Expert Physical Medicine & Rehabilitation

What is a Stroke?

A stroke occurs when a blood vessel in the brain is blocked or bursts. Without blood and the oxygen it carries, part of the brain starts to die. The part of the body controlled by the damaged area of the brain can't work properly.

Brain damage can begin within minutes. That's why it's so important to know the symptoms of stroke and to act fast. Quick treatment can help limit damage to the brain and increase the chance of a full recovery.

Symptoms: A stroke may cause:

• Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body
• Sudden vision changes
• Sudden trouble speaking
• Sudden confusion or trouble understanding simple statements
• Sudden problems with walking or balance
• A sudden, severe headache that is different from past headaches

Types of Stroke:

• Ischemic stroke: Happens when a blood clot blocks a blood vessel in the brain. The clot may form in the blood vessel or travel from somewhere else in the blood system. About 8 out of 10 strokes are ischemic strokes. They are the most common type of stroke in older adults.
• Hemorrhagic stroke: Develops when an artery in the brain leaks or bursts. This causes bleeding inside the brain or near the surface of the brain. Hemorrhagic strokes are less common but more deadly than ischemic strokes.

Diagnosis: You need to see a doctor right away. If a stroke is diagnosed quickly—right after symptoms start—doctors may be able to use medicines that can help you recover better. The first thing the doctor needs to find out is what kind of stroke it is: ischemic or hemorrhagic. This is important, because the medicine given to treat a stroke caused by a blood clot could be deadly if used for a stroke caused by bleeding in the brain.

To find out what kind of stroke it is, the doctor will do a type of X-ray called a CT scan of the brain, which can show if there is bleeding. The doctor may order other tests to find the location of the clot or bleeding, check for the amount of brain damage, and check for other conditions that can cause symptoms similar to a stroke.

What is Traumatic Brain Injury?

A traumatic brain injury (TBI) can range from a mild concussion to a severe head injury. It is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain. This can cause bruising, swelling, or tearing of brain tissue.

With rest, most people fully recover from a mild brain injury. But some people who have had a severe or repeated brain injury may have long-lasting problems with movement, learning, or speaking.

Symptoms: Symptoms of a traumatic brain injury range from mild to severe and can last for hours, days, weeks, or even months. These symptoms may include:

• Not thinking clearly, or having trouble remembering new information
• Having headaches, vision problems, or dizziness
• Feeling sad, nervous, or easily angered
• Sleeping more or less than usual

If you develop these kinds of symptoms at any time after a head injury—even much later—call your doctor.

Diagnosis: The doctor will ask you questions about the injury. He or she may ask questions that test your ability to pay attention, learn, remember, and solve problems. The doctor will check for physical signs of a brain injury by checking your reflexes, strength, balance, coordination, and sensation. The doctor may order imaging tests such as a CT scan or an MRI to make sure that your brain isn't bruised or bleeding.

Treatment: If your brain has been damaged, you may need treatment and rehabilitation, perhaps on a long-term basis. This might include:

• Physical and occupational therapy to help you regain the ability to do daily activities and to live as independently as possible
• Speech and language therapy to help you with understanding and producing language, as well as organizing daily tasks and developing problem-solving methods
• Counseling to help you understand your thoughts and learn ways to cope with your feelings
• Social support and support groups so that you get the chance to talk with people who are going through the same things you are
• Medicines to help relieve symptoms like sleep problems, chronic pain, and headaches

Treatment can help you feel more in control of your emotions, have fewer symptoms, and enjoy life again.

What is Multiple Sclerosis?

Multiple sclerosis, often called MS, is a disease that affects the central nervous system—the brain and spinal cord. It can cause problems with muscle control and strength, vision, balance, feeling, and thinking.

Your nerve cells have a protective covering called myelin. Without myelin, the brain and spinal cord can't communicate with the nerves in the rest of the body. MS gradually destroys myelin in patches throughout the brain and spinal cord, causing muscle weakness and other symptoms. These patches of damage are called lesions.

