Questions and Answers

The spinal vertebrae are separated by flexible disks of shock absorbing cartilage. These disks are made of a supple outer layer with a soft jelly-like core (nucleus). If a disk is compressed, so that part of it intrudes into the spinal canal but the outer layer has not been ruptured, it may be referred to as a “bulging” disk. This condition may or may not be painful and is extremely common.

Herniated disks are often referred to as “slipped” or “ruptured” disks. When a disk herniates, the tissue located in the center (nucleus) of the disk is forced outward. Although the disk does not actually “slip,” strong pressure on the disk may force a fragment of the nucleus to rupture the outer layer of the disk.

If the disk fragment does not interfere with the spinal nerves, the injury is usually not painful. If the disk fragment moves into the spinal canal and presses against one or more of the spinal nerves, it can cause nerve impingement and pain.

If the injured disk is in the low back, it may produce pain, numbness, or weakness in the lower back, leg, or foot. If the injured disk is in the neck, it may produce pain, numbness, or weakness in the shoulder, arm, or hand.

The medial and lateral menisci (plural of meniscus) of the knee are two crescent moon-shaped disks of tough tissue that lie between the ends of the upper leg bone and lower leg bone that form the knee joint. Meniscus tears commonly occur during sports when the knee is twisted while the foot is planted firmly on the ground. In people over the age of 40 whose menisci are worn down, a tar might occur with normal movement, minimal activity, or minor injury.

The rotator cuff is a group of tendons and their related muscles that help keep the shoulder and upper arm bone securely placed in to the socket of the shoulder blade. The rotator cuff stabilizes the shoulder joint and helps you to raise and rotate your arms.

There are three stages of rotator cuff tears:

• A stage 1 tear is a partial tear less than 1 cm in size. It is accompanied by some pain following overhead arm movements, but range of motion is not limited.
• A stage 2 tear is a partial tear greater than 1 cm but less than 5 cm in length. Pain is common during and after overhead arm movements, as well as at night. It may be accompanied by a slight decrease in range of motion.
• A stage 3 tear is a full tear greater than 5 cm in size. Stiffness, weakness, and pain occur during and after overhead arm movements and during sleep. There may be a slight to severe decrease in range of motion in the shoulder.

The most common form of arthritis, osteoarthritis, can affect any joint in the body, but most often afflicts the knees, hips, and fingers. Most people will develop osteoarthritis from the normal wear and tear on the joints through the years. Joints contain cartilage, a rubbery material that cushions the ends of bones and facilitates movement. Over time, or if the joint has been injured, the cartilage wears away and the bones of the joint start rubbing together. As bones rub together, bone spurs may form and the joint becomes stiff after long periods of activity or inactivity

Bursitis is inflammation of a bursa or bursae (more than one bursa), small fluid-filled sacs that cushion areas of friction around joints. Bursae contain synovial fluid that lubricates the joints. Bursitis typically occurs as a result of overuse during physical activities or infection of the synovial fluid. If a bursa becomes infected or irritated from repetitive stress, it will cause pain and limited movement. Bursitis is most common in the shoulder, knee, hip, elbow, or heel.

Carpal tunnel syndrome is the term used to describe a specific group of symptoms (tingling, numbness, weakness, or pain) in the fingers or hand and occasionally in the lower arm and elbow. These symptoms occur when there is pressure on a nerve (median nerve) within the wrist (carpal tunnel). Carpal tunnel syndrome develops over time because of repetitive hand motions that damage muscle and bone in the wrist area.

Impingement syndrome is a common disorder of the shoulder that refers to an improper alignment of the bones and tissues in the upper arm. Inflammatory conditions such as tendinitis, bursitis, and arthritis are all closely related to impingement syndrome, as are tears to the rotator cuff tendons.

If the rotator cuff becomes inflamed from overuse or there is a bone deformity or spur on the end of the shoulder blade, then the space between the upper arm bone and tip of the shoulder blade is narrowed, causing the rotator cuff and its fluid-filled bursa to be squeezed or pinched. This impingement causes irritation and pain to the rotator cuff when the shoulder is raised.

Teninitis is inflammation of a tendon, a band of tissue that connects muscle to bone. It is most commonly the result of overuse during physical activities. Repetitive motions can stretch and irritate the tendon, causing pain and swelling. Tendinitis occurs around joints such as the elbow, shoulder, wrist, ankle, or knee.

A strain occurs when a muscle is stretched or torn. A sprain occurs when a ligament is stretched or torn.

Strains are often the result of overuse or improper use of a muscle, while sprains typically occur when a joint is subjected to excessive force or unnatural movements (e.g., sudden twists, turns, or stops). Sprains can be categorized by degree of severity:

• A first-degree sprain stretches the ligament but does not tear it. Symptoms include mild pain with normal movement.
• A second-degree sprain is characterized by a partially torn ligament, significant pain and swelling, restricted movement, and mild to moderate joint instability.
• In a third-degree sprain, the ligament is completely torn with mild to severe pain, swelling, and significant joint instability.