What is De Quervain’s Tenosynovitis?

De Quervain’s Tenosynovitis is a painful condition that affects two tendons on the thumb-side of the wrist. These tendons are responsible for moving the thumb sideways and backwards and sometimes become trapped as they pass through a small tunnel between the wrist and the thumb.

These tendons respond poorly to the extra compression and become sore to move and tender to touch. In some circumstances, the thickened, inflamed tissues may develop adhesions, or scarring, restricting movement of the thumb.

This condition affects many people, typically between the ages of 30 and 50. Women are affected 10 times more than men. Those affected include sportspeople who use rackets, bowlers, rowers, golfers, and canoeists. Manual labourers who perform repetitive duties are also commonly affected. De Quervain’s tenosynovitis is caused by a combination of overuse and overload factors.

Hormones during pregnancy can also contribute as they sometimes cause tendon swelling. New mothers often develop this condition while holding their newborn to breastfeed.

What are the signs and symptoms of De Quervain’s Tenosynovitis?

The hallmark symptoms of De Quervain’s Tenosynovitis are pain and swelling at the base of the thumb. These may develop suddenly, or over a period of time. The symptoms are made worse by activities requiring forceful gripping, pinching between the thumb and another finger, movement of the thumb, as well as twisting of the wrist.

To diagnose this condition, your physiotherapist will perform a Finkelstein’s test. This involves creating a fist with the hand, then tilting the hand away from the thumb. A positive result is pain on the thumb side of the wrist.

How can physio help?

Your physiotherapist is trained to effectively assess the condition and begin your rehabilitation. In most cases, you will be managed alongside a doctor as well. Typically, you will be immobilized in a splint for 3-4 weeks, which allows the inflamed tissues to rest and heal.

Hormones during pregnancy can also contribute as they sometimes cause tendon swelling. New mothers often develop this condition while holding their newborn to breastfeed.

What are the signs and symptoms of De Quervain’s Tenosynovitis?

The hallmark symptoms of De Quervain’s Tenosynovitis are pain and swelling at the base of the thumb. These may develop suddenly, or over a period of time. The symptoms are made worse by activities requiring forceful gripping, pinching between the thumb and another finger, movement of the thumb, as well as twisting of the wrist.

To diagnose this condition, your physiotherapist will perform a Finkelstein’s test. This involves creating a fist with the hand, then tilting the hand away from the thumb. A positive result is pain on the thumb side of the wrist.

How can physio help?

Your physiotherapist is trained to effectively assess the condition and begin your rehabilitation. In most cases, you will be managed alongside a doctor as well. Typically, you will be immobilized in a splint for 3-4 weeks, which allows the inflamed tissues to rest and heal.

In severe cases your doctor may request a corticosteroid injection to assist the inflamed tissues to heal. Following splinting your physio can help with other treatments including electrotherapies (ultrasound, TENS or interferential therapy), stretching, and a graduated strengthening program.

Other methods of treatment to improve function of the thumb and wrist include increasing grip size on objects (pens, steering wheel), improving mechanics of the hand in sports, and altering hand and arm position when cradling bub for breastfeeding.

If symptoms persist at 3 months, your physio and doctor can assist you in deciding if surgery is indicated. None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

WHAT IS IT?

Carpal Tunnel syndrome is a progressive disorder caused by compression of a key nerve in the wrist. The carpal tunnel refers to a space or “tunnel’ at the front of the wrist where tendons and nerves pass from the wrist to the hand. The median nerve is most commonly affected. This nerve controls sensation to the palm, side of the thumb and fingers, (excluding the little finger). The median nerve also sends impulses to some of the small muscles that allow the fingers and thumb to move.

SIGNS AND SYMPTOMS

Symptoms usually begin gradually with frequent burning, tingling or itching/numbness in the palm of the hand and fingers, especially the thumb, index and middle fingers. Your fingers may feel fat and swollen, even if they aren’t. Symptoms are often relieved by shaking of the wrists, even if only temporarily.

These symptoms may show up during the night as many people sleep with their wrists bent. Gradually, tingling symptoms may increase and grip strength may begin to weaken, which can affect your ability to form a fist, grasp small objects or perform other manual tasks. Left untreated, carpal tunnel syndrome can result in permanent nerve damage.

