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The Rehabilitation Institute of the Caribbean is pleased to introduce Radial Pulse Activation Therapy, more commonly known as, Shockwave therapy to its suite of modern, medical treatment for musculoskeletal injuries and painful conditions.

Our multidisciplinary centre currently houses Mettler Electronics’ latest Radial Pulse Activation Therapy machine, the Auto Wave 695 used to relieve pain and increase local circulation for orthopaedic injuries that affect tendons and ligaments.

The Auto Wave 695

This relatively new, non-invasive therapy device, which was on display recently at the Caribbean Medical Devices Exhibition at the Jamaica Pegasus hotel in Kingston, uses a compressed air ballistic pulse energy generator that transfers pulse energy to the transmitter in the hand piece.

Treatment of Adhesive Capsulitis (Frozen Shoulder)

Treatment of Plantar Fasciitis

Shock wave is an acoustic wave which carries high energy to painful spots and area of tissues with long standing chronic injured. The energy helps with healing by regenerating and repairing bones, tendons and other soft tissues. Shock wave stimulates new blood vessel formation called neovascularization, into injured tissue as well as the release of growth factors and other active substances that promote healing. This occurs in the tendon, bone and tendon-bone interface.

Shock wave works by producing kinetic energy that is converted into pulse energy when the bullet strikes the surface of the transmitter. The acoustic pulse energy is transformed into impact energy from the contact area into the therapeutic target tissue radially. The high energy acoustic waves trigger the body’s healing response, reduce pain and help increase circulation.

Shock wave therapy was first introduced to orthopaedic medicine in the early 1980s and has since grown in popularity among clinicians who have used this modality to treat common, orthopaedic conditions including Plantar Fasciitis, muscle strain- hamstring, groin pain, Lateral Epicondylitis (elbow pain), Morton’s Neuroma (foot pain).

The neck or cervical spine has bony parts called vertical bodies and discs that serve as cushion in between them. The discs are soft and allow for flexibility but when they are injured, they lose the support that they would usually offer the spine and a part of the disc is squeezed out of place and often pressed on the nerves and the spinal cord that are in close proximity. Herniated disc in the neck or slipped disc may cause severe neck pain that runs down the shoulders, arms and fingers. It often causes tingling and numbness. These symptoms give a sense of pinching of the nerve and may occur because the nerves are being compressed

A herniated disc in the neck, known as cervical spine disc herniation, may cause a severe, sharp shooting or electric, shock-type pain that runs down the shoulders into the arms and often into the fingers. The pain is made worse with moving the head, holding the head down, or sleeping may become uncomfortable, the person may feel some relief by lifting the arm and resting it over or on the head.

The discs in the neck may become herniated after trauma, a strain on the neck especially when the neck is positioned poorly. It may also be seen in the age-related, degenerative changes that take place in the spine that lead to spine arthritis also referred to as Spondylosis.

In severe cases, disc herniation that compresses the spinal cord actually affects the function of the spinal cord itself, causing weakness in the arms and legs, problems with walking and balance and loss of control of bowel and the bladder. A medical doctor should be consulted urgently if these symptoms occur as this will need urgent, medical intervention.

Management of cervical disc herniation, without spinal cord compression, includes controlling the pain with anti-inflammatory medication, therapy, exercise and evaluation to see if there is anything that the person is doing at work or at home that may be aggravating the pain, and putting pressure on the discs. For example; a good way to sleep and avoid putting too much pressure on the discs in the neck, that may cause pinching of the nerve, is to sleep with your head and neck supported properly.

Your neck should be in the right or neutral position. This does not happen when you use a very large pillow or too many pillows that twist and bend your head too high above your body, or on the other hand, having your head too low such as using a very low pillow or no pillow at all, especially when you sleep on your side.

When you sleep on your tummy, you often end up turning your head to one side and this position may cause twisting of the neck and pinching of the nerves. An ideal pillow is one where your head and neck are well-supported and the spine is in a normal and neutral position.

An exercise routine for the neck that maintains range of motion and muscle strength is essential to preventing neck pain and to maintain a healthy spine.

Frozen shoulder is a condition characterized by stiffness and pain in the shoulder joint which is medically known as adhesive capsulitis. The shoulder is made of bones, ligaments and tendons encased in a capsule of connected tissues. The capsule thickens and tightens around the shoulder and restricts your movement and this can be very painful.

Structure of the Shoulder

The shoulder is made up of a connection of three bones- the arm bone (the humerus), the shoulder blade called the scapula and the clavicle (the collar bone). They meet together around the shoulder and you have articulation or movement around each other. There are four rotator cuff muscles that keep the shoulder stable; two at the back, one at the top and one in front of the shoulder blade. They all keep the shoulder together. The shoulder is a very mobile joint; it can almost go around in a circle therefore it is more prone to injury.

