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Category: General

Singapore Sports and Orthopaedic ClinicBlogGeneral
Applying pressure for back shoulder pain
By Cindy Soh 0 Comments Orthopaedic Injuries ,

Experiencing Muscle Pain? It could be Myofascial Pain Syndrome

Muscle pain of any type can be get difficult to handle. Sometimes the pain may be minor and can be worked through, while other times it can debilitating and hard to handle. One chronic condition that involves muscle pain that many of us may deal with is called the Myofascial Pain Syndrome.

This involves inflammation that is in the soft tissues of the body and cause pain in different areas (referred pain). It could involve one particular muscular area or a group of muscles causing pain.

Here are a few things you should know if you’re dealing with muscle pain or if you think you’re dealing with myofascial pain.

Causes and Symptoms of Myofascial Pain Symptoms

The causes of myofascial pain can be due to an injury or strain of a muscle in the body. It could be due to repetitive motions that injury the muscle groups being used, an excessive strain that is put on the muscle, tendon or even ligaments, or it can be due to inactivity in a group of muscles. This could be due to having an injury to your arm and not being able to move it due to the cast or sling you’re having to wear.

This type of muscle pain originates from what are known as “Trigger Points”. Trigger Points are sensitive areas in the muscle which may under undue pressure. These can cause pain in those specific areas, or it can also produce other problems such as depression, behavioral problems, or fatigue due to the pain the patient is in.

When examined for Myofascial Pain, you may have few types of Trigger Points

  • Active – is very tender can cause the muscle to twitch when manipulated and is the most common type
  • Latent – which do not cause any immediate pain when probed but can get activated where there’s stress or trauma. Basically, waiting to cause future problems
  • Primary – A central trigger point that was activated directly by acute or chronic overload, or repetitive overuse of the muscle in which it occurs.
  • Secondary – painful point in the muscle that becomes active when you stress another muscle.
  • Satellite – This Trigger Point that activates coz its located near to another Trigger Point
example trigger point and referred pain
Source: Mayo Clinic

Treatment Options for Myofascial Pain

  1. There are several options available to treat this type of muscle pain depending on what you’re dealing with at the time.
  2. You can opt for massage therapy to help reduce the trigger points and work out the kinks in the muscles.
  3. Physiotherapy to help you gain movement back in those muscles if you’ve dealt with an injury that restricted your movement.
  4. You may also find that trigger point injection therapy works well for you. This is where the doctor will inject either anaesthetic, saline, or corticosteroids into the trigger point and make it dormant so that it doesn’t cause pain anymore.
  5. One other method that may be used is the “spray and stretch” method. This is where the trigger point is sprayed with a cooling type spray and then it is slowly stretched out.
  6. You can also take anti-inflammatory medications to assist with the pain as well

Myofascial Pain Relief in Singapore

Singapore Sports & Orthopaedic Clinic has been in service for the past 20 years in Singapore helping patients with pain relief and treatments. Our team of doctors (specialists & generalists) have treated Myofascial Pain Syndrome for many patients. Call us today for more info.

By Cindy Soh 1 Comments Back Pain, FAQ, General, Joint Pain, Shoulder Pain, Sports Injury , , , , , ,

Stiff Neck – Cause And Relief

Have you ever woke up to a stiff neck before? That uncomfortable and tight feeling that makes movement almost impossible and causing you a lot of discomfort throughout the entire day. Stiff neck are frequently experienced by many and it will usually go away by itself after a few days. You may rest assure that stiff neck is not an indication of any serious problems with your neck.

A stiff neck is typically characterized by difficulty moving the neck, especially when trying to turn the head to the side. It may also be accompanied by a headache, neck pain, shoulder pain or arm pain. In order to look sideways an individual may need to turn the entire body instead of the stiff neck. Most people are familiar with the pain of a stiff neck. In most cases, pain and stiffness go away naturally within a week.

If a stiff neck has not improved after a week, it should be checked by a doctor. Also, regardless of how long it has lasted, a stiff neck accompanied by fever, headache, nausea or unexplained sleepiness should be treated by a medical professional immediately.