Types: MS is different for each person. Generally, MS follows one of four courses:

• Relapsing-remitting: Symptoms fade and then return off and on for many years
• Secondary progressive: At first follows a relapsing-remitting course and then becomes progressive
• Primary progressive: The disease is progressive from the start
• Progressive relapsing: Symptoms are progressive at first and are relapsing later

Causes: The exact cause is unknown, but most experts believe that MS is an autoimmune disease. The immune system mistakenly attacks the central nervous system. Experts don't know why MS happens to some people but not others. There may be a genetic link, and MS is more common in those who grew up in colder regions that are farther away from the equator.

Symptoms: Early symptoms may include:

• Muscle weakness, stiffness, and heavy limbs
• Vision problems including blurred vision, eyeball pain, blindness, or double vision
• Tingling, pins-and-needles sensation, or numbness
• Lightheadedness, dizziness, or feeling like you're spinning

Diagnosis: MS is not diagnosed unless a doctor can be sure that you have had at least two attacks affecting at least two different areas of your central nervous system. An MRI is often used to confirm the diagnosis, because the patches of damage (lesions) caused by MS attacks can be seen with this test.

What is Parkinson's Disease?

Parkinson's disease affects the way you move. It happens when there is a problem with certain nerve cells in the brain. Normally, these nerve cells make an important chemical called dopamine. Dopamine sends signals to the part of your brain that controls movement. It lets your muscles move smoothly and do what you want them to do.

When you have Parkinson's, these nerve cells break down. Then you no longer have enough dopamine, and you have trouble moving the way you want to. Parkinson's is progressive, which means it gets worse over time. But usually this happens slowly, over many years. And there are good treatments that can help you live a full life.

Causes: No one knows for sure what makes these nerve cells break down. Scientists are studying many possible causes, including aging and poisons in the environment. Abnormal genes seem to lead to Parkinson's disease in some people. But so far, there is not enough proof to show that it is always inherited.

Symptoms: The four main symptoms of Parkinson's are:

• Tremor (shaking or trembling), which may affect your hands, arms, or legs
• Stiff muscles
• Slow movement
• Problems with balance or walking

Tremor may be the first symptom you notice. It's one of the most common signs of the disease, although not everyone has it. Tremor often starts in just one arm or leg or on only one side of the body. It may be worse when you are awake but not moving the affected arm or leg.

In time, Parkinson's affects muscles all through your body, so it can lead to problems like trouble swallowing or constipation. In the later stages of the disease, a person with Parkinson's may have a fixed or blank expression, trouble speaking, and other problems. Some people also lose mental skills (dementia).

Diagnosis: Your doctor will ask questions about your symptoms and your past health and will do a neurological exam. This exam includes questions and tests that show how well your nerves are working. There are no lab or blood tests that can help your doctor know whether you have Parkinson's. But you may have tests like an MRI to rule out other diseases that could be causing your symptoms.

People usually start to have symptoms between the ages of 50 and 60, but sometimes symptoms start earlier.

What is Back Pain?

Most people will have a minor back problem at one time or another. Our body movements usually do not cause problems, but it's not surprising that symptoms develop from everyday wear and tear, overuse, or injury. Back problems and injuries often occur during sports or recreational activities, work-related tasks, or home projects.

Back pain can cause problems anywhere from the neck to the tailbone (coccyx). The back includes:

• The bones and joints of the spine (vertebrae)
• The discs that separate the vertebrae and absorb shock as you move
• The muscles and ligaments that hold the spine together

Causes: Back injuries are the most common cause of back pain. Injuries frequently occur when you use your back muscles in activities that you do not do very often, such as lifting a heavy object or doing yard work. Minor injuries also may occur from tripping, falling a short distance, or excessive twisting of the spine. Severe back injuries may result from car accidents, falls from significant heights, direct blows to the back or the top of the head, a high-energy fall onto the buttocks, or a penetrating injury such as a stab wound.

Although back pain is often caused by an injury to one or more of the structures of the back, it may have another cause. Some people are more likely to develop back pain than others. Things that increase your risk for back pain and injury include getting older, having a family history of back pain, sitting for long periods, lifting or pulling heavy objects, and having a degenerative disease such as osteoporosis.

