Regional Pain Syndromes Treatment Tomball, Texas
Technically, RPSs are not arthritis (inflammation of the joint) but usually represent tendinitis (inflammation of the cord-like tendons attaching muscles to bones) or bursitis (inflammation of the pouch-like bursa that provides cushioning to bony surfaces). Most commonly, they arise from overuse of the affected part of the body. Consequently, most individuals with these conditions have a good long-term outlook. Less commonly, a RPS may be the sign of another inflammatory arthritic condition, such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA) or part of the condition know as fibromyalgia (see related sections).
Features of RPSs: The main symptoms that prompt a patient with a RPS to seek medical care are pain and loss of function. The pain is usually worse with activity of the affected area but if the injury or inflammation is particularly intense, symptoms may be present at rest. Because of the large number of RPSs that may be observed, we will group them together according to the region of the body affected.
In fact, the vast majority of patients who do not feel exercises helped their RPS never truly performed the exercises consistently or for a sufficient period of time. In certain situations, the help of a physical or occupational therapist may be useful to help supervise an exercise program. Splints or braces over an inflamed or painful tendon or other soft tissue structure helps rest this region and allow it to heal. Some splints may be difficult to wear during certain activities during the day but can be valuable in protecting painful muscles or tendons from overuse. These devices are less useful in the larger joints such as the shoulder or hip but are quite helpful in treating RPSs of the hand, wrist, foot, and ankle in particular. Some of these items can be purchased over the counter at the pharmacy, but many patients achieve better results with a custom-made splint fashioned by a therapist. Injections of corticosteroids, with or without local anesthetic, typically provide rapid relief of symptoms for patients with a number of RPSs, and results may be long-lasting.
The risk of infection and other complications is quite low, and while many areas are painful to inject, when performed by a skilled practitioner the pain of the procedure is brief and can be minimized. Most patients report more pain from their underlying condition than from the injection itself. These injections can be repeated, but to avoid excessive scarring in the soft tissues the interval between procedures in the same region should be no less than about three months. When a number of successive injections are required to relieve symptoms, other treatment options should be considered. Surgery has a role only in a minority of patients with RPSs. Rotator cuff tears and other permanent injuries may be appropriately referred to a surgeon, and carpal tunnel syndrome, tendinitis of the hand/wrist, plantar fasciitis, and other conditions listed above may also require surgery if standard therapies listed above are without benefit.
The decision on when to pursue such procedures requires a good deal of discretion on the part of the surgeon and referring practitioner, but the patient is ultimately the one who must make this decision based on the degree to which the RPS is interfering with daily activities. A combination of these therapies usually results in satisfactory outcomes for the majority of patients with RPSs. Using these tools, the primary care physician, occasionally in conjunction with the specialist and physical or occupational therapist working together with the patient’s preferences will typically yield favorable results over time.