Happy New Year!
With the new year comes new resolutions, new workout routines, and usually some associated new pain. How do I determine the source of my pain, and who should I see when I need medical advice?
New workout routines involve increased impact and load to the upper and lower body. The resultant pain is good when it is primarily muscular, leading to strength and endurance gains over time. However, when the pain is primarily in the joints or associated with radiation and sensory disturbances, the resultant dysfunction may outweigh the benefits of the activity. When symptoms persist and medical advice is needed, it is important to be sure you’re seeing the right doctor for the given injury.
In the upper body, pain in the neck and upper back/scapular (shoulder blade) area, especially if associated with burning pain or paresthesias (numbness), is a neck issue, NOT a shoulder problem. Pinched nerves in the cervical spine (neck) are caused by mechanical compression from discs or bone spurs, leading to pain/weakness/sensory disturbances in the distribution of the nerve. This often causes radiating pain into the arm and hand. If you experience these symptoms, seek the care of a spine specialist. Pain resulting from shoulder injuries (labrum/rotator cuff/biceps/AC joint/etc) is characterized by pain/weakness/popping and other mechanical symptoms localized to the shoulder joint itself without sensory or other issues. If this is your issue, a variety of non-surgical interventions may lead to recovery, and occasionally surgical intervention is appropriate. An orthopaedic surgeon specializing in sports medicine/arthroscopic surgery is the best physician to help you make these decisions.
In the lower body, pain in the buttock or lower back, especially if associated with radiation to the lower leg with burning or numbness (“radicular symptoms”), is a low back problem, NOT a hip problem. Interventions include medication, physical therapy, epidural blocks, and surgical decompression of the injured nerves. See a spine specialist for this. Pain resulting from an injury to the hip joint itself – whether from arthritis/stress injury/etc – will occur primarily in the groin, usually reproduced with rotation of the leg or weight bearing. When symptoms are localized to the hip (groin not buttock/back), especially if these progressively occur after a new running program, radiologic evaluation is necessary to rule out a stress fracture of the femur. Failure to diagnose this injury can have devastating consequences for active patients if fracture displacement occurs, as hip replacement may be necessary. Radiographic evaluation with x-ray and MRI also determines the extent of arthritis (cartilage wear) in the hip and can rule out other injuries such as avascular necrosis (loss of blood supply to the hip), labral/cartilage tears, etc. Treatment of these injuries can be non-surgical or surgical, including hip replacement when severe arthritis is present.
As an orthopaedic surgeon with fellowship training in arthroscopic surgery/sports medicine, I see patients with shoulder and hip injuries on a daily basis and perform arthroscopic and open surgery, including complex joint replacement, when appropriate and necessary. If you are dealing with these problems I would be happy to help guide your care. For neck and back problems, my partner, Dr. Wade, has expertise in surgical and non-surgical interventions.
Stay healthy and have a great 2020!
-Dr. Robert S. Wolf, MD (205) 971-1750