January 2013 Repair Your Rotator Cuff Through Physical Therapy Rotator cuff tears are common, and

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1 Repair Your Rotator Cuff Through Physical Therapy Rotator cuff tears are common, and recovery can take a long time. But do all rotator cuff tears need to be surgically repaired? After reviewing 137 studies on the outcomes of rotator cuff treatments, the Agency for Healthcare Research and Quality, a division of the federal Department of Health and Human Services, said no. The rotator cuff is a complex of four muscles and the tendons that attach them to the three bones of the shoulder joint and keep it stable. Tears in any of the tendons or muscles can cause pain, weakness and limited range of motion. Rotator cuff tears are categorized by their severity. Full-thickness tears extend from the top to the bottom of a rotator cuff muscle and tendon. Partial-thickness tears affect a portion of a rotator cuff muscle and tendon but do not extend all the way through. Tears can develop in two ways. Acute tears produce immediate pain. They are usually caused by falling on an outstretched arm, walking a dog that strains on the leash or lifting a heavy object. Young people are at highest risk for acute tears. Chronic tears are slower to develop. They are caused by overuse and are more common in older adults and athletes. The pain and weakness of a chronic tear develop when the rotator cuff is damaged by repetitive motions such as throwing a baseball or performing painting and carpentry work where the arms are repeatedly held above the head. Ignoring a chronic tear only makes it worse. Although about half of all rotator cuff injuries respond to rest, physical therapy exercises and medication, it can be difficult to determine which injuries will eventually need surgery. Discuss the benefits and drawbacks of both surgical and nonsurgical treatment with your physician and with us. If you require surgery, we can design an appropriate program to rehabilitate your rotator cuff after the operation. In many cases, physical therapy can restore range of motion, improve coordination, strengthen the rotator cuff muscles, speed up healing and avoid permanent damage. Whatever the treatment you elect, committing to an exercise program can help you return to your former activity level, feeling better than ever.

2 That Ugly Lump on Your Wrist The lump on your wrist may look worrisome, but if your physician has diagnosed it as a ganglion cyst, there is no cause for alarm. Although they may grow larger, particularly after vigorous activity, these fluid-filled growths are not cancerous and will not spread. Frequently, ganglion cysts cause continuous aching pain that is worsened by activity. Ganglion cysts may result from a sudden injury or blow to the wrist or from repetitive activities, such as playing tennis, that stress the joint. When the wrist joint is strained or not moving properly, the synovial tissue cushioning the bones becomes irritated and squeezes out from between the bones, forming a pouch under the skin that fills up with synovial fluid. Ganglion cysts usually require no treatment, although wearing a wrist brace during activity may ease pain. Some cysts simply disappear over time; others come and go. However, many patients want the bump removed for aesthetic reasons. Aspiration is the treatment of choice to remove a cyst. After numbing the wrist, the physician then uses a needle and syringe to draw out the fluid. While this procedure is usually successful, the cyst often returns, and several aspirations may be needed to permanently remove it. Surgery is recommended when the cyst recurs despite repeated aspirations, causes severe pain or interferes with normal activities. The surgery is usually performed on an outpatient basis, after which the wrist is bandaged and placed in a splint. An exercise program begun soon after treatment can ease stiffness and increase circulation, strength and range of motion (ROM). In passive ROM exercises, the therapist gently rotates the wrist in full circles. Active ROM exercises, performed by you, stretch the wrist and increase flexibility. Other wrist-strengthening exercises performed either with a therapist or by you include squeezing Silly Putty to contract the wrist and hand muscles, and flexing and extending the wrist while holding light weights. If your physician recommends physical therapy after treating your ganglion cyst, we will create an exercise program that will restore circulation, increase muscle strength and attain full joint mobilization all of which will accelerate your recovery and may help prevent a ganglion cyst from forming again as well.

