When contemplating surgery, remember that choosing not to operate preserves all future options, whereas surgery permanently alters the operative field and subsequent interventions. Prioritize a pause to fully evaluate the decision.
Never make clinical, especially surgical, decisions based solely on an MRI. A thorough patient history, including injury mechanics and usage patterns, combined with a comprehensive physical examination, is crucial for accurate diagnosis.
Offer your doctor a meticulous account of your injury’s mechanics, how you use your body, and the specific symptoms you experience. This detailed history, alongside a physical exam, can lead to 95% diagnostic accuracy without an MRI.
When evaluating orthopedic injuries, especially rotator cuff tears, consider surgical intervention not just for acute pain but also for significant functional impairment. Maintaining vitality and desired activity levels can be a primary indication for repair, even if pain is not severe.
Engage in a shared decision-making process with your surgeon, understanding that treatment plans should be a conversation. Your input, knowledge, and preferences, combined with their expertise and your specific condition, are vital.
For adhesive capsulitis (frozen shoulder), focus on controlling inflammation, engaging in consistent physical therapy, and adhering to a home exercise program, as approximately 80% of cases can resolve without surgery.
If you have shoulder stiffness but retain decent motion, begin with physical therapy to stretch out the joint. However, if motion is severely limited and painful, a cortisone injection may be necessary first to reduce pain and enable effective physical therapy.
If shoulder pain radiates below the elbow and into the hand, it is highly indicative of a neck (cervical spine) origin rather than an intrinsic shoulder problem, which typically does not extend past the elbow.
If you are aware of an anatomical predisposition to injury, such as a narrow C-spine or a Type 3 acromion, proactively engage in rehabilitative exercises to strengthen supporting structures and mitigate future injury risk.
If you have a Type 3 (bird beak) acromion, be cautious with repetitive overhead activities, as this anatomical shape can irritate the bursa and rotator cuff tendon, predisposing you to bursitis and tears.
If you experience a ‘stinger’ (nerve injury) during contact sports, get screened for a congenitally narrow spinal canal. This condition significantly increases the risk of catastrophic spinal cord injury with further impact.
If you have hypermobile (loose) joints, select sports and activities that allow for dynamic stabilization and avoid those that subject the joints to excessive or unnatural forces, to prevent recurrent injury.
If you experience weakness during specific lifting movements, especially when fatigued, it may not be true muscle weakness but rather your brain’s protective response to prevent injury or overstressing a compromised joint.
For neck-related symptoms (e.g., tingling, mild pain) without significant motor weakness, a short course of low-dose prednisone may resolve the issue, potentially avoiding the need for extensive imaging and associated anxiety.
Be aware that asymptomatic rotator cuff tears do not heal spontaneously; larger tears are more likely to progress in size and eventually become symptomatic over time.
For small rotator cuff tears, consider managing inflammation first if the tear is not yet biomechanically significant, as symptoms may stem from inflammation rather than the tear itself.
Approach claims about PRP (Platelet-Rich Plasma) and stem cell injections for common orthopedic conditions like rotator cuff tears or epicondylitis with skepticism, as robust scientific evidence for their widespread effectiveness is often lacking.
For certain AC (acromioclavicular) joint separations, such as Type 3, waiting a few weeks to assess symptoms before deciding on surgery does not negatively impact the outcome and may allow for non-operative recovery.
Consider total shoulder replacement primarily for chronic pain that significantly limits function and quality of life, rather than solely for severe arthritis visible on X-rays, as many with advanced arthritis remain asymptomatic.
After a total shoulder replacement, avoid heavy weightlifting, particularly movements like bench press and iron cross, to protect the longevity and integrity of the implant.
For tennis elbow (lateral epicondylitis) or golfer’s elbow (medial epicondylitis), begin treatment with rest, consistent stretching, and oral NSAIDs, as these conservative measures are often effective.
If epicondylitis pain is severe, limiting elbow movement and causing significant inflammation, a low-dose cortisone injection can help cool down the inflammation and enable more effective stretching and rehabilitation.