WHAT CAUSES CARPAL TUNNEL SYNDROME

Because this tunnel is made from the ligaments and bones of the hand, it is quite rigid, and any thing that causes the narrow space to be taken up can compress the structures that sit within. Often the tendons that pass through the carpal tunnel will become thickened or swollen through overuse, resulting in compression of the median nerve. People who suffer from thyroid or pituitary disorders, rheumatoid arthritis, diabetes, wrist dysfunction, work related stress or use of vibrating tools are more likely to develop this disorder.

Women are three times as likely to develop carpal tunnel syndrome as men, this is thought to be due to smaller wrist dimensions.

HOW CAN PHYSIOTHERAPY HELP?

Your physiotherapist or doctor can diagnose carpal tunnel syndrome with specific tests. Neck pathology can mimic carpal tunnel syndrome and it is important that a correct diagnosis is made. In many cases, symptoms can be resolved with physiotherapy, where you will be advised of rest, wrist splinting, exercises, manual therapy, dry needling and postural changes to prevent further injury.

Physiotherapy treatment is almost always recommended before considering other treatments such as surgical release or cortisone injection and is often very effective, particularly in mild and moderate cases. For more information, don’t hesitate to ask your physiotherapist.

Vertigo, the feeling that you are moving even though you aren’t, is an unpleasant yet common experience caused by a variety of conditions. It may surprise you to learn that in some cases your physiotherapist is actually able to treat vertigo.

Our brain’s ability to tell if we are moving or still is a complex process involving many different parts of the nervous system. The inner ear plays a very important role, with 3 semi-circular canals being responsible for gathering information about head movement. The vestibulocochlear nerve (remember that for quiz nights!) relays that information back to the brain where it is processed. Certain conditions can interrupt the smooth transition of that message, causing the brain to perceive movement when there is none. Physiotherapists may be able to help with a certain kind of vertigo called Benign Paroxysmal Positional Vertigo.

Commonly referred to as BPPV or positional vertigo, sufferers will only feel dizzy when their head moves in certain positions or directions. Most people complain of dizziness and nausea when rolling over in bed or when looking upwards. Other symptoms may include disturbance of balance and lightheadedness. BPPV can occur for no reason, however it has been noticed more commonly following a recent head trauma, previous bouts of vertigo, recent respiratory infections or recent travel on an airplane. All of these conditions have the ability to disrupt the inner ear’s normal function.

The odd symptom pattern of BPPV can be explained by a disruption in the signal sent by the semicircular canals off the inner ear to the brain.

Each of the three canals is positioned in a different direction and filled with fluid. As your head moves, the fluid in each of the canals moves slightly differently depending on the orientation of your head. Receptors are able to pick up that movement direction and speed, sending that message to the brain.

Sometimes, small calcium crystals, which typically form and reside in the space where all three semi-circular canals meet, called the utricle, escape and become lodged within the semi-circular canals. This causes disruption to the free-flowing fluid, and obscures the messages being sent to the brain.

If your doctor has diagnosed you with BPPV, they or your physiotherapist will be able to show you a series of movements, which can be done to assist in dislodging and moving the calcium crystals away from the semi-circular canal. You may be asked to perform exercises to keep the crystals from returning as well. In most instances, only one or two treatments are required for resolution of symptoms, however some cases require more.

If you think you have vertigo, it is necessary to be assessed by a medical professional, as your symptoms may be caused by any number of conditions and require correct diagnosis prior to treatment.

Most people experience joint pain at some point in their lives, and many will assume that their joint pain is arthritis-related, especially as they get older. But what is arthritis? How do medical professionals determine if the condition of “joint pain” is truly arthritis? You may be surprised to learn that there are multiple types of arthritis with different symptoms, causes and treatments. Below we describe four of the most common types.

1. Osteoarthritis is defined as the degeneration of the cartilage and underlying bone of joints due to abnormal wear and tear. This leads to pain, stiffness, formation of bony spurs and clicking or grating sensations. Symptoms occur most often in the lower back, hips, knees and even the hands.

While osteoarthritis and degeneration will occur in most people as they grow older, it can be made worse by poor posture, increased weight, abnormal biomechanics and poor nutrition. Doctors can diagnose most cases of osteoarthritis based on symptom history, and may request X-rays for confirmation. Osteoarthritis is a degenerative condition, meaning it will become progressively worse over time.

2. Rheumatoid arthritis belongs to the autoimmune classification of diseases, which is where the immune system becomes confused and attacks normal tissues in the body. The body mistakenly mounts an inflammatory reaction around the joint capsule, which over time leads to destruction and deformity.