Slumping or slouching alone may not cause low back pain. But after the back has been strained or injured, bad posture can make pain worse. "Good posture" generally means your ears, shoulders, and hips are in a straight line. If this posture causes pain, you may have another condition such as a problem with a disc or bones in your back.

Low back pain may occur in children and teenagers, but children and teens are less likely to see a doctor for low back pain. Although most back problems occur in adults ages 20 to 50, back problems in children younger than 20 and adults older than 50 are more likely to have a serious cause.

Acute Injuries: Pain from an injury may be sudden and severe. Bruising and swelling may develop soon after the injury. Pain from an acute injury usually does not last longer than 6 weeks. Acute injuries include:

• An injury to the ligaments or muscles in the back, such as a sprain or a strain
• A fracture or dislocation of the spine. This can cause a spinal cord injury that may lead to permanent paralysis. It is important to immobilize and transport the injured person correctly to reduce the risk of permanent paralysis.
• A torn or ruptured disc. If the tear is large enough, the jellylike material inside the disc may leak out (herniate) and press against a nerve.
• An injury that causes the compression of nerves in the lower back (cauda equina syndrome)

Spinal cord injury rehabilitation focuses on maximizing independence and function. We provide specialized therapy to help patients adapt and regain as much mobility as possible through comprehensive rehabilitation programs tailored to each patient's specific needs and goals.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is numbness, tingling, weakness, and other problems in your hand because of pressure on the median nerve in your wrist.

The median nerve and several tendons run from your forearm to your hand through a small space in your wrist called the carpal tunnel. The median nerve controls movement and feeling in your thumb and first three fingers.

Causes: Pressure on the median nerve can come from swelling or anything that makes the carpal tunnel smaller, including illnesses such as hypothyroidism, rheumatoid arthritis, and diabetes, or making repetitive hand movements.

Treatment: We offer conservative treatment including wrist splinting, anti-inflammatory medications, activity modification, and therapeutic exercises to relieve symptoms and prevent progression.

What is Trigger Finger?

Trigger finger is a painful condition that causes the fingers or thumb to catch or lock when bent. In the thumb it's called trigger thumb.

Trigger finger happens when tendons in the finger or thumb become inflamed. Tendons are tough bands of tissue that connect muscles and bones. Together, the tendons and muscles in the hands and arms bend and straighten the fingers and thumbs.

A tendon usually glides easily through the tissue that covers it (called a sheath) because of a lubricating membrane surrounding the joint called the synovium. Sometimes a tendon may become inflamed and swollen. When this happens, bending the finger or thumb can pull the inflamed tendon through a narrowed tendon sheath, making it snap or pop.

What Causes Trigger Finger?

Trigger finger can be caused by a repeated movement or forceful use of the finger or thumb. Rheumatoid arthritis, gout, and diabetes also can cause trigger finger. So can grasping something, such as a power tool, with a firm grip for a long time.

Who Gets Trigger Finger?

Farmers, industrial workers, and musicians often get trigger finger since they repeat finger and thumb movements a lot. Even smokers can get trigger thumb from repeated use of a lighter, for example. Trigger finger is more common in women than men and tends to happen most often in people who are 40 to 60 years old.

What Are the Symptoms of Trigger Finger?

One of the first symptoms of trigger finger is soreness at the base of the finger or thumb. The most common symptom is a painful clicking or snapping when bending or straightening the finger. This catching sensation tends to get worse after resting the finger or thumb and loosens up with movement.

In some cases, the finger or thumb locks in a bent or straight position as the condition gets worse and must be gently straightened with the other hand.

How Is Trigger Finger Diagnosed?

Trigger finger is diagnosed with a physical exam of the hand and fingers. In some cases, the finger may be swollen and there may be a bump over the joint in the palm of the hand. The finger also may be locked in bent position, or it may be stiff and painful. No X-rays or lab tests are used to diagnose trigger finger.

How Is Trigger Finger Treated?

The first step is to rest the finger or thumb. Your doctor may put a splint on the hand to keep the joint from moving. If symptoms continue, your doctor may prescribe drugs that fight inflammation, such as ibuprofen or naproxen. Your doctor may also recommend an injection of a steroid into the tendon sheath. If the trigger finger does not get better, your doctor may recommend surgery.

