Chronic Musculoskeletal Pain
As well as seeing your everyday injuries we also focus on specific conditions, offering specialist, focused treatment and care for the likes of:
Frozen shoulder
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. Signs and symptoms usually begin gradually, worsen over time, and then slowly improve. Most people recover within 1 to 3 years. Keeping the shoulder immobile for a prolonged period increases the risk of developing frozen shoulder. This may occur after surgery or following an arm fracture. Symptoms Frozen shoulder typically develops in three stages: Freezing stage: Any movement of the shoulder causes pain, and the shoulder’s range of motion begins to decrease. This stage usually lasts between 2 and 9 months. Frozen stage: Pain may lessen during this stage, but the shoulder becomes increasingly stiff, making daily activities more difficult. This stage typically lasts from 4 to 12 months. Thawing stage: Shoulder movement gradually improves as stiffness decreases. This stage can last from 5 to 24 months. For some people, shoulder pain worsens at night and may disrupt sleep. Causes The shoulder joint is surrounded by a capsule of connective tissue. Frozen shoulder develops when this capsule thickens and tightens around the joint, restricting movement. The exact cause is not fully understood. However, frozen shoulder is more likely to occur after prolonged shoulder immobilization, such as following surgery or an arm fracture. Risk Factors Age 40 and older, particularly women Prolonged shoulder immobility Restricted shoulder movement may result from several conditions, including: Rotator cuff injury Arm fracture Stroke Recovery following surgery Diagnosis During a physical examination, a healthcare provider may ask you to move your arm in specific ways to assess pain and active range of motion. You may then be asked to relax your muscles while the provider moves your arm to evaluate passive range of motion. Frozen shoulder affects both active and passive movement. Frozen shoulder can often be diagnosed based on symptoms and physical examination alone. Imaging tests such as X-rays, ultrasound, or MRI may be used to rule out other shoulder conditions.
Cervical Spondylosis
Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in the neck. As the disks gradually dehydrate and shrink, signs of osteoarthritis develop, including the formation of bony projections along the edges of bones, known as bone spurs. Cervical spondylosis is very common and tends to worsen with age. More than 85% of people over the age of 60 are affected. Symptoms Symptoms of cervical spondylosis may include: Tingling, numbness, or weakness in the arms, hands, legs, or feet Lack of coordination and difficulty walking Loss of bladder or bowel control Causes As people age, the structures that make up the spine and neck gradually undergo wear and tear. These changes may include: Dehydrated disks: Spinal disks act as cushions between the vertebrae. By around age 40, most people’s disks begin to dry out and shrink, leading to increased bone-on-bone contact. Herniated disks: Cracks can develop in the outer layer of spinal disks, allowing the softer inner material to protrude. This may press on the spinal cord or nerve roots. Bone spurs: As disks deteriorate, the body may produce extra bone in an attempt to stabilize the spine. These bone spurs can narrow the spinal canal and compress nerves or the spinal cord. Stiff ligaments: Ligaments that connect bones can stiffen with age, reducing neck flexibility. Cervical spondylosis refers to degeneration of the bones and disks in the neck and can lead to conditions such as herniated disks, bone spurs, and nerve compression. Risk Factors Age: Cervical spondylosis commonly develops as part of the aging process. Occupation: Jobs involving repetitive neck movements, prolonged awkward positioning, or frequent overhead work place added stress on the neck. Previous neck injuries: Past neck trauma may increase the risk of developing cervical spondylosis. Genetic factors: Some people inherit a tendency to develop more pronounced degenerative changes. Diagnosis A healthcare provider will usually begin with a physical examination, which may include: Checking the range of motion in the neck Testing reflexes and muscle strength to assess possible nerve or spinal cord compression Observing gait to determine whether spinal compression is affecting walking Imaging Tests Neck X-ray: Can reveal changes such as bone spurs and help rule out other causes of neck pain and stiffness, including fractures, infections, or tumors. Magnetic Resonance Imaging (MRI): Uses radio waves and a strong magnetic field to produce detailed images that help identify areas where nerves may be compressed. CT myelography: Involves injecting contrast dye into the spinal canal before a CT scan, allowing clearer visualization of the spinal cord, spinal canal, and nerve roots. Nerve Function Tests Additional tests may be needed to evaluate whether nerve signals are traveling properly to the muscles.
