Common Chronic Pain Conditions

Symptoms:

Neck pain, stiffness, loss of normal range-of-motion

Possible Diagnosis:

Cervical Strain/Sprain

Physiatric Treatment Options:

Ice, moist heat, electrical stimulation, Tylenol, non-steroidal anti-inflammatory drug (NSAID), range-of-motion exercises, isometrics

Symptoms:

Neck pain, spasms, stiffness, loss of normal range-of-motion

Possible Diagnosis:

Cervical Spine Disc Herniation (HNP)

Physiatric Treatment Options:

Cervical traction, muscle relaxant, non-steroidal anti-inflammatory drug (NSAID), ultrasound, electrical stimulation, range-of-motion exercises, isometrics

Symptoms:

Spasms, pain radiating to back of head - ear or shoulders, painful range-of-motion of spine or shoulder

Possible Diagnosis:

Myofascial Pain Syndrome (upper trapezius muscles)

Physiatric Treatment Options:

Trigger point injections, moist heat, myofascial massage, electrical stimulation, muscle relaxant, non-steroidal anti-inflammatory drug (NSAID), TENS unit

Symptoms:

Neck pain with pain,tingling, numbness, pins/needles, dysesthias, parasthesias down the arm

Possible Diagnosis:

Cervical Radiculopathy

Physiatric Treatment Options:

Cervical spine traction, muscle relaxant, NSAID, isotonic strengthening exercises to the affected limb, TENS unit, other oral meds (AED - i.e. Lyrica, Neurontin; SNRI - i.e. Cymbalta, Effexor; TCAs - i.e. Elavil, Pamelor), Epidural cervical spine steriod injections

Symptoms:

Neck pain, stiffness, loss of normal ROM

Possible Diagnosis:

Cervical Spine Spondylosis (Osteoarthritis)

Physiatric Treatment Options:

Cervical spine ROM, cervical isometrics, ultrasound, electrical stimulation

Symptoms:

Back pain, stiffness, loss of normal ROM

Possible Diagnosis:

Cervical Spine Spondylosis (Osteoarthritis)

Physiatric Treatment Options:

Cervical spine ROM, cervical isometrics, ultrasound, electrical stimulation

Symptoms:

Low back pain, stiffness, loss of normal range of motion (ROM)

Possible Diagnosis:

Lumbar Strain/Sprain

Physiatric Treatment Options:

Ice, moist heat, electrical stimulation, Tylenol, NSAID (non-steroidal anti-inflammatory drug), ROM exercises, isometrics

Symptoms:

Low back pain, spasms, stiffness, loss of ROM

Possible Diagnosis:

Lumbar Spine Disc Herniation (HNP)

Physiatric Treatment Options:

Lumbar traction, muscle relaxant, NSAID, ultrasound, electrical stimulation, ROM, isometrics

Symptoms:

Low back pain with pain, tingling, numbness, pins/needles, dysesthias, parasthesias down leg

Possible Diagnosis:

Lumbar Radiculopathy

Physiatric Treatment Options:

Lumbar spine traction, muscle relaxant, NSAID, isotonic strengthening exercises to the affected limb, TENS unit, other oral meds (AED- i.e. Lyrica, Neurontin, SNRI - i.e. Cymbalta, Efffexor, TCAs - i.e. Elavil Pamelor), Epidural lumbar spine steroid injections

Symptoms:

Spasms, muscle pain with specific trigger or tender points

Possible Diagnosis:

Myofascial Pain Syndrome (gluteal/piriformis muscles)

Physiatric Treatment Options:

Trigger point injections, moist heat, myofascial massage, electrical stimulation, muscle relaxant, NSAID, TENS unit

Symptoms:

Low back pain, stiffness, loss of normal ROM

Possible Diagnosis:

Lumbar Spine Spondylosis (Osteoarthritis)

Physiatric Treatment Options:

Lumbar spine ROM, lumbar isometrics, ultrasound, electrical stimulation

Symptoms:

Pain - especially with overhead reaching and lifting

Possible Diagnosis:

Rotator Cuff Tendonitis (Shoulder Strain)

Physiatric Treatment Options:

Moist heat, relative rest, NSAID, ultrasound, eletrical stimulation, ROM exercises

Symptoms:

Pain - especially with ROM in abduction and external rotation, weakness in abduction, flexion and external rotation

Possible Diagnosis:

Rotator Cuff Tear

Physiatric Treatment Options:

Ultrasound, electrical stimulation, cortisone injection to subacromial bursae, theraband isotonics, shoulder girdle muscles, NSAIDs

Symptoms:

Anterior shoulder pain, pain with shoulder adduction

Possible Diagnosis:

Shoulder Sprian (acromioclavicular sprain)

Physiatric Treatment Options:

Steroid injection in glenohumeral joint, ultrasound, electrical stimulation, ROM, theraband isotonics shoulder girdle muscles

Symptoms:

Anterior shoulder pain - especially with shoulder flexion and passive shoulder extension

Possible Diagnosis:

Bicipital Tendonitis

Physiatric Treatment Options:

Ultrasound, peritendinous steroid injection to biciptal tendon area

Symptoms:

medial/lateral elbow pain worsened with ROM, forearm pronation/supination

Possible Diagnosis:

Elbow sprain (medial collateral ligament/lateral collateral ligament)

Physiatric Treatment Options:

ice, relative rest, prolotherapy injections to ligaments

Symptoms:

medial elbow pain especially with wrist flexion with ulnar (medial) deviation

Possible Diagnosis:

Medial Epicondylitis (Golfer's Elbow)