How Long Does Recovery From Trigger Finger Take?

The time it takes to recover from trigger finger depends on how bad it is. The choice of treatment also affects recovery. For example, splinting may be necessary for six weeks. But most patients with trigger finger recover within a few weeks by resting the finger and using anti-inflammatory drugs.

What is Flexor Tendon Repair?

Tendon repair is surgery to repair damaged or torn tendons.

Description

Tendon repair can be performed using:

• Local anesthesia (the immediate area of the surgery is pain-free)
• Regional anesthesia (the local and surrounding areas are pain-free)
• General anesthesia (the patient is asleep and pain-free)

The surgeon makes a cut on the skin over the injured tendon. The damaged or torn ends of the tendon are sewn together.

If the tendon has been severely injured, a tendon graft may be needed.

• In this case, a piece of tendon from the foot, toe, or another part of the body is often used.
• If needed, tendons are reattached to the surrounding tissue.
• The surgeon examines the area to see if there any injuries to nerves and blood vessels. When complete, the wound is closed.

If the tendon damage is too severe, the repair and reconstruction may have to be done at different times.

The surgeon will perform one operation to repair part of the injury, and then allow the hand to heal for a few weeks. Another surgery will be later done to complete the reconstruction and repair the tendon.

Why the Procedure is Performed

The goal of tendon repair is to bring back normal function of joints or surrounding tissues following a tendon laceration.

What is DeQuervain's Tenosynovitis?

De Quervain's tenosynovitis, also called De Quervain's, is a problem that makes the bottom of your thumb and the side of your wrist hurt. When you have de Quervain's, the ropey fiber (tendon) that helps move your thumb away from your fingers becomes swollen.

What causes de Quervain's?

People can get de Quervain's when they hurt or use the thumb or wrist too much. Common activities that need your wrist and thumb can cause the problem. Some activities that might cause de Quervain's are:

• Wringing out wet clothes
• Hammering
• Skiing
• Knitting
• Lifting heavy objects such as a jug of milk, taking a frying pan off of the stove, or lifting a baby out of a crib

If you are pregnant or if you have diabetes or rheumatoid arthritis, you are more likely to get de Quervain's. More women than men have de Quervain's. You can get the disease at any age. Most people who have de Quervain's are women between the ages of 30 and 50.

What are the symptoms?

De Quervain's may cause pain when you twist your wrist. You might also have pain if you grab something between your thumb and finger. Many people hear a funny sound like a squeak, crackle, snap, or creak when they move the wrist or thumb.

The bottom of the thumb or the side of the wrist might also be sore or swollen. This can make it hard to move your thumb or wrist. The back of the thumb and index finger may also feel numb. Sometimes de Quervain's can cause a small bump on the thumb side of the wrist. If you don't get treatment, the pain can spread up your forearm or down into your thumb.

How is de Quervain's diagnosed?

Your doctor will check for swelling, tenderness, or numbness around the base of the thumb. There may also be crackling or popping when you move your thumb.

Your doctor may or may not use the Finkelstein test to help diagnose de Quervain's. To do this test, make a fist with your thumb inside. Then bend your wrist outward toward your little finger. If you feel pain on the thumb side of your wrist, then you most likely have de Quervain's.

The Finkelstein test is done to make sure that you do not have a different problem, such as arthritis in the bottom of your thumb or intersection syndrome. Both of these problems affect the same area of the hand and wrist as de Quervain's.

How is it treated?

The goal of treatment for de Quervain's is to relieve the pain and swelling in your thumb and wrist, and restore normal function. Try the following steps to help your symptoms:

• Avoid moving the hand and wrist that hurt.
• Until your symptoms are better, stop the activities that caused the pain.
• Keep your wrist in a straight line with your arm by using a splint to keep your thumb and wrist from moving.
• Try ice or heat on the area that hurts or is swollen. You can use ice for 15 minutes every 4 to 6 hours. Put a thin cloth between the ice and your skin. You can use heat for 20 to 30 minutes, 2 or 3 times a day. Try using a heating pad, hot shower, or hot pack.
• Use nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (such as Advil) or naproxen (such as Aleve). NSAIDs come in pills and in a cream that you rub over the sore area. Acetaminophen (such as Tylenol) can also help with pain.

