What Is an Ankle Sprain?
The most common of all ankle injuries, an ankle sprain occurs when there is a stretching and tearing of ligaments surrounding the ankle joint. The numerous ligaments around the ankle can become pulled and torn when the ankle is forced into a position not normally encountered.

What Is Bursitis of the Elbow?
The elbow contains a slippery, fluid filled sack called the bursa to help the skin slide over the bone in that area. The olecranon bursa, covers the olecranon process (the extension of the ulna that fits into the humerous). It lies between the skin of the elbow and the bones of the forearm.

What is Carpal Tunnel Syndrome?
Where the wrist and hand meet, nine tendons and one large nerve pass together through a tight tunnel into the palm. This tunnel, called the carpal tunnel, is formed on three sides by the small bones of the wrist and on the fourth side by the very tough fibrous tissue that makes the heel of the hand firm. The nerve passing through the carpal tunnel is called the median nerve. This nerve gives feeling to the thumb, index, middle and part of the ring fingers, and it gives movement to the muscles that lift the thumb away from the palm. Anything that causes swelling within the narrow carpal tunnel can put pressure on the median nerve. A frequently repeated motion of the fingers or wrist can cause irritation and swelling, and a sudden injury, like a blow to the hand or a fractured wrist, can do the same. Pregnancy or arthritis can also cause swelling, and sometimes swelling occurs without any obvious cause. Whatever the cause, swelling and increased pressure in the carpal tunnel can interfere with the flow of blood to the median nerve. Over time the constriction in blood flow can lead to chronic irritation and eventual damage to the nerve. This problem is called carpal tunnel syndrome.

Symptoms
Chronic irritation of the median nerve can cause a variety of sensations in the hand and forearm including numbness, tingling, burning, sleepiness, pins and needles or even shock-like feelings. The patient's hand may cramp and tire easily or lose strength and dexterity. Feeling may be lost in the thumb, index and middle fingers, and patients may sometimes wake at night with numb or aching hands. Many patients feel they have arthritis and that nothing can be done. Symptoms often occur in both hands.

Diagnosis
Carpal tunnel syndrome is diagnosed by evaluating the patient's symptoms, examining the hand and forearm and performing two tests of the electrical functioning of the affected nerves. EMGs (electromyography) detect the irritability of muscles in the hand and arm, and NCVs (nerve conduction velocities) measure the speed of electrical impulses traveling along the median nerve and its branches. EMGs and NCVs can detect significant changes in nerve function and thus confirm a diagnosis of carpal tunnel syndrome. However, patients with milder irritation of the median nerve will sometimes have normal electrical tests because their problem has not progressed far enough to be detected by electrical changes.