Causes of Stiff Neck

Injury

Injuries are one of the most common reasons that one will experience stiff neck. A sudden jerking movement at the neck region can injure the muscles and ligaments, causing injury and subsequent pain and stiffness. Injuries can be caused by sports, accidental falls or even a car accident.

Stress

Our body response to stress is the natural tensing of our muscles. If you did not suffer any injuries recently and is experiencing stiff neck, it could be an indication that you are under tremendous stress. It’s time to take things easy and relax.

Muscle spasm

Muscle spasm are due to the signalling of certain messages from our nerves to the muscles which will result in them involuntary contracting, causing stiff neck.

Improper sleeping posture

Improper sleeping posture is probably the most common reason for stiff neck. Our body is in a relaxed state when we are asleep and an improper sleeping posture can cause the pulling of the neck muscles without us being aware of it. Only when we finally wake up do we realise it and it is often too late.

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disorder that targets the joints, especially those in the neck. It will result in neck pain and stiffness.

Meningitis

Meningitis is a very serious inflection of the fluid that surrounds our brain and spinal cord and if you suffer from neck pain and stiffness and they are not caused by the factors listed above, you should consult a doctor immediately as a stiff neck is a common symptom of meningitis.

 

Diagnosis of Stiff Neck

Your doctor will take a medical history and do an exam. He or she will check for tenderness, numbness and muscle weakness, as well as see how far you can move your head forward, backward and side to side.

Imaging tests

Your doctor might order imaging tests to get a better picture of the cause of your stiff neck. Examples include:

  • X-rays can reveal areas in your neck where your nerves or spinal cord might be pinched by bone spurs or other degenerative changes.
  • CT scans combine X-ray images taken from many different directions to produce detailed cross-sectional views of the internal structures of your neck.
  • MRI uses radio waves and a strong magnetic field to create detailed images of bones and soft tissues, including the spinal cord and the nerves coming from the spinal cord.

It’s possible to have X-ray or MRI evidence of structural problems in your neck without having symptoms. Imaging studies are best used as an adjunct to a careful history and physical exam to determine the cause of your pain.

 

Treatment Regime for Stiff Neck

An individual can do several things to begin treating a stiff neck. Some common self-care strategies include:

  • Rest. Taking it easy for one or two days gives injured tissues a chance to begin to heal, which in turn will help relieve stiffness and possible muscle spasm. For example, someone who swims may want to avoid certain swim strokes that involve lots of head twisting for a few days. However, it is recommended to limit rest to one or two days, as too much inactivity can lead to a weakening of the muscles, and weak muscles have to struggle to adequately support the neck and head.
  • Cold and/or heat therapy. Cold therapy/ice packs help relieve most types of neck stiffness by reducing local inflammation. Applying ice during the first 24 to 48 hours of a painful flare-up usually has the most benefit in terms of reducing inflammation. Applying heat to the neck can spur blood flow, which fosters a better healing environment. Some patients prefer ice, whereas others prefer heat. Both may be used alternately.
  • Over-the-counter medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), which work by reducing inflammation, are typically a first line of treatment for neck stiffness and soreness. Even non prescription medications have risks, possible side effects, and drug interactions, so be sure to discuss any medications with a doctor.
  • Gentle stretching. Stretching, as soon as tolerated, helps ease the stiffness and restore the neck to a more natural range of motion. For many, it is a good idea to learn appropriate stretches with the help of a physical therapist.
  • Low-impact aerobic exercise. Stretching or any form of low-impact aerobic exercise, such as walking, is often helpful in relieving any type of stiffness. Even if walking does not directly involve the neck, it helps circulate oxygen to the soft tissues throughout the spine, which in turn promotes healing.

 

Stiff Neck Treatment in Singapore

You can contact us for counselling regarding stiff neck treatment. We are closely working with more than 35 Insurance companies for cashless payments. We are an Accredited Specialist Clinic. E-filing facility is also available at our clinic.

