Corticosteroid injections, sometimes called Cortisone, are often employed to reduce inflammation and pain following an injury, or in the degenerative conditions of arthritis or carpal tunnel syndrome. It is best to consult with a doctor who specializes in the area needing treatment. In the case of the hands and arms, a hand specialist should perform the injection. For the foot, ankle and lower extremities, a podiatrist should be consulted.
In the case of injury or degeneration in the hands or wrists, corticosteroid injections are just one part of an overall plan to return the patient to full health and mobility. Hand exercises, hot and cold modalities and massage therapy may also be employed by the team of hand therapists at Midwest Hand Therapy.
Here is a step by step description of what you can expect from a corticosteroid injection procedure:
The patient will be placed in a comfortable position, so that the area requiring the injection is readily accessible to the doctor.
The injection site will be disinfected with alcohol or iodine.
The patient will be encouraged to relax. If the muscles around the joint are relaxed, the injection will glide more smoothly and with less resistance and discomfort.
If ultrasound is being used, a gel will be applied near the injection site, and a technician will gently press an ultrasound transducer against the skin to show an image of the joint space.
If the affected joint or bursa contains excess fluid, the doctor may gently draw off the fluid with a needle and syringe. This is known as joint aspiration or arthrocentisis.
The doctor will then inject a small amount of cortisone into the joint; the cortisone may be mixed with an anesthetic such as lidocaine or bupivacaine. The patient may notice a pinching or a burning sensation.
The injection area will then be cleaned and bandaged, and the patient may be asked to flex the joint several times to help distribute the medication.
Usually patients wait about 30 minutes in the doctor’s waiting room, following this procedure, just to insure they have no unusually severe pain or an allergic reaction to the medication.
These injections can be helpful in reducing inflammation and its associated pain over varying periods, depending on the individual. Frequently the pain is reduced for several weeks or even months, allowing the patient to participate in therapy to strengthen and elongate the muscles and tendons around the joint, to help resolve the issue.
If someone you know is struggling with pain, swelling, tenderness or tingling in the fingers, hands, wrists or elbows, contact Dr. Rehman today. She specializes in injuries and conditions of the upper extremities, and will perform an in-depth analysis of the cause of the condition. Utilizing state-of-the-art technology, she will design a comprehensive program of therapy to return the affected area to full strength and mobility.
Arthritis is inflammation in the joints. Most joints in the body have the potential to develop arthritis, which causes swelling, stiffness, pain, a reduction in mobility of the joint, and sometimes deformity.
There are generally two types of arthritis: osteoarthritis and rheumatoid arthritis. Osteoarthritis is the more common, and tends to worsen over time. It can be the result of a traumatic injury or a defect in the cartilage; the smooth white tissue that cushions bones in the joint where they come together. Osteoarthritis affects the large weight-bearing joints in the body, such as the knees, hips, shoulder and spine, but it can also affect the small joints of the hand, most commonly the thumb. Gripping, grasping or pinching objects may become painful with this condition.
Rheumatoid arthritis is a chronic disorder that can affect any part of the body, including large or small joints, the heart, circulatory system, the lungs, the muscles used for breathing and even the digestive system.
Oftentimes joint replacement surgery is recommended if the condition becomes too painful, and interferes with the activities of daily living or the patient’s occupation. But prior to that, there are steps you can take to make your daily life more comfortable if you have arthritis.
To reduce pressure in your hands when holding or gripping objects:
Wrap foam, cloth or tape around the handles of everyday objects like knives, pots and pans, to cushion the grip. Look for household or gardening tools with larger, ergonomically-designed handles. These are available in many retail stores. Keep a pair of gardening gloves with rubberized palms in the kitchen, to help grip and hold, and use common tools like jar openers to help with household tasks.
To reduce pain or pressure before or after activities, and while sleeping:
Apply either heat or cold to the affected joints before and after activities, and before bed. Elevate and support your arms and legs on pillows when sleeping.
Reduce pain and stress on your joints:
Use carts or carriers with wheels to move heavy items like garbage bags, laundry, or grocery bags, so you don’t need to lift them. Replace round doorknobs with lever-style handles.
An entire profession, known as Occupational Therapy, is devoted to helping people with disability issues perform their jobs and household tasks more easily. They can recommend personalized adaptive equipment that will put less weight on the joints. They can also instruct patients on how to use compression garments and thermal agents (heat and cold), and can make custom splints to support or properly position your joints during activities or while sleeping. These professionals can evaluate your home environment and suggest changes or modifications that will make it easier for you to perform your activities. They can also address both the physical and emotional effects of arthritis. They can recommend therapeutic exercises and activities designed to decrease stiffness and improve endurance and strength. And they can address the emotional stress that results from lack of sleep or being in constant chronic pain.