What is Osteoarthritis?

Osteoarthritis is a painful problem with the joints. Healthy joints help your body move, bend, and twist. But when you have arthritis, simple, everyday movements can hurt. Using the stairs can be painful. Walking a few steps, opening a door, and even combing your hair can be hard.

Arthritis is mainly a disease of the spine, hip, hand, knee, and foot, but it can happen in other joints too. A joint is where two bones connect. Arthritis is most common in older people. Even though you can't cure arthritis, there are many treatments that can help with your pain and make it easier for you to move.

Causes: The simplest way to describe arthritis is that it's wear and tear on the cartilage of your joints. This cushioning tissue is firm, thick, and slippery. It covers and protects the ends of bones where they meet to form a joint. With arthritis, there are changes in the cartilage that cause it to break down. When it breaks down, the bones rub together and cause damage and pain. Aging, joint injury, being overweight, and genetics may be part of the reason.

Symptoms:

• Pain - Your joints may ache, or the pain may feel burning or sharp
• Stiffness - Getting up in the morning can be hard. Your joints may feel stiff and creaky
• Muscle weakness - The muscles around the joint may get weaker
• Deformed joints - Joints can start to look like they are the wrong shape
• Reduced range of motion and loss of use of the joint
• Cracking and creaking - Your joints may make crunching, creaking sounds

Diagnosis: Your doctor will check that your pain is not caused by another problem and will ask questions about your symptoms. If your joints are tender and swollen and the muscles are weak, this will help your doctor confirm whether you have arthritis. You may also have X-rays to check your joints for damage.

Rheumatoid arthritis is an autoimmune condition causing joint inflammation. Our rehabilitation programs focus on maintaining joint mobility, reducing pain, and preserving function through therapeutic exercise and modalities.

Post-operative rehabilitation after joint replacement is essential for optimal recovery. We provide specialized therapy to restore strength, range of motion, and function following hip, knee, or shoulder replacement surgery.

What is Neck Pain?

Neck pain can occur anywhere in your neck, from the bottom of your head to the top of your shoulders. It can spread to your upper back or arms. It may limit how much you can move your head and neck.

Neck pain is common, especially in people older than 50.

Most neck pain is caused by activities that strain the neck. Slouching, painting a ceiling, or sleeping with your neck twisted are some things that can cause neck pain. These kinds of activities can lead to neck strain, a sprain, or a spasm of the neck muscles.

Neck pain can also be caused by an injury. A fall from a ladder or whiplash from a car accident can cause neck pain. Some less common medical problems can also lead to neck pain, such as:

• An infection in the neck
• Narrowing of the spinal canal in the neck (cervical spinal stenosis)
• Rheumatoid arthritis

Symptoms: You may feel a knot, stiffness, or severe pain in your neck. The pain may spread to your shoulders, upper back, or arms. You may get a headache. You may not be able to move or turn your head and neck easily. If there is pressure on a spinal nerve root, you might have pain that shoots down your arm. You may also have numbness, tingling, or weakness in your arm.

If your neck pain is long-lasting (chronic), you may have trouble coping with daily life. Common side effects of chronic pain include fatigue, depression, and anxiety.

Diagnosis: Your doctor will ask questions about your symptoms and do a physical exam. He or she will also ask about any injuries, illnesses, or activities that may be causing your neck pain.

During the physical exam, your doctor will check how well you can move your neck. He or she will also look for tenderness or numbness, tingling, or weakness in your arms or hands. If your pain started after an injury, or if it doesn't improve after a few weeks, your doctor may want to do more tests. Imaging tests such as an X-ray, an MRI scan, or a CT scan can show the neck muscles and tissues.

What is Plantar Fasciitis?

Plantar fasciitis is the most common cause of heel pain. The fascia is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk.