By Cindy Soh 0 Comments Orthopaedic Injuries, Sports Injury

Common Cause of Overuse Injuries: Prevention & Treatment

Sports are a great way to keep active and healthy throughout your entire life. One concern with playing a variety sports are the common overuse injuries or even stress fractures. There are many different injuries that can come about from using the same muscles over and over, but there are ways to prevent them as well. Take a look at some of the most common overuse injuries and how you can avoid or treat them if you fall victim.

Going Farther Than You Actually Can

When it comes to a new exercise program or sports adventure, you must be realistic on what you are capable of handling. Most common injuries come about due to the inability to admit you can only go so far with your new activity. Start slow and make sure to take your time in pushing yourself. If you push yourself too far too fast you can end up with stress fractures or pulled muscles and ligaments.

Know The Correct Form

When you are learning a new sport or exercise, it is important that you use the correct form at all times. Work with a professional or seasoned trainer in the specific sport you’re trying to learn. This will help you to learn the correct form before you start making bad habits in the way you play or perform the move. Bad form can cause a variety of overuse injuries in your body when you do not learn the right way to perform the sport or move beforehand.

Preventing and Treating These Injuries

To treat an overuse injury, you want to make sure to start cutting back on the practice during your time of being injured. Be sure to warm-up properly during every exercise or workout. Ice down the injury so that you can help to reduce any inflammation that may be present and be sure to get plenty of rest. You may also find that anti-inflammatory medications will help during treatment as well.

To prevent these common overuse injuries from happening in the first place, be sure you learn the proper form before you start an exercise or program. Make sure your shoes are worn in but also offer the proper support for the activity you’re about to do. Remember you do not have to be the fastest at the program right away. Learn the proper technique from the get go and take it easy to ensure you have it right. All of these tips can help you to prevent injures such as stress fractures from happening to you and taking you out of the game.

By Cindy Soh 0 Comments General

Common Childhood Orthopedic Conditions

When it comes to your child’s growth, you may notice things from time-to-time that don’t seem quite as they should. Those could include things such as their speech, you may notice they seem to have flatfeet, or even that they suffer from knock-knees. While most often times you’ll find your children grow out of some of these concerns you have, others may not grow out of them and need assistance in handling the situation. Here are some common conditions children deal with of an orthopedic nature.

Walking on Their Toes

Most times you’ll find your toddler that is learning to walk with walk on their toes. As they get stronger and walk more consistently, this should disappear. However, if it does not and your child is over age 3, they need to see a doctor about this condition. This can cause harm to their muscles later in life if it is not dealt with at an early age.

Flatfeet That Stay

Typically, babies are born with their feet flat and develop their arches later on in life. However, there are some children who never get an arch and they still have flat feet later on. This may appear that they have weakness in their ankles due to the way their foot appears when they are standing straight up. Doctors say that most times this is not a cause for concern but in those cases where pain is involved, they may prescribe arch supports to assist in reducing the discomfort and help the foot to develop correctly.

Knock-Knees

While a lot of children do show a slight tendency towards the knock-knee condition, more often they not it is something they grow out of. However, if they do not grow out of it or one side is more pronounced than the other, you should seek medical assistance. Such items as braces or inserts in the shoes can help your child’s legs start to straighten out and reduce any pain they may be having.

Other conditions that may require a doctor’s visit include pigeon toes or children who seem to have the bowing out of their legs. In most cases all of these conditions are something your children will grow out of without any intervention. In the cases where you do need to seek intervention, the orthopedic specialists can assist you in making sure your child is comfortable and growing at the pace they should be.

By Cindy Soh 0 Comments Back Pain, General

Chronic Back Pain: Top 5 Common Misconceptions

Chronic back pain is a condition that many people go through but too often overlooked or treated with wrong methods because of common misconceptions. Like other similar medical conditions, chronic back pain should be diagnosed and can be treated and managed, as long as these mistaken beliefs are out of the way.

1) Resting in bed helps to recover from back pain.

While resting in bed for 1 to 2 days is recommended to reduce stress on the discs of the spine and lessen the pain, any longer than that would backfire on the recovery. Long hours in bed would cause an increase in pain, muscle atrophy, loss in bone mineral and a higher risk of blood clots forming due to the lack of movement.