If someone you know is struggling with arthritis, or numbness, tingling or pain in the hands, wrists, elbows or shoulders, contact Dr. Rehman and her team of Occupational Therapists today for help! Dr. Rehman is a specially-trained orthopedic doctor who specializes in conditions and injuries affecting the upper body. She will conduct a thorough evaluation and design a comprehensive, individualized treatment program to correct the problem and return the affected area to health, strength and full range of mobility.
Call Dr. Rehman and her team today for more information: 586-532-0803
The golfing season will soon be here, and most devotees are dying to get out on the links in the fresh air and sunshine of a fine Michigan spring.
What can you do to prepare yourself for the activities ahead?
Hopefully, you have not taken the whole fall and winter off being a couch potato! Golf is a rigorous, demanding sport, and proper conditioning will not only help your game, it will help you avoid injuries as well.
First, evaluate where you are now
You should be able to move fluidly, without pain or stiffness. You should also be able to perform the basics of strength conditioning: squatting, hinging, pressing, pulling, planking, jumping and throwing. Even though these moves seem unrelated to golf, they are essential for a powerful swing with maximum force, and to protect you from injury.
Before you head out to play, incorporate dynamic activities that get your body moving, your heart beating faster, and your muscles warmed up. Consider brisk walking, jumping rope and/or doing jumping jacks to fire up the system. Dynamic stretches, incorporating movement of the shoulders, arms, hands and wrists are also helpful to reduce the chance of injury.
If you begin to notice pain
On the bony bump on the inner side of the elbow, this could indicate the condition of golfer’s elbow, also known medial epicondylitis. The elbow joint is comprised of the bone in the upper arm (the humerus) and one of the bones in the lower arm (the ulna), joined together by forearm muscles and tendons. The bony bumps at the bottom of the humerus are called epicondyles. The bump on the inside of the elbow is called the medial epicondyle. The tendons of the muscles that work to bend your wrist attach at the medial epicondyle. Medial epicondylitis may also be referred to as wrist flexor tendonitis.
What causes it?
An overuse of the muscles that allow you to bend your fingers and wrist causes this condition. When these muscles are overused, the tendons are repeatedly tugged at their point of attachment, which is the medial epicondyle. As a result, the tendons become inflamed (tendonitis) and repeated, tiny tears cause pain. This is a common injury in sports such as golf, in throwing sports, and in racquet sports. It also may happen in occupational activities such as carpentry or data entry.
What are the symptoms?
Pain in the bony bump of the elbow on the side closest to the body is the most obvious indicator of this condition. The pain may also radiate along the entire inner side of the forearm when the wrist is bent. You may also notice pain when you make a fist.
How is it diagnosed?
A doctor who specializes in the hands, wrists and shoulders is the best person to diagnose this condition. He or she will examine your elbow and discuss your activities and occupation to make the diagnosis.
What is the treatment?
Ice packs applied to the elbow for 20 to 30 minutes, 3 to 4 times per day should be continued for 2 to 3 days, or until the pain goes away. If the elbow is swollen, you should elevate it on a pillow when lying down, or on the back of a chair or the couch when sitting up. You may be given an elastic bandage to wrap around your elbow to keep the swelling down.
While recovering from such an injury, you will need to change to a different sport or activity. The doctor may also prescribe a tennis elbow strap for you to wear just below the tender spot on the elbow. This will allow the forearm muscles to pull against the strap instead of against the tender area of your elbow.
Your doctor may also prescribe oral anti-inflammatory drugs, or give you an injection of corticosteroid medication around the injured area, to reduce inflammation. Exercises to regain range of motion and strength will also be prescribed. In severe cases of medial epicondylitis, surgery may be required.
When can I return to my activity or sport?
In general, the longer you have symptoms before you begin rehabilitation, the longer the time period of recovery. Returning to your sport or activity will be determined by your rate of healing, rather than a set number of days or weeks. Continuing to perform the activity while the arm is injured could cause permanent damage. Dedication to executing the exercises, and performing them with the correct form, will also positively influence the rate of healing. The goal of rehabilitation is to get you back to full function as soon as it is safe for you to do so.
When you can forcefully grip your tennis racquet, bat or golf club, or type on a keyboard painlessly, it is safe to return to the activity. In the case of an injury in gymnastics, it is imperative that you can bear weight on the elbow painlessly; that there is no swelling at the elbow and that your strength and range of motion in the injured elbow is equal to the uninjured one.