Sign and Symptoms

With frozen shoulder, you have pain in almost every movement, in fact, you are unable to lift your shoulder. This happens after your shoulder has been immobilized meaning you’re not moving your arm for a period of time. This is seen in individuals who have had Rotator Cuff Injury or a broken arm, a broken collar bone, after a stroke or even after mastectomy (breast surgery). Essentially what happens within the shoulder joint is the injury/condition limits movement around the shoulder and it seizes up. The capsule becomes so rigid that it inhibits movement. This can be very painful and it limits your function.

Stages of Frozen Shoulder

Freezing Stage

This is the earlier part of the frozen shoulder pathway characterized by high pain intensity with movement.

Frozen Stage

In the frozen stage, it is more difficult to move the shoulder but the pain is not as intense as the freezing stage.

If the condition is detected during the freezing stage, a physiatrist or musculoskeletal doctor such as an Orthopaedic surgeon can offer treatment that will decrease the pain and increase mobility.

Thawing Stage

It’s interesting to note that frozen shoulder is self-limiting meaning that the condition can resolve on its own after 12 – 18 months, introducing the thawing stage. In this stage, the pain returns but it eventually goes away, resolving the condition.

Risk Groups

The older you become, the more susceptible you are to frozen shoulder. Specifically, people over 40 years old and women are more prone to frozen shoulder. Studies have shown that reduced mobility of the arm predisposes individuals to frozen shoulder. There are systemic diseases that may influence frozen shoulder such as Diabetes, Thyroid problems, cardiovascular diseases and even Parkinson’s disease.

Treatment

Doctors will recommend over-the-counter, anti-inflammatory medication such as ibuprofen and aspirin that will reduce the pain and inflammation.

The therapist will help to increase the range of motion by recommending appropriate shoulder exercise.

The musculoskeletal doctor such as physiatrist, can inject steroid injection. During an examination for frozen shoulder, the physiatrist will inject the shoulder with numbing medication similar to what you receive before a dental procedure. This numbing medication will reduce the pain allowing the physiatrist to manipulate and move the shoulder increasing mobility in the joint.

If the pain is unresolved, you may need to see an orthopaedic surgeon who may treat you with arthroscopic surgery (a small camera) to identify the scar tissues or adhesions (looking similar like cobwebs).

It is important to visit your general practitioner or primary medical doctor to identify the cause of your shoulder pain so that the most appropriate treatment can be recommended.

Have you ever felt a pop or pain in your shoulder while stretching to grab an item behind you? Do you feel pain in your shoulders when you lift your arms above your head? These may be symptoms of injury around the tendons of the shoulder known as Rotator Cuff Syndrome.

The shoulder is a very mobile joint and gets its stability from the muscles and tendons arranged in a cup or cuff-like manner, around the joint. These structures may be injured from sudden movement that tears the tendon, as seen when you lift a heavy item or overuse from repetitive, overhead activity as seen in painting, carpentry, playing tennis or volleyball.
Some people get rotator cuff injury even without having an aggravating factor and they are found to have weakness or poor control of the muscles around the shoulder.

What are the symptoms of Rotator Cuff Syndrome?

The pain is felt in front of the shoulder and often radiates down into the mid-arm and worsens whenever the person reaches overhead. If this injury is left untreated, the pain may be felt while at rest. The person may experience decreased range of motion in the shoulder especially when lifting the arm.

How do I treat my shoulder pain?

The treatment of rotator cuff injury is dependent on the severity of the injury and it is aimed at controlling the inflammation in the tendons and restoring the range of motion and strength so that you can improve the function of your shoulder.

An ice pack can be applied as soon as the injury occurs. It can be applied for fifteen minutes. You can make your own ice pack by putting ice cubicles in a plastic bag and then wrap the plastic bag in a towel to prevent skin irritation from the ice directly placed on your skin. Icing can be done 3- 4 times per day.

Over-the-counter, anti-inflammatory medication such as ibuprofen or naproxen can be taken with food for short periods.

Basic Exercise for Shoulder Pain

• Pendulum Exercise

A basic exercise program may begin with pendulum exercise.

This is done by leaning forward and allowing the affected shoulder and arm to hang down freely. Start by rotating your arm in small circles, in one direction then switch direction.

Count to 10 each time. Start with very small circles and increase the size of the circle every day as the pain improves until you can make a large circle without pain.

• Wall Crawl

Another exercise that you can try for treating your shoulder pain is to use your fingers to crawl up a wall. Crawl as far up as you can get without pain and as the pain improves, try to crawl higher each day.

• Glass Wipe

Hold a soft cloth in your hand, stand in front of a large mirror or glass, even a wall with a smooth surface. Bend your elbow and raise your hand to your eye level, start by wiping a small area in one direction and then change direction. As your pain improves over time, increase the size of the circle.

If the pain persists, a doctor will recommend therapy where ultrasound and other treatments are added. In some cases, a steroid injection around the shoulder in the inflamed area may be necessary.