Contrary to popular beliefs, patients with chronic back pain should not rest for too long. On the other hand, doing back exercises regularly would strengthen the muscles and speed up recovery.

2) Only painkillers can help to relief pain.

Painkillers may be prescribed to help manage the pain for daily activities. However, without proper treatment, the condition does not get better. Physical therapy like ultrasound treatment and electrotherapy can help to reduce the inflammation and joint mobilization helps to decrease tension in the muscles. Other pain management methods include having a healthy diet, a better sleep routine and exercising.

3) The pain would go away with heat and back massage.

Heat and massage would help to manage pain for the short-term. But for chronic pain, the soothing effect wears off and the pain would be just as bad as before. This method is good if you just need a quick alleviation from acute pain. However, the condition would not get any better without appropriate treatment advised by the doctor.

4) Chronic back pain is a natural occurrence of aging.

Many people live with chronic back pain undiagnosed and untreated, thinking that the symptoms are due to aging. Back pain can happen to people of any age, with or without injury. In fact, those that go through chronic back pain at a younger age tend to feel less pain when they get older with proper treatment and exercise. Even though disc degeneration occurs between ages 35 and 55, it does not necessarily come with pain. Never ignore any kind of pain or discomfort and always get it checked.

5) If I have chronic back pain, I should not exercise.

Exercising helps strengthen the back muscles, giving a stronger support for the spine. Though vigorous exercises that add pressure on the back should be avoided, regular light exercises are good for long-term recovery.

By Cindy Soh 0 Comments General, Orthopaedic Injuries, Sports Injury

Pelvis Fractures: Cause & Treatments

The pelvis consists of a series of ring-like structure of bones located at the lower end of the trunk. There are three ones supporting the side of the pelvis namely the ilium, ischium and pubis. Ligaments and tendons join the pelvis to the sacrum located at the bottom of the spine, creating a bowl-like cavity just below the rib cage. On each side is the acetabulum, a hollow cup serving as the socket for the hip joint.

Many digestive and reproductive organs are located within the pelvic ring as well as large nerves and blood vessels passing through it. The pelvis acts as an attachment point for muscles reaching into the legs up into the trunk of the body. With all these important structures running through the pelvis, a fracture can be serious and life threatening.

Causes

The group of people most susceptible to pelvis fracture are those heavily involved in sports. Very often, a muscle is pulled and these may go undetected. Such undetected pulls might be avulsion fractures of the pelvis due to sudden muscle contractions. In avulsion fracture, a small piece of bone from the ischium located at the hamstring muscles region is broken and torn away by the muscles. This fracture however do not render the pelvis unstable. Most pelvis fractures can also be caused by high impact forces such as those sustained during a motor vehicle accident or falls from great heights. Depending on the impact and height, such injuries can be deadly.

Nonsurgical treatment

Nonsurgical is usually administered for stable fractures such as the avulsion fracture mentioned above. Stable fractures will heal on their own without the need for surgery. However, the patient will need the assistance of a walking aid such as a crutch or walker for at least three months while the bones heal. To lessen pain, doctors may prescribe painkillers. Due to the significant reduced amount of movement and prolonged periods of inactivity, blood-thinners may also be prescribed to reduce the chances of blood clot formation.

Surgical treatment

Pelvis fractures resulting from trauma are life threatening due to extensive bleeding and surgery is inevitable. An external fixator may be used to stabilise the pelvic area while the surgeon performs surgery. The external fixator has long screws that are drilled into the pelvic bones.

A pelvis fracture will heal well if treatment is administered in a timely manner. Some patients may walk with a slight limp months after surgery due to damage to the muscles surrounding the nerves. However, this is only temporary. In serious cases, patients may suffer from impaired mobility or even sexual dysfunction due to damage to nerves and organs.

By Cindy Soh 0 Comments General, Spine Injury

Spinal Stenosis: Cause & Symptoms

Spinal stenosis is the result of the narrowing of free spaces in the spine. This will cause extra pressure to act onto the spinal cord and the nerves running through it. In majority of the cases, spinal stenosis affects the lumbar spine. This will eventually cause pain along the legs and make walking a difficult task to accomplish.