Usually many joints are affected, particularly small joints in the hands and feet and around the lower back. While it is characterized by periods of exacerbation and relief, ultimately this is a progressive disease that will become worse over time.

With this type of arthritis the pain may actually get worse as you rest due to the build-up of inflammation. Blood tests and x-rays can help doctors to diagnose the condition, and treatment by a rheumatologist is central to management.

3. Gout is caused by excess build-up of uric acid within the blood stream. The uric acid forms urate crystals, which accumulate within the joint spaces, causing pain and inflammation. Excess uric acid is associated with a diet rich in meat, seafood, fructose and alcohol, as well as other factors including obesity, metabolic medical conditions, family history, and increased age. Historically known as “Rich man’s disease”, gout is also associated with kidney stones and management includes changing your diet to lower uric acid levels.

4. Psoriatic arthritis is an arthritis that visibly affects the skin as well as underlying joints. People tend to report symptoms such as red, white or silvery patches of dry skin, pain or discomfort in the skin, or pain in the underlying joints. The dry skin may appear on the knees, elbows, scalp, hands and feet, or on the spine. Factors that can make the symptoms of psoriasis worse include stress or anxiety, medications, exposure to excessive sunlight, smoking and alcohol, or injury to the skin.

If you suffer from arthritis, contact your GP and friendly physio for advice and proper assessment. They will help to guide your exercise journey and assist with other pain management strategies, helping to keep you active and healthy. Activities such as hydrotherapy, Pilates, and stretching have their place in maintaining correct posture and strengthening muscles appropriately to protect the body in areas of pain.

The above advice does not take the place of proper medical consultation. If you think you may have an arthritic condition, it is advisable to seek professional medical advice for the correct treatment.

What is Hip Osteoarthritis and how does it occur?

Hip osteoarthritis (also called Degenerative arthritis of the Hip) is one of the most common types of osteoarthritis. Osteoarthritis occurs as the cartilage of a joint, a soft tissue that provides cushioning and a smooth surface for joint movement, begins to degrade due to wear and tear caused by mechanical stress. As the cartilage breaks down and is worn away, the joint begins to function abnormally and small bony deposits can form around the joint. As this process progresses, movement of the joint begins to be painful and can eventually lead to significant disability.

As we age, our cartilage often loses quality and elasticity - resulting in an increased likelihood of degeneration as we age, however osteoarthritis is not limited to the elderly and many young people are affected, although much less frequently.

While there is no single identified cause for osteoarthritis, there are known risk factors that make a person more likely to develop the condition.

These risk factors are increasing age, a family history of osteoarthritis, previous injury to the hip joint, obesity, improper formation of the hip joint at birth (a condition known as developmental dysplasia of the hip), genetic defects in the cartilage and, activities that put extra stress on the hips.

What are the signs and symptoms?

The most common symptom is pain, followed closely by joint stiffness. The location of arthritic pain is usually around the hip joint but it can also appear in the groin, buttocks, thigh or knee. Other symptoms include a grating or cracking sensation with joint movement, tenderness around the joint, and swelling.

Pain is most noticeable with weight-bearing activities such as walking, running or negotiating stairs. After a period of prolonged rest, the arthritic joint will often feel quite stiff. This can be particularly noticeable in the morning with many people reporting feeling stiff for 15-20 minutes after waking.

In osteoarthritis, complete elimination of pain is not always a possibility as physiotherapy is not able to change the structure of an arthritic joint, however it can assist in improving the function and strength of the surrounding muscles, which often contribute to pain.

How can physiotherapy help?

Physiotherapy management for osteoarthritis of the hip will usually include stretching, exercises and joint mobilization to increase the joint's mobility, as well as resistive exercise to the muscles surrounding the hip, allowing them to better support the joint.

Many other factors can help with arthritic symptoms such as appropriate rest, weight loss, physical activity and environment modification, mobility aids and NSAIDS. For many people the best course of action is a surgical joint replacement, which can have great outcomes when coupled with effective preparation and rehabilitation.

What Is It?

Achilles tendinosis is an overuse injury of the Achilles tendon, most commonly affecting runners between 30 to 40 years of age.

The term tendonitis is often used in place of tendinosis, however this is not strictly accurate as most terms that use ‘-itis’ describes an inflammatory condition and inflammation has been shown to be largely absent in tendon overuse injuries.