When resuming physical activities after a break, gradually increase intensity and duration to prevent overuse injuries like epicondylitis, which often occur when individuals overdo it too quickly.
For epicondylitis, if grip strength exercises are tolerable with minimal pain, prioritize a program of stretching and strengthening, as this can often cure the condition.
Understand that Tommy John surgery (ulnar collateral ligament reconstruction) is an operation specifically designed for elite throwing athletes with a torn ligament, not for non-athletes or to artificially increase throwing velocity.
If you experience wrist pain after a fall, especially as an athlete, seek prompt medical evaluation. Scaphoid fractures can be subtle and easily missed on initial X-rays, but early diagnosis is crucial for proper healing.
Be aware that scaphoid fractures take significantly longer to heal (10-12 weeks) than other bones due to their unique, retrograde blood supply, which is easily disrupted by injury.
For non-displaced scaphoid fractures, immobilization with a splint that supports the wrist while leaving the thumb and fingers free can allow the bone to heal without surgical intervention.
Following percutaneous scaphoid fracture repair, expect to return to activities like catching a ball in about six weeks, with some professionals (e.g., surgeons) able to resume work within a week.
When immobilizing the wrist, ensure it is placed in a neutral position (slight extension) to prevent increased pressure on the median nerve in the carpal tunnel, which can lead to acute carpal tunnel syndrome.
If you are a musician requiring wrist immobilization, discuss with your doctor the possibility of splinting your hand in a specific position that allows you to continue playing your instrument.
Actively engage your hands in meaningful tasks to maintain cognitive vitality, as over 60% of higher cortical neurons are dedicated to hand function, and hand use stimulates brain activity.
Prioritize handwriting over typing for tasks like essay writing, as studies show it stimulates more cortical activity, leading to longer sentences, richer vocabulary, and more ideas generated faster.
To self-assess for carpal tunnel syndrome, confirm that numbness and tingling are specifically located in the palm side of the thumb, index finger, middle finger, and typically half of the ring finger.
If you have carpal tunnel syndrome, pay close attention to your ergonomic setup and posture, as repetitive activities and poor positioning can significantly exacerbate symptoms.
Be aware that a sudden decrease in perceived strength during novel or challenging grip exercises (e.g., fewer fingers) might be your brain’s protective mechanism to prevent overstressing tendons, rather than a true loss of muscle strength.
To maximize overall grip strength, focus on exercises that engage the pinky and ring fingers, as the ulnar nerve, which controls these digits, is disproportionately important for powerful grip.
For trigger finger, seek early intervention, ideally within six weeks of onset, as one or two cortisone injections can achieve a 75% cure rate.
Limit cortisone injections to a maximum of three per tendon sheath over its lifetime to prevent soft tissue degradation and potential tendon ruptures.
Seek immediate medical attention for a finger that is swollen, exquisitely tender along its sheath, and held in a flexed position, as these are signs of suppurative tenosynovitis, an orthopedic emergency.
If you experience numbness, tingling, or pain in multiple nerve distributions (e.g., median and radial nerves) along with neck stiffness, consider ‘double crush’ syndrome, where nerve compression occurs at both the neck and a distal site.
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Engage proactively with your healthcare provider by bringing relevant scientific articles you’ve researched, as well-informed patients can contribute to the diagnostic and treatment process.
If you have a rotator cuff tear, even if currently asymptomatic, consider repair to prevent muscle atrophy and preserve long-term function, especially if you wish to maintain your current activity levels.
Do not ignore the onset of new shoulder symptoms after a period of being asymptomatic; this indicates a change in your anatomical or physiological state and warrants reassessment.
When making medical decisions, especially regarding surgery, assess an individual’s biological age and physiological condition rather than solely relying on chronological age, as modern individuals are often physiologically younger.
Consider incorporating rucking (walking with a weighted backpack) into your fitness routine 2-3 times a week, as it can significantly improve overall body strength and lightness, even at an older age.
Visit mtfusa.org to learn more about and get involved with the Musician Treatment Foundation, a non-profit providing free orthopedic care to uninsured and underinsured professional musicians.