Plantar fasciitis is common in middle-aged people. It also occurs in younger people who are on their feet a lot, like athletes or soldiers. It can happen in one foot or both feet.

Causes: Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen if:

• Your feet roll inward too much when you walk (excessive pronation)
• You have high arches or flat feet
• You walk, stand, or run for long periods of time, especially on hard surfaces
• You have tight Achilles tendons or calf muscles

Symptoms: Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.

Treatment: No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better:

• Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces.
• To reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen (such as Advil or Motrin), naproxen (such as Aleve), or aspirin.
• Do toe stretches, calf stretches and towel stretches several times a day, especially when you first get up in the morning.
• Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts (orthotics) in both shoes, even if only one foot hurts.

If these treatments do not help, your doctor may give you splints that you wear at night, shots of steroid medicine in your heel, or other treatments. You probably will not need surgery. Doctors only suggest it for people who still have pain after trying other treatments for 6 to 12 months.

What is Achilles Tendonitis?

The Achilles tendon connects the calf muscle to the heel bone. It lets you rise up on your toes and push off when you walk or run.

The two main problems are:

• Achilles tendinopathy: This includes tendinitis (inflammation) and tendinosis (tiny tears in the tissue). In most cases, Achilles tendon pain is the result of tendinosis, not tendinitis.
• Achilles tendon tear or rupture: An Achilles tendon can partially tear or completely rupture. A partial tear may cause mild or no symptoms. But a complete rupture causes pain and sudden loss of strength and movement.

Problems with the Achilles tendon may seem to happen suddenly, but usually they are the result of many tiny tears in the tendon that have happened over time.

Causes: Achilles tendinopathy is most often caused by overuse or repeated movements during sports, work, or other activities. For example, if you do a lot of pushing off or stop-and-go motions when you play sports, you can get microtears in the tendon. It is likely to occur in men older than 30, and most ruptures occur in people 30 to 50 years old who are recreational athletes.

Symptoms: Symptoms of Achilles tendinopathy include swelling in the ankle area and mild or severe pain. The pain may come on gradually or may only occur when you walk or run. You may have less strength and range of movement in the ankle. Symptoms of a rupture may include sudden, sharp pain. Most people feel or hear a pop at the same time.

Diagnosis: Your doctor can tell if you have an Achilles tendon problem by asking questions about your past health and checking the back of your leg for pain and swelling. If your symptoms are severe or don't improve with treatment, you may get an X-ray, ultrasound scan, or MRI.

IT band syndrome causes pain on the outside of the knee, common in runners and cyclists. We provide treatment including stretching, strengthening exercises, manual therapy, and activity modification to reduce pain and prevent recurrence.

What is a Rotator Cuff Tear?

The rotator cuff is a group of tough, flexible fibers (tendons) and muscles in the shoulder. Rotator cuff disorders occur when tissues in the shoulder get irritated or damaged. Rotator cuff disorders include:

• Inflammation of the tendons (tendinitis) or of a bursa (bursitis). In the shoulder, a bursa is a small, fluid-filled sac that serves as a cushion between the tendons and the bones.
• Impingement, in which a tendon is squeezed and rubs against bone.
• Calcium buildup in the tendons, which causes a painful condition called calcific tendinitis.
• Partial or complete tears of the rotator cuff tendons.

The shoulder is a joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). The bones are held together by muscles, tendons, and ligaments. The rotator cuff keeps the upper arm bone in the shoulder socket and lets you raise and twist your arm.

The shoulder is a ball-and-socket joint. The ball at the top of the upper arm bone fits into the socket of the shoulder blade. This socket is shallow, which lets you move your arm in a wide range of motion. But it also means that the muscles and tendons of the rotator cuff have to work hard to hold the bones in place. As a result, they are easy to injure and are prone to wear and tear.

Causes:

• Normal wear and tear. Using your shoulder for many years slowly damages the rotator cuff. As you age, everyday activities can lead to changes in the rotator cuff, such as thinning and fraying of the tendons and reduced blood supply.
• Overuse. Activities in which you use your arms above your head a lot—such as tennis, swimming, or house painting—can lead to rotator cuff problems. Even normal motions made often over a long period can stress or injure the rotator cuff.