A herniated disk
A herniated disk refers to a problem with one of the rubbery cushions, called disks, that sit between the bones of the spine, known as vertebrae. Each spinal disk has a soft, jelly-like center called the nucleus, which is surrounded by a tougher, rubbery outer layer known as the annulus. A herniated disk occurs when part of the nucleus pushes through a tear in the annulus. This condition is sometimes referred to as a slipped disk or ruptured disk. A herniated disk can occur anywhere along the spine, but it most commonly affects the lower back. Depending on its location, a herniated disk may cause pain, numbness, or weakness in an arm or leg. Symptoms Most herniated disks occur in the lower back, though they can also develop in the neck. Symptoms depend on the location of the disk and whether it is pressing on nearby nerves. Herniated disks often affect only one side of the body. Arm or leg pain Numbness or tingling: Radiating numbness or tingling may occur in the area served by the affected nerve. Weakness: Muscles supplied by the affected nerves may become weak. Causes Disk herniation most often results from gradual, age-related wear and tear known as disk degeneration. As disks age, they become less flexible and more susceptible to tearing or rupture, even with minor strain or twisting. In many cases, people cannot identify a specific cause. Improper lifting techniques—such as using the back instead of the leg and thigh muscles—can increase the risk. Twisting or turning while lifting may also contribute. Less commonly, a traumatic event such as a fall or direct blow to the back can cause a herniated disk. Risk Factors Weight: Excess body weight places additional stress on the disks in the lower back. Occupation: Physically demanding jobs that involve repetitive lifting, pulling, pushing, bending, or twisting increase the risk. Genetics: Some individuals inherit a tendency toward disk degeneration and herniation. Smoking: Smoking may reduce oxygen supply to spinal disks, causing them to deteriorate more quickly. Frequent driving: Prolonged sitting combined with vibration from a vehicle engine can place increased pressure on the spine.
Wrist pain
Wrist pain is often caused by sprains or fractures resulting from sudden injuries. However, wrist pain can also develop from long-term conditions such as repetitive stress, arthritis, or carpal tunnel syndrome. Because many different factors can lead to wrist pain, identifying the exact cause can be challenging. An accurate diagnosis is essential to ensure proper treatment and healing. Symptoms Wrist pain can vary depending on the underlying cause. For example, pain from osteoarthritis is often described as a dull, aching sensation similar to a toothache. Carpal tunnel syndrome commonly causes a pins-and-needles or tingling sensation, particularly in the thumb, index, and middle fingers, and often worsens at night. The exact location of wrist pain can also provide important clues about its cause. Causes Damage to any part of the wrist can cause pain and limit the ability to use the wrist and hand. Common causes include: Injuries Sudden impact: Wrist injuries frequently occur when a person falls onto an outstretched hand, leading to sprains, strains, or fractures. Repetitive Stress Repeated wrist movements can inflame tissues around the joints or lead to stress fractures over time. Osteoarthritis This form of arthritis develops when the cartilage that cushions the ends of bones gradually wears away. Osteoarthritis of the wrist is relatively uncommon and usually occurs in people with a history of wrist injury. Carpal Tunnel Syndrome Carpal tunnel syndrome develops when increased pressure is placed on the median nerve as it passes through the carpal tunnel on the palm side of the wrist. Diagnosis During a physical examination, a healthcare provider may: Check the wrist for tenderness, swelling, or deformity Ask you to move the wrist to assess range of motion Test grip strength and forearm strength Imaging Tests X-ray: The most commonly used test for wrist pain. X-rays use a small amount of radiation to detect fractures or signs of osteoarthritis. CT scan: Provides more detailed images of the wrist bones and can identify fractures not visible on X-rays. Magnetic Resonance Imaging (MRI): Uses radio waves and a strong magnetic field to create detailed images of bones and soft tissues. Wrist MRIs may be performed using a smaller, dedicated scanner. Ultrasound: A noninvasive test that can help evaluate tendons, ligaments, and cysts. Nerve Tests If carpal tunnel syndrome is suspected, a healthcare provider may order an electromyogram (EMG). This test measures the electrical activity of muscles and helps assess nerve function.
Scoliosis
Scoliosis is a sideways curvature of the spine that is most often diagnosed during adolescence. While scoliosis can occur in people with conditions such as cerebral palsy or muscular dystrophy, the cause of most childhood scoliosis is unknown. Children with mild scoliosis are usually monitored closely, often with periodic X-rays, to determine whether the curve is worsening. In many cases, no treatment is required. Some children may need to wear a brace to prevent the curve from progressing, while others with more severe curves may require surgery to correct the spinal alignment. Symptoms Common signs and symptoms of scoliosis include: Uneven shoulders One shoulder blade appearing more prominent than the other An uneven waist One hip positioned higher than the other One side of the rib cage protruding forward A visible prominence on one side of the back when bending forward In most cases, the spine not only curves sideways but also rotates or twists. This rotation causes the ribs or muscles on one side of the body to protrude more than those on the opposite side. Causes Less common forms of scoliosis may be caused by: Neuromuscular conditions such as cerebral palsy or muscular dystrophy Birth defects affecting spinal bone development Previous chest wall surgery during infancy Injuries to or infections of the spine Spinal cord abnormalities Risk Factors Age: Signs and symptoms usually begin during adolescence. Sex: Girls are at a higher risk of curve progression and may be more likely to require treatment. Family history: Scoliosis can run in families, although most children with scoliosis do not have a known family history of the condition. Diagnosis The healthcare team will begin by taking a detailed medical history and may ask questions about recent growth. During the physical examination, the provider may ask the child to stand and then bend forward at the waist with arms hanging loosely. This helps determine whether one side of the rib cage is more prominent than the other. A neurological examination may also be performed to assess: Muscle strength Sensation (numbness) Reflexes X-rays are used to confirm the diagnosis of scoliosis and to measure the severity of the spinal curvature.