Causes

There are many different possible causes for spinal stenosis:

  • As we grow older, our soft connective tissues such as the tendons and ligaments will start to harden and thicken. When this happens, spurs will start to develop and some may make their way into the spinal canal. This will result in the damaging of the vertebrae and cause the facet joints to wear and tear. Eventually, this will cause the narrowing of the lower spine.
  • When one of the many vertebrae slips over another, this will cause congestion and narrow the spinal canal.
  • Spinal tumour. Spinal tumours are abnormal growth of soft tissues that will cause inflammation of the spinal canal. White blood cells will rush to the site and cause an overgrowth of new tissues. This will eventually result in the narrowing of the spinal canal.
  • Accidents especially high impact ones may shatter or dislocate the spine, causing small bones to impinge onto the canal.

Symptoms

Patients suffering from early stages of spinal stenosis often have no symptoms. Symptoms will develop slowly over time and may include:

  • Pain in the back
  • Burning pain at the buttocks
  • Numbness in the legs
  • Loss of feeling in the feet
  • Loss of sexual abilities
  • Loss of bowel or bladder control
  • Pain and weakness of legs

The pain in the legs are usually due to inefficient circulation of the blood. Leg pain will usually go away with rest but patients with spinal stenosis will get persistent leg pain despite resting. Narrowing of the spine will also cause nerve impingement, resulting in important nerves to be deprived of the abilities, leading to incontinence.

Spinal stenosis have no unique signs nor symptoms and will worsen over time. Although x-ray results look promising, there is still uncertainties. The best method to manage lumbar spinal stenosis is to understand the disease better and to strengthen the back by engaging in strengthening activities daily.

By Cindy Soh 0 Comments General , ,

Bunions: Cause & Treatments

Bunions are bony humps that form at the base of the big toe. When this happens, the big toe will curve towards the other toes and cause the base of the toe to push towards the first metatarsal bone. It usually occurs at a joint and the entire body weight will be acting on it. This will result in tremendous pain and discomfort.

Causes

As we grow and develop, more pressure is acting on the foot due to the need to support the body’s entire weight. Therefore, it gets worse as age increases. Bunions is hereditary and will run in the family due to the fact that foot type and shape is hereditary. In some cases, bunions will develop with existing medical conditions such as arthritis. Women are also at a higher risk of suffering from bunions due to the fact that most women wear tight and ill-fitting high heeled shoes, pushing the foot bone into awkward positions for long periods of time. In many cases a correction treatment may be needed if the pain persists

Non-surgical treatment

Non-surgical is targeted to reduce pressure on the big toe and provide pain relief.

  • Wearing wide and comfortable shoes with sufficient space for toes to wriggle. The insoles should also provide good arch support.
  • Custom made orthotics will help to distribute the body’s weight equally throughout the foot and reduce any unnecessary pressure acting on the big toe.
  • Pain relief medication will provide instant pain relief for patients and bring down the swelling.
  • Ice is a cheap and effective method to reduce swelling and provide pain relief.

Surgical treatment

If non-surgical treatment does not provide adequate pain relief, daily activities such as walking can be severely hindered. In such cases, surgery may be the only option left. The main aim of bunion surgery is to straighten the curved toe bone and provide pain relief.

  • Bunionectomy is a bunion specific surgery and involves removal of part of the affected metatarsal head.
  • Osteotomy involves the cutting of bones located in the toe to prevent bone spurs from sticking out and re-alignment the soft tissues around the toe joint.
  • Resection arthroplasty is reserved for more serious cases and involve the removal of bone located at the end of the first metatarsal joining the metatarsophalangeal joint.

As the saying goes, prevention is better than cure. A good pair of footwear is often all that is needed to prevent one from getting bunions. Selecting a pair of functional shoes over one that is aesthetically pleasing is a much sensible choice.