Tendinosis is instead due to repeated microtrauma as heavy, sudden or repetitive loads are applied. Tendon tissue typically has poor blood supply which means it is often unable to heal adequately before the trauma is applied again, resulting in a damaging cycle that eventually leads to the breakdown of collagen fibers. It is these fibers that provide a tendon with most of its strength and flexibility. The end result is a degenerating tendon containing damaged and disorganized collagen fibers. As the tendon degenerates it is able to support increasingly smaller loads, adding to the cycle of damage and degeneration.

Tendinosis can be a difficult condition to treat and can take anywhere between six weeks to six months to resolve. Untreated tendinosis can even increase the risk of tears and complete rupture of the Achilles tendon. To aid in treatment, the condition is often classified as either acute or chronic depending on the duration of symptoms, and insertional or non-insertional depending on location.

What are the symptoms?

Pain, stiffness and weakness are the primary symptoms of tendinosis, with many people experiencing intense pain when they take their first steps out of bed in the morning. Many people notice swelling and thickening over the tendon, which may be tender to touch. More chronic conditions will give a ‘creaking/cracking’ sensation when the affected area is pressed.

Typically these symptoms will begin gradually with the onset of exercise or activity and fade as the exercise progresses. As the condition progresses the pain will become more constant, last longer and be triggered by lighter stress. It is important to note that tendinosis can be asymptomatic, only becoming painful when the condition is already quite advanced.

How can physio help?

Physiotherapy treatment for tendinosis is targeted towards breaking the cycle of injury and stimulating healthy collagen production. This means identifying factors what increase tendon stress, such as training errors, biomechanical faults and poor footwear, while prescribing appropriate rest from activity. There are many manual treatments which have been shown to be very effective along with a specific exercise program involving eccentric exercises. Ultrasound, extracorporeal shockwave therapy and dry needling are helpful treatments that may also be used.

For more information, don’t hesitate to ask your treating physiotherapist.

For someone suffering from pain, to be told “It’s all in your head” can be a frustrating experience. What many people don’t understand is that pain is a complex process and the mind plays a role in the perception of pain for everyone.

All pain, no matter the cause, must be recognized by the brain and processed for you to be aware of it. Pain is actually an important part of human survival, letting you know which activities are dangerous and encouraging you to rest and in many cases to protect damaged tissue. When the body loses the ability to perceive pain, this can lead to further injury and even death.

There is a famous condition where people don’t feel any pain at all, known as “congenital analgesia”. This is actually a very dangerous condition and these people are at risk of dying young. They have no warning system letting them know that they need to seek treatment. It can be hard to get your head around the idea that pain helps you survive, but it really is an important strategy of our bodies to keep us protected.

Pain isn’t always associated with tissue damage.

Even though pain is an important part of human survival, sometimes things go wrong. A famous example of this is phantom limb pain, where amputees continue to have severe pain, sometimes for decades after the limb has been removed.

Sometimes pain can even be felt on the injured side when looking at a mirror image of their uninjured limb moving.

The amount of attention you give to pain and how you feel about it will also change how severely you experience that pain.

Have you ever noticed a bruise and couldn’t remember how you got it? That is an experience of tissue damage without much pain. On the flip side, if you have suffered recent emotional trauma or are grieving you might find a small injury very difficult to deal with. Some people believe the best way to deal with pain is to ignore it and push through with all activities. Other people believe that the best treatment for all pain is to rest and stop all activities.

What you believe about pain and how you react to it can have a big effect on how your brain interprets pain signals. Feeling in control of your pain is also very important. For people who are experiencing pain for long periods of time without any way to reduce symptoms this can be very distressing, particularly if this pain is impacting their ability to participate in activities.

Your physiotherapist is trained to help you deal with pain in the best way possible. This may involve counselling and education about how to deal with your pain and not just physical treatment of your injury. Don’t hesitate to ask us more next time you come in.

Cauda equina syndrome is a rare condition that you may not have heard of, however it can have catastrophic consequences if it is not recognized and treated quickly. This condition occurs in about two percent of cases of herniated lumbar discs, causing loss of lower leg function, incontinence and lower back pain. It is one of the few medical emergencies related to back pain and can be devastating if symptoms persist.

WHAT CAUSES CAUDA EQUINA SYNDROME?

At the end of the spinal cord there is an area of spinal nerves arranged together in a bundle that looks a little like a horses tail. (In Latin horses tail is cauda equina). These nerves are encased in the spine at the lumbar region.

If for some reason these nerves are compressed, nerve signals to the bowel, bladder and lower extremities can become disrupted. Left untreated, this compression can cause permanent paraplegia and incontinence.