Both normal wear and tear and overuse can lead to impingement, when a tendon rubs against bone. This damages and irritates the tendon, which causes bleeding and inflammation. Over time, damage to the tendon may build up, so the tendon is more easily injured.

It takes great force to tear a healthy rotator cuff tendon. This can happen during sports, an accident, or a severe fall. But even a simple movement like lifting a suitcase can cause a rotator cuff tear in an older adult or someone whose shoulder is already damaged.

Symptoms: Symptoms of a rotator cuff disorder include pain and weakness in the shoulder. Most often, the pain is on the side and front of the upper arm and shoulder. It may hurt or be impossible to do everyday things, such as comb your hair, tuck in your shirt, or reach for something. You may have pain during the night and trouble sleeping.

What is Medial Epicondylitis?

Golfer's elbow is pain or soreness in the inner part of the elbow from movement of muscles and tendons in the arm. A tendon is tissue that connects your muscles to bone. Golfer's elbow isn't just a problem with the elbow. It also involves the wrist. When the wrist moves, it affects the tendons that attach to the elbow.

What causes golfer's elbow?

Golfer's elbow is an overuse injury. These kinds of injuries are caused by putting too much stress on your muscles, joints, or other tissues without allowing them to recover. Golfer's elbow is seen most often in people who garden, bowl, play golf, or play baseball.

What are the symptoms?

Golfer's elbow causes pain on the inside of your elbow. Your elbow may feel stiff, and it may hurt when you make a fist. Some people with golfer's elbow feel weakness and tingling in the arm and fingers. These symptoms can happen slowly or quickly. The pain may get worse when you swing a racket or golf club, squeeze a ball, shake hands with someone, turn a doorknob, lift weights, or flex your wrist.

How is golfer's elbow diagnosed?

There is no one test for this problem. Your doctor may ask questions about your past health and then examine you. The doctor may press on areas and move your hand and wrists in certain ways to see if that causes pain. These tests will show the doctor if your pain is in your elbow and where in the elbow it is.

How is it treated?

The goal of treatment is to relieve pain and allow the tendon in the elbow to heal.

• Treatment usually starts with rest, using ice and anti-inflammatory medicines, and trying a physical therapy and exercise program. Many people get better using these treatments.
• Some people get cortisone shots. These are shots of steroid medicine into the painful area to reduce swelling. Cortisone shots often work well to relieve pain.
• If other treatments don't work and you are not getting better, surgery might be an option.

Prevention: Golfer's elbow can be prevented:

• Take time to stretch the muscles in your forearm before and after your activity.
• Be sure not to overuse your elbow.
• If you have pain or swelling in your elbow after an activity, ice the elbow, rest it, and try not to use it until the pain is gone.

What is Lateral Epicondylitis?

Tennis elbow is soreness or pain on the outer part of the elbow. It happens when you damage the tendons that connect the muscles of your forearm to your elbow. The pain may spread down your arm to your wrist. If you don't treat the injury, it may hurt to do simple things like turn a key or open a door.

Your doctor may call this condition lateral epicondylitis.

Causes: Most of the time tennis elbow is caused by overuse. You probably got it from doing activities where you twist your arm over and over. This can stress the tendon, causing tiny tears that in time lead to pain. A direct blow to the outer elbow can also cause tendon damage.

Tennis elbow is common in tennis players, but most people get it from other activities that work the same muscles, such as gardening, painting, or using a screwdriver. It is often the result of using equipment that is the wrong size or using it the wrong way.

Anyone can get tennis elbow, but it usually occurs in people in their 40s.

Diagnosis: To diagnose tennis elbow, a doctor will examine your elbow and ask questions about the elbow problem, your daily activities, and past injuries. You probably won't need to have an X-ray, but you might have one to help rule out other things that could be causing the pain.

If your symptoms don't get better with treatment, you might have an imaging test, such as an MRI. This can tell your doctor whether a bone problem or tissue damage is causing your symptoms.