How can it be prevented?
Medial epicondylitis occurs due to overuse of the muscles that bend your wrist. Avoidance of this overuse is the best prevention. At the earliest signs of pain on the inner side of your elbow, slow down your activity and seek treatment. Wearing a tennis elbow strap and doing elbow stretching exercises will help you prevent medial epicondylitis.
If you or someone you love is experiencing pain in the hands, wrists, arms, elbow or shoulder, contact Dr. Rehman’s office today. She will conduct a thorough evaluation to determine the exact cause of the problem, and will begin with the least invasive treatment possible. Her team of experienced hand therapists will guide you in your recovery so you can regain full strength and range of motion in the affected area. Call Dr. Rehman today for more information at 586-532-0803.
It’s an odd feeling, and one that can be bothersome and problematic. Your hands and fingers may tingle, or you may notice numbness in one of the joints of your fingers or in your thumb.
Some of the more common causes of this condition are:
Carpal Tunnel Syndrome
The carpal tunnel is a narrow passageway located on the palm side of your wrist. A main nerve to your hand runs through this tunnel, as do the nine tendons that bend your fingers. Compression of the nerve causes the numbness, tingling, and eventual weakening of the hand itself. Sometimes this compression is the result of repetitive motion activities. But there may be a genetic predisposition to the condition as well. For some people, the carpal tunnel is narrower and more at risk for irritation of the nerve running through it.
Trigger Finger or Trigger Thumb
In this situation, numbness, tingling or weakness in the hand may be noticed. Typically the result of overuse injuries, trigger finger or thumb affects women more often than men, and is often associated with people who have diabetes. The affected appendage will “snap back” into place like a trigger releasing. Inflammation of the tendon in the affected appendage is the culprit here, and if the condition is severe, the finger or thumb may be locked into a bent position. People whose work or hobbies require repeated gripping actions are at higher risk of developing trigger finger or trigger thumb.
Tendonitis
Tendons are the thick cords in the body that attach the muscles to the bones. If tingling in the hands or fingers is present, or a burning sensation is noted, tendons in the wrist or near the hand may be irritated, inflamed or swollen. This can be the result of a repetitive motion injury, or it could be an acute injury such as occurs in sports. Tendons become less elastic as we age, and damage can occur more easily.
If you are experiencing numbness or tingling in your hands and fingers, contact a Board Certified osteopathic doctor for a complete evaluation. Many of the conditions described above can be treated with minimally invasive procedures such as rest, applying cold packs, anti-inflammatory medication and sometimes corticosteroid injections.
Dr. Rehman has a team of hand therapists who will design a program of hand and wrist exercises and occupational therapy to return your affected appendage to full function and strength. Dr. Rehman is a hand surgeon who specializes in conditions and injuries to the upper body. If the minimally invasive procedures don’t provide relief, surgery may be considered. The hand and wrist are delicate structures, and it is best to have a specialist who is trained and experienced in the hand and wrist to insure a good outcome and a full recovery.
Our hands and wrists are ultra-sensitive structures, and they can be easily damaged, resulting in pain, tingling, stiffness, weakness, numbness and swelling. The causes of these myriad symptoms may be obesity, which puts pressure on the tendons and ligaments, and the channels through which they run, or other factors such as an injury, stress or overuse. Arthritis can play a role in tendon and nerve damage, as can diabetes.
Tendon and nerve damage can often be reversed and healed if proper treatment is sought early on. Non-invasive methods will often result in success, thereby avoiding more invasive procedures.
Some of the more common approaches are:
Activity modification
The application of ice and rest
Anti-inflammatory medications
Steroidal injections
Splinting or immobilizing the area
Specialized exercises to strengthen or stretch the area
Being aware of the overuse of your hands and wrists, and warming them up before sports or repetitive activities can help avoid damage to tendons and nerves. If you work at a computer for long hours, keep your posture erect and your wrists straight, using an ergonomic keyboard or even splints. If you perform other repetitive tasks with your hands, take a break every hour and do the following:
Rest your forearms on the edge of your table or desk and bend your wrists and fingers back toward you; hold for 5 seconds.
Gently press your hand against your table or desk, spreading the fingers, and hold for 5 seconds.
Clench your fists tightly, hold for 5 seconds, then release, fanning out the fingers. Do this 5 times.
If pain, numbness, tingling, warmth or stiffness are present in your hands, wrists, arms, elbow or shoulder, seek out an experienced, Board Certified osteopathic doctor such as Dr. Rehman for a thorough work-up and a comprehensive treatment plan. The sooner you start, the more likely you will be to achieve healing and freedom from unpleasant feelings in your hands and joints.
