Li, MD, a Duke pediatric cardiologist, discusses common causes of chest pain in children What causes chest pain? Chest pain in children and adolescents is common but is generally benign. However, chest pain with exercise or that is associated with fast heart beat, dizziness, or fainting can indicate a heart problem. Many structures located in the chest can cause or contribute to chest pain. Among these are the muscles, tendons, cartilage, or bones of the chest, lungs, heart, gastrointestinal system, and nerves. A problem in any one of these areas can cause chest pain. How often is chest pain due to a heart problem? In older adults, chest pain is frequently due to a heart problem. This is because heart disease mostly strikes older people. In kids, chest pain is very rarely due to a heart problem. A prospective study in 50 children referred to a cardiology clinic showed that 76% had pain from the muscles, bones, or cartilage; 12% had exercise-induced asthma; 8% had pain from gastrointestinal causes; and 4% had pain due to psychogenic causes. Another study of 3700 children without previously known heart problems found a low incidence of heart problems (1%). What about the kid who dies on the playing field? While a lot of media attention is given to cases of sudden cardiac death in kids playing sports, these are extremely rare events among the millions of children and adolescents who participate in athletics. Many instances are related to previously undiagnosed underlying heart conditions. Because of this, it’s important and necessary to have your child complete a sports physical before participating in competitive athletics. Sometimes underlying conditions related to sudden cardiac death have genetic factors, so a careful family history is also an important part of the pre-sports evaluation. What are some common causes of chest pain? Some common causes include: Musculoskeletal: This is usually related to muscle strain or heavy lifting. Costrochondritis: Inflammation of the cartilage around the junction of the ribs to the breastbone. Precordial Catch Syndrome: Sharp stabbing chest pain below the breast that lasts a few seconds and is worsened by taking a deep breath. It may be due to a pinched nerve. Asthma: This is frequently a cause of exercise-induced chest pain. Gastroesophageal Reflux: Usually burning pain worsened while lying down after eating. Anxiety: Typically related to stress or excessive worry. What are some heart-related causes of chest pain? Several cardiac problems have the potential to cause chest pain. Some of these include: Left ventricular outflow tract obstruction (blockage of the outflow of the heart to the body): a heart murmur is present. Hypertrophic cardiomyopathy: usually an inherited condition causing a thickened heart muscle. Anomalous coronary arteries: coronary artery arising off of the wrong sinus, causing chest pain with exercise. Rhythm disturbances: chest pain is typically associated with the feeling of the heart beating too fast. Pericarditis: inflammation of the lining of the heart often preceded by a viral illness. What are some worrisome symptoms of a heart-related cause of chest pain? Chest pain with exercise, associated with irregular or fast heart beat, or associated with dizziness or syncope (fainting) are symptoms that can indicate a serious heart problem. Chest pain in someone with a first-degree relative who has a history of sudden death or cardiomyopathy should be evaluated. Chest pain that occurs at rest without other associated symptoms is not typically due to a heart problem. What is the usual evaluation that is performed? A careful history and physical examination are necessary and can usually identify the cause for the chest pain. Sometimes laboratory studies may be needed such as an electrocardiogram, an echocardiogram, or an exercise stress test. To read the original article click here.

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The Main Signals of Depression + How to Find Healing

AHA Publisher — Fri, 29 Jul 2022 07:00:34 +0000

Dr. Caroline Leaf – In this podcast (episode #397) and blog, I discuss the common signs of depression, why we should never be afraid of seeking help, how we can learn to manage depression, and more! Depression is something we should never ignore. When we feel depressed, we need to listen to what our mind, brain and body are trying to tell us. Depression is a signal telling us we have something going on—that there is a “because of…” in our life that we need to investigate. The sooner you recognize the signals associated with feelings of depression, the sooner you can make the necessary adjustments to your life and get the help you need to start healing. But it is important to remember that you are not your depression; it’s not your identity. You experience depression—it does not define you. Because the mind is how we experience depression, and because the mind is our “aliveness” (the driving force that keeps our body alive and helps us experience life), learning how to manage the mind is of paramount importance. This means listening to the signals of depression we experience, not suppressing how we feel, to get to the root (the “cause”), and reconceptualize it. Essentially, we need to become thought detectives to find the source(s) of our depression. This starts with understanding the signals that the mind, brain, and body send us when we are going through something. These signals alert us TO protect us. There are 4 main signals: our emotions, our behaviors, our physical symptoms, and our perspective/outlook. Some examples are: Feelings of irritability and/or hopelessness (an emotional warning signal) Ignoring calls, texts or emails (a behavioral warning signal) The world feels more negative (a perspective warning signal) Muscle aches and/or pains (a physical warning signal) Let’s say you feel down. As an exercise to help you start managing these feelings of depression, try to categorize what signals you are experiencing into these 4 categories. Some other examples of signals from a recent post I shared on social media are: Feeling self-conscious or flat around people Your personal hygiene goes out the window Your thoughts make you sad Your room gets messy Your hobbies no longer make you happy Brain fog You stop missing people and isolation feels more comfortable Constant fatigue How do you feel emotionally? Physically? Are any of your behaviors bothering you? What is your outlook/worldview/perspective? Write this down any way you wish to help you start organizing your thinking. Then, once you go through this exercise, you can start listening to what these signals are telling you, and work through how you feel to reconceptualize these thought patterns. For more on this, see my in-depth podcast on depression (episode #105) and blog on depression, or check out my book Cleaning Up Your Mental Mess and app Neurocycle. To read the original article click here.

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