Physiatric Treatment Options:

ultrasound, electrical stimulation, NSAID, wrist isotonics in flexion, extension, peritendinous steroid injection at medial eplcondyle, elbow strap, prolotherapy injections to medial epicondyle tendon (wrist flexion tendons)

Symptoms:

medial elbow pain especially with wrist flexion with wrist extension

Possible Diagnosis:

Lateral Epicondylitis (Tennis Elbow)

Physiatric Treatment Options:

ultrasound, electrical simulation, NSAID, wrist isotonics in flexion & extension, peritendinous steroid injection at lateral epicondyle, tennis elbow strap, prolotherapy injections to lateral wrist extensions at lateral epicondyle

Symptoms:

medial elbow/forearm pain, tingling, numbness, pins & needles, weakness in the hand/wrist

Possible Diagnosis:

Ulnar Neuropathy (cubital tunnel syndrome)

Physiatric Treatment Options:

ultrasound, NSAID, digiflex isotonics to hand intrinsic muscles,cortisone injection to cubital tunnel

Symptoms:

pain, numbness, tingling, pins & needles sensations in outer half (radial aspect) of hand - exacerbated by hand/wrist repetitive motions (i.e. - typing, knitting, manual hand work (fine finger grasping)

Possible Diagnosis:

Carpal Tunnel Syndrome

Physiatric Treatment Options:

ultrasound, myofascial release to carpal tunnel fascia, resting wrist splint, NSAID, tricyclic antidepressants, AED/NSRI (relief of neuropathic pain ), steroid injections to carpal tunnel

Symptoms:

dorsal thumb/wrist pain - especially with grasping objects, turning down a handle, squeezing with hand

Possible Diagnosis:

deQuervains Stenosing Tenosynovitis

Physiatric Treatment Options:

ultrasound, NSAID, thumb splint, relative rest, peritendinous steroid injection to thumb abduction/extension tendons, TENS unit

Symptoms:

dorsal wrist pain - especially with flexion/extension

Possible Diagnosis:

Transverse Fibrocartilaginous Complex Tear (TFCC Tear), Dorsal wrist ligament Tear

Physiatric Treatment Options:

ultrasound, TENS unit, ROM, theraband isotonics wrist flexors, prolotherapy injections to dorsal wrists ligaments

Symptoms:

medial knee pain/lateral kneepain, feeling of an unstable knee

Possible Diagnosis:

MCL/LCL sprain

Physiatric Treatment Options:

ice, electrical stimulation, ultrasound, NSAID, relative rest, prolotherapy injections

Symptoms:

pain behind knee cap, positive Theatre sign (having the need to fully extended the knee after prolonged sitting with knee flexed beyond 90 degrees)

Possible Diagnosis:

Chondromalacia Patella (Patellofemoral Pain Syndrome)

Physiatric Treatment Options:

ultrasound, electrical stimulation, McCommell Taping , short arc quadriceps isotonics, static streching hamstrings - illiotibial band, NSAID, steroid injection (retropatellar)

Symptoms:

buckling, locking of the knee, retropatellar knee pain, knee pain with turning/twisting of the knee

Possible Diagnosis:

Meniscus Tear

Physiatric Treatment Options:

ultrasound, NSAID, steroid, steroid injection, prolotherapy to knee (intraarticular), quadriceps isotonics

Symptoms:

pain along medial aspect of tibia (shin), body habitus, obese, genu valgus (knocked knee), feet pronated (flat feet)

Possible Diagnosis:

Pes Anserine Bursitis

Physiatric Treatment Options:

ultrasound/phonophoresis, shoe orthotics to properly align flat feet (pes planus), steroid injection to bursae

Symptoms:

knee pain, at rest/activity, swollen knee

Possible Diagnosis:

Osteoarthritis

Physiatric Treatment Options:

ultrasound, Tylenol, NSAID, steroid injection, prolotherapy injections, quadricep isometrics/isotonics

Symptoms:

pain, swelling, painful galt, decreased ROM

Possible Diagnosis:

Ankle Sprain

Physiatric Treatment Options:

ice, electrical stimulation, ultrasound/phonophoresis, NSAID, prolotherapy injections

Symptoms:

medial foot pain, numbness, tingling, weakness on foot inversion

Possible Diagnosis:

Tarsal Tunnel Syndrome

Physiatric Treatment Options:

ultrasound/phonophoresis, foot muscle/ankle theraband isotonics, steroid injections to tarsal tunnel, NSAID, AED/SNRI (for neuropathic pain)

Symptoms:

pain along medial arch/sole of foot, soreness of foot with walking

Possible Diagnosis:

Plantar Fascitis

Physiatric Treatment Options:

ultrasound/phonophoresis, TENS, NSAID, steroid injection to plantar fasciae

Symptoms:

pain along the plantar aspect of foot (balls of the toes)

Possible Diagnosis:

Metatarsalgia

Physiatric Treatment Options:

ultrasound/phonophoresis, arch supports, NSAID

Symptoms:

heel pain on heel strike during gait

Possible Diagnosis:

Heel Spur (calcaneal spur)

Physiatric Treatment Options:

ultrasound/phonophoresis, NSAID, TENS, steroid injection, heel pad in shoe/arch support

Symptoms:

toe pain(1 ^st toe), skeletal deformity dorsal aspect of toes rubbing against top part of shoe causing reddening

Possible Diagnosis:

Hammer Toes/Bunion (Hallus valgus)

Physiatric Treatment Options:

orthotic support/structural devices, streching of feet & toe ligaments

Symptoms:

posterior heel pain - epecially with push off during gait cycle

Possible Diagnosis:

Achilles Tendinitis

Physiatric Treatment Options:

ultrasound/phonophoresis, NSAID, Achilles tendon strap, relative rest, oral steroid