Common causes of compression are disc herniation associated with disc degeneration, tumours, inflammatory disorders, spinal stenosis or complications from surgery. Trauma-related cauda equina syndrome from knife wounds or motor vehicle accidents can affect people of all ages.

SIGNS AND SYMPTOMS

This disease is difficult to diagnose because its symptoms mimic many other conditions. However, there are a few symptoms that health professionals know to take very seriously. These include:

• Sudden loss of reflexes in the legs
• Unusual and rapid onset of Bladder/bowel incontinence or sexual dysfunction
• Pain in one or both legs
• Motor and sensory loss
• Tingling or numbness in the saddle region (Groin and inner thighs)
• Bilateral sciatica

These symptoms may be associated with severe low back pain and if you suddenly experience more than one, particularly incontinence, contact a health professional immediately.

TREATMENT OPTIONS

Treatment will depend on the severity and cause of the syndrome. However, most of the time cauda equina syndrome requires decompression surgery as soon as possible to relieve pressure on the nerves. The longer the period between symptom onset and surgery, the less likely it is for a full recovery. Most patients will need physiotherapy, pain management and counseling even if their condition is treated quickly. Recovery time is based on the amount of damage to the nerves.

While this a very rare condition, public education is important, as rapid treatment is vital to prevent permanent damage.

What is Ankylosing Spondylitis?

Ankylosing Spondylitis, a type of inflammatory arthritis, causes inflammation and pain in the spinal column as well as other joints in the body. The classic marker of Ankylosing Spondylitis is involvement of the sacroiliac joints, which are large joints connecting the pelvic bones to the sacrum in the lower back.

In many cases of Ankylosing Spondylitis, inflammation within the spinal column can cause new bone to begin forming between the vertebrae. Vertebrae are the individual bones that compose the spinal column. This leads the vertebrae to fuse in various areas, typically fusing the spine in flexed forward, immobile postures.

As Ankylosing Spondylitis progresses, other areas of the body may be affected. These areas include the smaller joints within the hands and feet, as well as the ribs and shoulders. In some instances, the disease can affect other systems of the body such as the skin, lungs and eyes.

The cause of Ankylosing Spondylitis is not clear, however there are markers and predisposing factors that may contribute to the development of the condition.

Genetics, environment and frequent gastrointestinal infections are among the pre-disposing factors. Men are more commonly affected than women and diagnosis tends to occur between the ages of 17 and 45 years.

What are the signs and symptoms?

Back pain and stiffness are the two most common symptoms of Ankylosing Spondylitis. Other symptoms include neck and buttock pain, as well as pain in the smaller joints of the hands and feet. Tendons and ligaments may also be affected. Symptoms tend to be worse following periods of rest, and better following periods of activity. It is common for people to experience “flare-ups” and “remissions” of symptoms.

Severity of disease is patient-dependent. Some people with Ankylosing Spondylitis may experience discomfort in the spine from time to time, while others experience severe and debilitating symptoms at frequent intervals with minimal time in remission from symptoms.

Many people with ankylosing spondylitis do not seek medication attention, especially if the symptoms are mild. In these cases, the disease is not diagnosed until it has progressed, leading to increased pain and disability for the patient.

How can physio help?

Ankylosing Spondylitis responds well to physical activity. Your physiotherapist will assess your spinal movement and posture as well as strength and overall movement ability. They will assist you with performing appropriate stretches and strengthening exercises to maintain your posture, spinal strength and mobility. If your hands, feet, hips or shoulders are involved, they will also provide you with specific exercises to help maintain mobility and strength in those joints.

In many cases, people can participate in group exercise programs in a pool and on land. Exercising in a pool is beneficial due to the buoyancy factor; people do not have to weight bear on sore and inflamed joints, however are still able to stay physically active. Many studies have proven the positive benefits of exercise for those with Ankylosing Spondylitis, such as improved rib cage expansion when breathing, and improved posture of the upper back and neck. A physiotherapist is also able to implement other pain relieving treatments that can help to manage symptoms.

We are now pleased to offer Pre-Pointe and Dance Screening Assessments conducted by physiotherapist Bridy White. Bridy has worked with the Australian Ballet Company since 2009. This has given her exposure to injury management at the highest level of ballet. Bridy has a background in dance herself, and is passionate about injury prevention, management, and optimising performance in dancers of all abilities. For any questions or to make an appointment for Dance Screening Assessments or Pre-Pointe assessments with Bridy call 9744 5066 and let our recepion staff know that you would like to book in for this particular assessment.