Treatment: You can start treating tennis elbow at home right away:

• Rest your arm, and avoid any activity that makes the pain worse.
• As soon as you notice pain, use ice or cold packs for 10 to 15 minutes at a time, several times a day. Always put a thin cloth between the ice and your skin. Keep using ice as long as it relieves pain. Or use a warm, moist cloth or take hot baths if they feel good.
• Take over-the-counter pain relievers such as ibuprofen or naproxen (NSAIDs) or acetaminophen if you need them. Or try an NSAID cream that you rub over the sore area.
• Wear a counterforce brace when you need to grasp or twist something. This is a strap around your forearm just below the elbow. It may ease the pressure on the tendon and spread force throughout your arm.

After the pain eases, your doctor or physical therapist can teach you rehabilitation (rehab) exercises to stretch and strengthen your tendon. Doing these exercises at home can help your tendon heal and can prevent further injury.

What is Iliotibial Band Syndrome?

The iliotibial band is a band of fibrous tissue that runs down the outside of the thigh. It provides stability to the knee and hip and helps prevent dislocation of those joints. The band may overdevelop, tighten, and rub across the hipbone or the outer part of the knee. Each time the knee is bent or the hip flexed, the band rubs against bone. This is particularly common in runners, cyclists, and people who participate in other aerobic activities.

Symptoms: Symptoms of iliotibial band syndrome include:

• Pain on the outside of the knee or hip
• Snapping hip pain as the iliotibial band snaps back and forth over the point of the hip (greater trochanter)
• Pain that generally disappears as the band is stretched out and becomes more flexible
• Pain that improves with rest

Treatment: Iliotibial band syndrome is treated with rest, medicines to relieve swelling and pain, and stretching exercises as instructed by a physical therapist or sports medicine doctor. Steroid injections at the most tender spot are sometimes helpful.

What is Fibromyalgia?

Fibromyalgia is widespread pain in the muscles and soft tissues above and below the waist and on both sides of the body. People with fibromyalgia feel pain, tenderness, or both even when there is no injury or inflammation.

Fibromyalgia can cause long-lasting (chronic) pain. It has no cure. But with treatment, most people with fibromyalgia are able to work and do their regular activities. There are many things you can do to help manage your symptoms.

Causes: No one knows for sure what causes fibromyalgia. But experts have some ideas, such as: nerve cells may be too sensitive, chemicals in the brain (neurotransmitters) may be out of balance, or the deep phase of sleep may be disrupted and affect the amount of hormones that your body releases.

Main Symptoms:

• Deep or burning pain in your trunk, neck, low back, hips, and shoulders
• Tender points (or trigger points) on the body that hurt when pressed

Other Problems: People with fibromyalgia may also experience anxiety and depression, sleep problems and tiredness, headaches, morning stiffness, trouble concentrating, and irritable bowel syndrome. Symptoms tend to come and go. You may have times when you hurt more, followed by times when symptoms happen less often or are absent.

Diagnosis: Doctors diagnose fibromyalgia based on widespread pain on both sides of your body above and below the waist, and tenderness in at least 11 of 18 points when they are pressed. Your doctor will make sure that you don't have other conditions that cause pain, such as rheumatoid arthritis, lupus, or other autoimmune diseases.

Treatment: Treatment is focused on managing pain, fatigue, depression, and other symptoms. You may be able to control your symptoms by getting regular exercise (one of the best ways to manage pain), taking medicine if needed, going to counseling to cope with chronic pain, and taking care of yourself through stress management, good sleep habits, and addressing symptoms of depression. Some people also find complementary therapies like tai chi, acupuncture, massage, and relaxation techniques helpful.

Post-amputation rehabilitation focuses on maximizing independence and function. We provide specialized therapy including prosthetic training, strengthening, and functional mobility training.

We treat pediatric conditions including Cerebral Palsy, Muscular Dystrophy, and Spina Bifida. Our specialized therapy focuses on improving motor skills, independence, and quality of life for children with developmental disorders.

We perform diagnostic electrodiagnostic testing including EMG and nerve conduction studies to evaluate nerve and muscle function, helping to diagnose conditions like neuropathy, radiculopathy, and carpal tunnel syndrome.