Treatment
Many patients have mild carpal tunnel syndrome. They never develop abnormal EMGs or NCVs, and their symptoms are not seriously bothersome or disabling. Treatment in these mild cases may include putting the wrists in splints at night or during the day. People often sleep with their wrists bent forward, which increases the pressure on the nerve by narrowing the size of the carpal canal. Wearing the splints at night and occasionally during the day prevents this. Most patients with more severe carpal tunnel syndrome have abnormal EMGs and/or NCVs though their symptoms may vary from mild to disabling. Some patients with normal electrical tests nevertheless have severe symptoms that persist for months. Because nerve damage can be progressive, the appropriate treatment for most patients with abnormal tests or persistent symptoms is carpal tunnel release surgery. In this operation, the tough tissue forming the palmar side of the carpal canal is opened to relieve the pressure on the median nerve. The increased space for the median nerve and tendons results in decreased pressure in the carpal canal and increased blood supply to the median nerve. The nerve then has a chance to heal itself. The surgery itself does not `cure' the nerve. The pattern of symptom relief after carpal tunnel release surgery depends on which of three types of injury the nerve has sustained. In the first type of injury, the nerve is in a sense stunned or `knocked out'. The nerve can `come to' in days or weeks. In the second type of injury, the nerve cell itself has died back, but the small nerve canals remain intact. After surgery relieves the pressure, the nerve cells begin growing down the small nerve canals at the rate of about one inch per month. Since the distance from the site of injury to the tips of the fingers is six or seven inches, recovery can take six to eight months after carpal tunnel release surgery. Occasional patients note recovery over one to two years. In the third type of nerve injury, the nerve cell has died back and the small nerve canals have collapsed as well. No nerve recovery is possible in this situation. There is no way to determine before surgery how much of each type of injury any individual patient has. Thus after carpal tunnel release surgery, recovery may occur almost immediately, may occur over six to eight months or more, or may never occur. Partial recovery often occurs. About 80 to 90 percent of patients experience good relief from their symptoms after carpal tunnel release surgery. Even those, whose symptoms are not relieved, are still helped because reducing the pressure on the median nerve prevents the problem from becoming worse in most cases. Carpal tunnel release surgery is done on an out-patient basis. No overnight stay in the hospital is necessary. In the procedure most commonly  used, an anesthesiologist administers intravenous sedation and the surgeon gives a local anesthesia. This method reduces the risk of the nausea sometimes caused by general anesthesia, and the sedation keeps even very nervous patients comfortable. Sutures remain in the skin for two to three weeks, and patients begin using their hand shortly after surgery.

What Is a Heel Spur?
A heel spur is a projection or growth of bone where certain muscles and soft tissue structures of the foot attach to the bottom of the heel. Most commonly the plantar fascia (a broad, ligament-like structure extending from the heel bone to the base of the toes) becomes inflamed and heel pain begins. As this inflammation becomes chronic, a heel spur is likely to form. If heel pain is treated early, conservative therapy is often successful and surgery is usually avoided.

R.I.C.E - Best for Acute Injuries
Treatment Tips for Managing Low Grade, Acute Injuries in the Initial Stage
Running, aerobics and other forms of exercise are good for your health, but these activities can raise your risk for sprained joints, strained muscles and other minor injuries. Proper care in the first day or two after injury can reduce the time you're sidelined by it. Should you suffer a sprain, strain, pull, tear or other muscle or joint injury, treat it with R.I.C.E. -- Rest, Ice, Compression and Elevation. R.I.C.E. can relieve pain, limit swelling and protect the injured tissue, all of which help to speed healing. After an injury occurs, the damaged area will bleed (externally or internally) and become inflamed. Healing occurs as the damaged tissue is replaced by collagen, perhaps better known as scar tissue. Ideally, the scar tissue needs complete repair before a full return to sport is recommended.

Shin Splints
What It Is
The term Shin Splints has long been used to describe generalized pains athletes get in the lower leg. A more accurate definition of this specific type of injury would refer to pain along the tibia either on the front outside (anterior lateral) portion of the lower leg (commonly called anterior shin splints) or pain on the back inside (posterior medial) portion of the lower leg (commonly called medial shin splints).

Causes
The first risk factor of injury is overtraining. Beginning runners are also at increased risk because they are not used to the high impact running has on the muscles and joints of the lower leg and foot. Running on hard, jarring surfaces is often a cause of shin splints; so choose the softest surface you can find. Also, make sure that the shoe you are wearing suits your foot type. Excessive pronation is another cause of shin splints. Other causes of shin splints include:

What is a Shoulder-Rotator Cuff Tear
The rotator cuff is comprised of four muscles and their tendons which insert on the top of the humerus or arm bone. They function along with the deltoid to elevate and rotate the arm. The four muscles, beginning in the front and moving up over the top to the back are the subscapularis, the supraspinatus, the infraspinatus and the teres minor. The subscapularis muscle inserts along the superior neck of the humerus at a bony prominence termed the lesser tuberosity. The supraspinatus, infraspinatus and teres minor insert in that order along individual ridges of another prominence termed the greater tuberosity.