3 How to Treat Nursemaid s Elbow You are walking hand-in-hand with your four-year-old when a skateboarder comes charging around the corner. You yank your child out of harm s way, but she instantly howls in pain, clutches her arm and seems unable to bend it. She may have incurred nursemaid s elbow, a dislocation of the joint commonly seen in children (more often girls) younger than six years old. A sudden pull on a child s hand while her arm is in a certain position can cause one of the bones near the elbow to slide out of place. The name nursemaid s elbow reflects the fact that caretakers may cause the injury while playing with the child or trying to pull the child to safety. Symptoms of nursemaid s elbow include swelling, discoloration and tenderness around the elbow. Generally, an immediately conducted physician s examination usually confirms the diagnosis, but x-rays are sometimes ordered to rule out a fracture. Treatment is simple and effective. The physician gently manipulates the arm to pop the bone back in place. Although the child may feel some discomfort during the procedure, she will likely feel immediate pain relief and regain full use of her arm in about half an hour. If the first episode of this injury is treated immediately, it is probably not necessary to immobilize the joint. However, after the first episode, a child is more vulnerable to recurrences. In these cases, we can help by designing with your child s physician a therapy program to enhance recovery and help prevent subsequent dislocations. A cast on the arm for a period of time allows ligaments to heal fully. To relieve pain and swelling, anti-inflammatory medication may be prescribed. After the cast is removed, gentle exercises, such as squeezing a tennis ball or bending and straightening the elbow, can help strengthen the ligaments around the joint and prevent further slippage. Parents, babysitters and child care providers must be instructed not to pull forcefully on the child s hand or lift the child by the arms. Children at risk should avoid activities, such as swinging on monkey bars, that stress the joint. In conjunction with your child s pediatrician, we can work with your child s natural growth patterns and ensure healthy development and strengthen surrounding ligaments, thus forestalling a recurrence of nursemaid s elbow. Regaining full range of motion will ensure your child s return to normal activities without pain and stiffness.

4 To Lunge or Not to Lunge? When performed correctly, the lunge exercise can strengthen a wide range of muscles. The lunge challenges stability, which is what makes it so effective. A body attempting to remain balanced engages many muscle groups, from the hamstrings to the calves to the core. That makes the lunge a highly effective exercise for people needing to rehabilitate or strengthen their lower extremities. But what about patients with knee problems? Even people with healthy knee joints may experience pain when performing lunges. This problem is typically caused by improper form. When the knee comes too far forward during the lunge, undue stress can be placed on the joint. You might also find yourself twisting your back knee outward or inward in an attempt to maintain your balance. This can lead to significant pain and even injury. Learning proper form can help you avoid these problems. We can ensure that your body is in proper alignment while engaging in this exercise. However, for some people, lunges are inappropriate. Patients with meniscus tears or damaged articular cartilage, for example, are often better off avoiding the deep squat motion required for a lunge. And for anyone who still experiences knee pain despite perfect lunging form, other exercises might be a better bet. For instance, to strengthen the calf muscles, you can perform calf raises. While standing, lift and lower your body on your toes 10 to 15 times; holding a dumbbell in each hand will increase the resistance. For the seated calf raise, place a dumbbell, medicine ball or weighted plate on top of your bended knee, hold the weight with one hand and lift your heel off the ground 10 to 15 times for each leg. While some discomfort is normal when building or rebuilding muscle strength, you should not suffer unnecessary joint pain or risk causing further damage to your body. We can determine specific exercises that will strengthen the same muscle groups targeted by lunges, employing exercises more appropriate and comfortable for your individual body mechanics. This will ensure successful physical rehabilitation, and the restoration of strength to your lower extremity will enable you to resume your normal activities without pain.

5 Break a Leg? Get Up and Walk! The benefits of getting out of bed and moving as soon as possible after surgery are well known. Now, doctors often prescribe the same therapy when treating leg fractures. Get up. Get moving. And with supervision, start stretching and putting weight on that broken leg. The leg contains three long bones the femur or thighbone, the tibia or shinbone, and the fibula, a thinner bone that runs alongside the tibia. Depending on the angle and force of the trauma, any one of these bones can fracture. There are three types of fractures: a nondisplaced or stable fracture where the broken ends of the bone have barely moved a displaced fracture where the broken ends have moved significantly out of alignment an open or compound fracture where the bone protrudes through the skin Some muscle atrophy and loss of strength may occur with all leg fractures. An open fracture is often accompanied by tendon and muscle damage that will need extended rehabilitation. Instead of the traditional plaster cast, many non-displaced fractures of the tibia and fibula are treated with a protective walking boot to immobilize and protect the bone. The boot, which is adjustable and removable, is more comfortable and gives the wearer more control than a cast. It enables you to engage in strengthening and flexibility exercises earlier than you can with a plaster cast. This helps reduce muscle atrophy and loss of muscle strength and may speed recovery time. Displaced fractures require surgical fixation followed by a cast or walking boot. They may require a delay before starting rehabilitation. Studies have found that even with displaced fractures, strengthening exercises and early weight bearing can speed healing and decrease disability. No matter what type of leg fracture you have incurred, we can work with your physician to develop a comprehensive program of safe stretching and strengthening followed, if necessary, by balance and gait improvement exercises. Under our guidance, you will be up on your feet and walking normally as soon as possible.