Shoulder Pain

This deals with what is referred to as the AC joint of the shoulder or the acromioclavicular joint. The AC joint is located at the far end of the clavicle, towards the end of the shoulder. It can be seen in the picture above. When an AC joint is "separated" it means that it has been injured to some severity.

Types of AC joint injuries:

Are all separated shoulders the same?

No.... Separated shoulders are graded according to the severity of the injury and the position of the displaced bones.

Shoulder separations are graded from type I to IV though some grade it up to VI:

Type I Shoulder Separation:
- Is an injury to the capsule that surrounds the AC joint.
- The bones are not out of position
- The primary symptom is pain.
- Ligaments damage is minimal if any

Type II Shoulder Separation:
- Injury to the AC joint capsule
- Additional injury to the important ligaments that stabilizes the clavicle.
- This ligament, the coracoclavicular ligament is often partially torn.
- Symptoms include pain, decrease motion, and a possible small bump over the injury.

Type III Shoulder Separation:
- Involves the same type of injury as a type II separated shoulder
- In addition the injury is more severe and damaged.
- Ligament tearing is more severe.
- Symptoms include pain, decrease motion, and a possible small bump over the injury.

Type IV Shoulder Separation:
- Involves the same type of injury as a type II and type III separated shoulder
- In addition the injury is more severe and damaged.
- Ligament tearing is more severe and can be complete.
- Symptoms include pain, decrease motion, and a possible small bump over the injury.
- In some rare cases the clavicle is pushed behind the AC joint.
- Other times the clavicle is pushed downward

Treatment -

- Types I and II often require ice, pain medication, shoulder sling, and time
- Types II and III include those for the other types. In addition, surgery, PT and other treatments may be necessary



Shoulder Dislocation

The joint of the shoulder consists of three bones that come together at one place. The arm bone (humerus), the shoulder-blade (scapula), and the collarbone (clavicle) all meet up at the top of the shoulder.

The joint between the humerus and scapula, also called the glenohumeral joint, is a ball-and-socket joint. The ball is on the top of the humerus, and this fits into a socket of the shoulder-blade called the glenoid. This joint is effective and multidimensional as it allows the movement of shoulder though a large arc of motion.

There is no other joint in the body that allows more motion than the glenohumeral joint. Unfortunately, by allowing this wide range of motion, the shoulder is not as stable as other joints. Because of this, shoulder dislocations are not uncommon injuries.

Types

1.) Anterior

95% of all shoulder dislocations are anterior or forward.

2.) Posterior

Posterior dislocations are behind the shoulder. They are possibly due to strength imbalance of the rotator cuff muscles. Other causes include falls, sports injuries, and other. Can occur and go unnoticed in elderly patients.

3.) Inferior

Are the least likely to occur with less than 1%. This can turn into a situation with large amount of complications. Blood vessels, nerves, tendons, and ligaments can be affected.

Treatment

Reduction - a process to return the shoulder back into the correct joint.

Sling, ICE, Pain Management following Reduction

Post Reduction X-ray to ensure in the right spot

Surgery is necessary in the more severe cases or is considered when chronic shoulder dislocations occur.

Toothache - watch out

Dental pain or toothache can be so detrimental that loss of work, school or daily activity can be seen. Several causes of dental pain are seen. Pain can be in the tooth itself, the gums, surrounding soft tissue or lymph nodes. Pain has been described as constant, sharp, pulsating, deep, or intermittent.

Causes:

- Dental Cavity is the number one reason for dental pain.
- The second most common cause of pain is gum disease.
- Dental Abscess
- Dental Decay
- Sinus infection
- Temporomandibular Joint Disorder (TMJ)
- Muscle spasms
- Exposed roots

Pain can be encountered when chewing, or sleeping, with hot and/or cold contact.

Other symptoms include: swelling, bleeding, ear pain, neck pain, facial pain, redness of gums, discharge

Diagnosis

Often an appointment with a Dentist is essential to determine cause of pain.

X-rays are often essential



Treatment

- IBU
- Tylenol
- Topical ointment placed on tooth
- Antibiotics
- Fillings

Prevention

- Daily brushing of teeth
- Flossing of teeth
- Fluoride
- Limit smoking
- Teeth cleaning [every six months]

A Possible Prevention of Kidney Stone

Ever had pain so severe in your sides, flank, or your lower stomach that caused you to your knees or even unable to get out of bed. This pain can be sharp and/or burning. In addition, you may have noticed some blood in your urine. After a few days the pain may have seemed to "pass" and so did the blood.

You may have just been subject to a kidney stone. And it is exactly as it sounds; a stone forms in your kidney and either it remains in the kidney or it passes out in your urine. Many Americans each year suffer from this condition. Some are required to go to the hospital for pain medications and others have kidney stones that are so large that specific procedures are done to break the stone into smaller pieces in order for them to pass.

Kidney stones have been described as equal or worse then pregnancy. If you have never had one it would be hard to believe. But if you have experienced a kidney stone then you know exactly what I am talking about.

Often the future prevention of kidney stones is at the top of the list for discussion by patients and their providers. Often individuals are encouraged to change their diet such as caffeine, sodas, chocolates, and others.

Often discussion about the benefit of fruit juices are in the mix. The hopes is that citrus juices may protect against the formation of calcium oxalate stones. These stones are one type of stones found in kidney stones and are the most common.

But are all juices equal?

It appears that the answer is no.

Often the juice recommended is Lemonade or diluted lemon juice along with dietary changes has been
found to be helpful.

But a study by the "National Institutes of Health" compared lemonade with Orange juice and it found that orange juice decrease levels of stones more efficiently then lemonade.

Other juices such as Apple and Cranberry did well with certain stones and bad for others. These two juices actually raised the risk for calcium stones but helped with the less common brushite stones.

Grapefruit juice appeared to fail completely and raised the risk of all stones.

Finally

Therefore a couple essential things have been noted. First, dietary changes are essential. Second, knowing the type of stone can be helpful. Third, try to avoid grapefruit juice if you are at risk for kidney stones.

Lastly, some individuals will only have one stone and they will be done. Others, despite the attempts at modifying diet will always be at risk. Drinking fruit juices my help reduce that risk but it doesn't mean that you won't ever have kidney stones again.