Rotator cuff tears may involve one or all of the aforementioned muscles and essentially involve separation of their attachment onto their respective bony prominences. The most commonly involved tendon in rotator cuff tears is the supraspinatus tendon.

Rotator cuff tears can be caused by severe trauma such as experienced during a high speed motor vehicle accident or by a simple motion such as pulling bed covers over oneself. In athletics, a tear may occur by an overuse syndrome caused by throwing too many pitches, or excessive force placed against the shoulder in external rotation, as in football.

Symptoms
Include pain along the outside aspect of the shoulder more significant at night and with attempts at raising the arm. Patients show traditional weakness in elevating and externally rotating the arm. Plain x-ray examination can sometimes show degeneration along the attachment site of the specific muscle, the rotator cuff. Magnetic Resonance Imaging with intrarticular contrast can demonstrate tears in cases which are more difficult to diagnose.

Treatment
Treatment is directed toward elimination of pain. Repair of the cuff back to its normal attachment and removal of any associated bone spurs results in an approximate 85% success rate in relieving of pain.

What is Tendonitis and Bursitis?
Cause
Tendonitis and bursitis are common causes of musculoskeletal pain in people between the ages of 30 and 60. They also occur in people who are both older and younger than that. These problems may occur in various parts of the body including the shoulder, elbow, wrist, hand, hip, knee, ankle and foot. The exact cause is not well understood. As you grow older, the different parts of your body do not tolerate stress as well as they used to. Rather than developing sore muscles which go away in a few days, your body appears to develop an inflammatory or irritated response that can last for a long time and be quite painful. These problems often follow an episode of unaccustomed activity such as raking leaves or they may follow a specific incident of excessive stress or injury to your body.

Bursitis
Anywhere in your body that two surfaces need to glide over each other, there is a bursa. A bursa consists of two surfaces of slick tissue which face each other and glide over each other. The edges are sealed and they form essentially a collapsed sac. When inflamed, this sac fills with fluid, swells and becomes sore and tender. There is a bursa where the skin at the point of your elbow glides over the underlying bone. Another bursa lies under the skin which glides over your knee cap. There are bursae in the heel where the skin glides a little over the bone. There are also bursa deeper within your shoulders and your hips. Inflammation of these structures is called bursitis.

Tendonitis
Detailed studies of the blood supply to the tendons that surround the shoulder indicate that the amount of blood supply decreases significantly as we age through the 30's, 40's and 50's. It is likely that a similar steady decrease in blood supply occurs in other tendons and muscle-tendon junctions of the body. This may explain why our tendons are less able to withstand stress and are more likely to become inflamed. Inflammation of the tendons, their attachments to bone and the muscle-tendon junctions is called tendonitis. An acute injury or multiple small injuries from chronic stress can lead to small tears in the tendons, at their attachments to bone, or at the muscle-tendon junction. These small tears can result in an area of chronic inflammation. This process is called tendonitis.

Deposits of calcium are sometimes laid down in areas of the tendons which develop decreased blood supply. The calcium crystals are very irritating to the tissues and cause pain and inflammation. This is called calcific tendonitis and often is the cause of the acute tendonitis that appears suddenly without cause. The pain may be severe enough to interfere with sleep.

Treatment
The mainstays of treatment for tendonitis and bursitis are non-steroidal anti-inflammatory medications (Motrin, Naprosyn, Dolobid, Ansaid, Orudis, Indocin, Clinoril, Feldene, Celebrex and Vioxx) and cortisone shots. Neither cures all cases. Some types of tendonitis and bursitis seem to respond better to medication and others are more amenable to cortisone shots. Both treatments have low risks associated with them. Anti-inflammatory medications can cause ulcer problems. Cortisone shots rarely cause a temporary increase in inflammation, rupture of tendons or depigmentation of the skin. Too many cortisone shots (usually more than six in one place) can increase the risk of rupture of a tendon. Rest and avoidance of repetitive stress to the inflamed area are also important.

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