By Cindy Soh 0 Comments General

All about Electrodiagnostic Testing

Our body possess a huge ability to generate electricity and it is through this ability that allows us to achieve good health. The electricity that is generated will send important signals from all parts of the body to the brain and provides a source of instantaneous communication. These electrical signals are created by the nerves and instructions are sent to the muscles to carry them out. However, signals can easily be affected due to diseases or injuries. The presence of pain and numbness in different parts of the body can help doctors to diagnose the exact cause of injury and this is what electrodiagnostic testing is all about.

Electrodiagnosis employs the science of electrophysiology, using electrical pulses to study neurophysiology. There are two separate parts in this test: testing the nerves and testing the muscles. Both tests will evaluate the ability of both nerves and muscles to function as a single entity unit. This test will allow narrow down the list of possible causes of pain and weakness.

Nerve conduction studies (NCS)

NCS is done in conjunction with its muscle counterpart. The main purpose is to determine if a particular nerve is functioning properly. It is done by placing sensors over nerves in both the hands and legs and stimulating it with electrical pulses. Patients will experience a warm and itchy sensation similar to suffering from an ant’s bite. Through this test, doctors will be able to evaluate the performance of the nerves and to identify which nerves are not performing well. A healthy nerve will conduct electricity at an extremely fast rate up to 200km/h whereas a damaged nerve will have a much lower conduction rate.

Electromyography (EMG)

EMG on the other hand analyses the electrical activity in muscles. When a muscle is in use, it will be buzzing with electrical signals as the muscle attempts to communicate with different parts of the body. Likewise when it is not in use, it will be electrically quiet. Unlike NCS, EMG will cause slight discomfort to patients as small needles are inserted to monitor and record electrical activities. The wires will be connected to a small TV that will broadcast these electrical signals. After the test, the needles will be removed and this will cause further trauma to the area, resulting in bruises in the following days.

Electrodiagnostic tests are pretty accurate due to the advancement of medical technology and devices. However, it is only able to identify whether the nerves are functioning properly and it is unable to identify the cause of pain.

By Cindy Soh 0 Comments General , , ,

Lisfranc (Midfoot) Injury: Cause & Treatments

Lisfranc or midfoot injuries are often the results of broken bones in the midfoot or torn ligaments. Lisfranc injuries can vary from complex to simple depending on the number of joints and bones that are involved. Many patients often mistaken their midfoot injury to that of a simple sprain. As a result, many choose to self-medicate with pain relief cream. However, Lisfranc injury is not as simple as it seems and may even require surgery in some cases.

Located in the midfoot are clusters of small bones forming an arch at the top of the foot. There are five long metatarsal bones extending to the tones and ligaments and tendons hold the bones in place. However, there are no connective tissues holding the first metatarsal to the second metatarsal.

Lisfranc injuries can occur due to either direct or indirect trauma. Direct trauma is often result of an external force striking the foot while an indirect trauma occurs due to a force transferring to the stationary foot that deforms the foot. The foot is a smart system that is divided into three different sections namely the hindfoot, midfoot and forefoot. The role of the midfoot is to translate force and provide rotational stability and it is the keystone for plantar flexion and dorsiflexion. Therefore with a lack of dorsal support, the load acting on the foot is sufficient to cause dorsal displacement, leading to broken bones and/or ligaments.

The earlier a Lisfranc joint injury is diagnosed, the better it is for both patient and doctor. An initial clinical evaluation involving radiographs such as x-rays and MRI will be performed to indicate the probability of a mild, moderate or complex sprain. If diastasis is not present, immobilisation will be needed. This will include the usage of an immobilisation cast for a period of four to six weeks followed by limited movements. After six weeks, rehabilitation exercises need to start immediately. This is due to the bone being a piezoelectric material and will resorb after periods of inactivity.

If surgery is needed, it will be performed within 24 hours of the injury or after 10 days to allow for the drainage of bodily fluid due to swelling. Kirshner wires will be used to fix the bones together and bone fragments will be removed. After surgery, patients need to be immobilised in a cast for up to 12 weeks with minimal movements.

Some people will no longer be able to return to pre-injury levels of activity after a midfoot injury despite advancement in medical technology.