These terms can be easily confused when discussing conditions or injuries to the body. First remember: both tendons and ligaments are part of the musculoskeletal system, comprised of all the bones, muscles and connective tissues in your body.Tendons and ligaments are two types of connective tissues; they are both comprised of dense layers of collagen fibers.
Ligaments attach bones to bones
Tendons attach muscles to bones
Ligaments are the connectors, linking bones together at the various joints throughout the body. They allow for all the range of motion that joints can perform. Just look at the amazing variety of movements your hand and fingers and wrist can do. The ligaments in your body support, strengthen and stabilize the joints.
Tendons are the connectors that allow your muscles to be attached to the bones of your body. They aid in the overall movement of your body by transmitting force from the muscle to the bone. They vary greatly in size and shape, depending on the size of the muscle and the size of the bone to which it is attached.
Both tendons and ligaments are very sturdy for the most part, but excessive pressure, forceful trauma or even repetitious movements can cause damage and injury to these important structures.
Pain is the number one signal that a problem is occurring in the tendons or ligaments of the body. Other conditions that can also be present are redness, heat and/or swelling. If you are experiencing chronic or acute pain in the joints of your body, seek treatment from a board certified osteopathic doctor such as Dr. Rehman. A thorough evaluation will be conducted, and a multi-modality treatment program may be recommended to help you get back to living an active, pain-free life.
Pain that is localized to the base of the thumb may indicate the presence of this condition. Often, everyday activities such as opening a jar lid, grasping a large object or sometimes even turning a doorknob can become painful. As the condition progresses, pain may become constant. The individual may not be able to move their thumb away from the hand to grasp large objects; they may even lose the function of the hand.
Sometimes as we age, cartilage wears away from the ends of the bones that form the thumb joint. Cartilage functions as a cushion for joints, and when it is missing, pain is usually the result.
A thorough examination by an osteopathic specialist is required to make a firm diagnosis of Basal Thumb Arthritis. Following that, a variety of non-invasive approaches may be used to treat the condition. Activities may be modified, the hand may need periods of rest, nonsteroidal anti-inflammatory drugs can be useful, specialized exercises may be prescribed and even splinting may be used. Sometimes an injection of Corticosteroid may be required; pain relief may last from several days to several months with this treatment.
While most often the treatments discussed above are successful, occasionally surgery is required if these methods fail or if the condition is very advanced.
If you are experiencing pain in or around the thumb area, contact Dr. Rehman for a full and thorough evaluation. The correct diagnosis, followed by a treatment plan that includes multiple modalities will yield the most effective and successful outcome.
The “bursa” are small, fluid-filled sacs that act as cushions between the various moving parts of the body, in particular the joints. “Bursitis” is a condition where these sacs become inflamed, either from an injury, or over-use, or in some cases, an infection.
Areas of the body that are commonly afflicted are the knees and the elbow. Sitting with your elbows on a hard surface for long periods of time, or kneeling for extended periods can cause an inflammation of the bursa. Likewise, doing repetitive movements that involve these joints over a period of time can result in the inflammation of the bursa.
Pain and swelling are the most common indicators of bursitis. An experienced orthopedic doctor will do a thorough evaluation including a physical exam, and may use X-rays or an MRI to understand the root cause of the problem. It is important to rule out the possibility of infection in the bursa, as swelling from an injury or swelling due to an infection (called “septic bursitis”) require different treatment approaches.
If the swelling is caused by an injury or over-use, the treatment may include rest of the affected area, pain medications and ice. If no improvement is noted, an injection into the area around the bursa may improve recovery. If, after 6 to 12 months the problem persists, surgery may be required to alleviate the pressure on the bursa.
If the doctor determines the bursitis is caused by an infection, some of the same steps may be taken, with antibiotics added to insure the reduction of the infection.
If you are experiencing pain in the elbow or the knee joints, seek the help of a Board Certified Orthopedic doctor such as Dr. Rehman for a complete evaluation of your condition. She and her team of therapists have extensive experience in rehabilitating conditions such as bursitis, so you can return to the full and active lifestyle you love.
serving Detroit,Troy, Southfield, Warren, Rochester Hills, Sterling Heights,
Macomb Township, Shelby Township, Utica, Washington MI, Bloomfield Hills, Lake Orion, Clarkston, White Lake, Waterford,
Commerce Township, Mount Clemens, Clinton Township, Chesterfield, Harrison Township, Pontiac,
Center Line, Fraser, Roseville, Clawson, and all the surrounding areas