Surgery may be necessary if the pain persists even with treatment or if there is a complete tear of the tendon.

Avoid aggravating activities during shoulder rehabilitation and comply with a home exercise program to improve and resolve your shoulder pain.

On Sunday, October 22, our Medical Director, Dr. Paula Dawson was a presenter at the launch of the Haemophilia Society of Jamaica at the Courtyard Marriott Hotel in Kingston, Jamaica. She spoke on the role of the physiatrist in the treatment program for Haemophiiacs.

On Wednesday, October 25, the Rehabilitation Institute of the Caribbean hosted its second public lecture entitled, “Non-Surgical Treatment for Lower Back Pain”. The presenters – Medical Director and Jamaica’s only US-Board Certified Physiatrist, Dr. Paula Dawson; Doctor of Physical Therapy, Dr. Norell-Lee Morrison Ramsay; and our distinguished guest speaker, Women’s Health Specialist, Dr. Bernadette Frankson delivered exceptional presentations. The event was sponsored by Pfizer.

Knee pain affects persons of all ages; young and old. Incidentally, it is one of the most common musculoskeletal complaints made by patients. The knee joint’s main function is to bend and straighten for moving the leg. In order to perform these actions and support the entire body, the knee relies on a number of structures including bones, ligaments, tendons and cartilage that can easily be damaged.

What are the common causes of knee pain?

The common causes of knee pain include strained or torn ligaments or tendons around the knee, meniscal tear (which usually occurs when twisting or turning quickly or with the foot planted while the knee is bent); Patellofemoral Syndrome or maltracking syndrome (a condition characterized by severe to mild pain originating from the kneecap); dislocating knee cap; gout; trauma; bone abnormalities and fracture.

Groups at Risk

People who are most at risk of knee pain include individuals with weak muscles (quadriceps) around the knee, runners and other athletes who do not secure the kneecap properly before bending or extending the knee; the elderly with arthritis and people recovering from a slip and fall, car accident and other trauma to the knee.

Treatment

The recommended treatment for knee pain is dependent on the cause of the pain. The first line of treatment for sudden onset of knee pain due to trauma or other acute causes can be recalled using this acronym: PRICE.

P- Protect the knee using a brace, bandage or crutches to prevent any further injury.

R- Relative rest because prolonged immobility can lead to loss of muscle strength and further weakness in the muscle.

I-Ice which should be done at 15 minutes intervals with 5 minutes rest, and repeated 3-5 times, to control swelling and reduce the pain.

C- Compression with a bandage which can also control swelling. Be sure not to bandage the knee too tight as this may lead to further pain, difficulty bending the knee and slow blood flow.

E- Elevation which will reduce swelling by allowing the excess fluid to flow back into the blood stream.

Mild to moderate cases of arthritis usually respond well to an effective therapy program and a few cases will need injection with medication to control inflammatory or regenerate the injured structures in knee. A lubricating injection is appropriate in other cases.

Surgery is necessary in severe cases.

Knee rehabilitation with a home exercise program may be essential for recovery.

Our Medical Director, Dr. Paula Dawson was the guest presenter at the first staging of SCOPE “My Journey As A…” career in medicine series held at the Faculty of Medical Sciences Teaching & Research Complex on the University of the West Indies Mona Campus.

The session, organised by a professional development committee within the Jamaican Medical Students Association, focused on Dr. Dawson’s journey to becoming Jamaica’s only US Board-certified Physiatrist. Dr. Dawson recalled her academic journey and shared insights into the field of Physiatry, complimented with a few anecdotes from her many years of experience.

According to Local Exchange Officer of SCOPE, Vikram Asnani, “we also asked her to specially highlight the importance of being a professional in her everyday life, and to give guidance on how she has honed her professional skills.”

More information on SCOPE

The Standing Committee on Professional Exchange (SCOPE) has launched a “My Journey As A…” series where professionals from different areas of medicine facilitate an engaging session with the UWI Mona medical student cohort. SCOPE, operated through the International Federation of Medical Students Associations (IFMSA), is a student-run organisation that facilitates the global exchange of medical students, thereby promoting cultural and intellectual understanding of different medical systems. SCOPE’s primary mandate is to offer educational programs including electives/clerkships to medical students worldwide.

Cerebral Palsy is a collection of syndromes characterized by disorders of movement and posture caused by non-progressive injury to the immature brain. This condition occurs when the area of the brain that controls movement has been damaged close to the time of birth or early in the child’s life. Therefore, some children are born with the condition (congenital) or the symptoms may develop after birth (acquired).

Is My Baby At Risk?

The main risk factors for cerebral palsy (CP) that occur before or at the time of birth include; low birth weight especially babies who weigh less than 5 pounds or 2500 grams, decreased oxygen to the baby during the delivery called perinatal hypoxia even in babies delivered at full term; and maternal problems such as certain infections while pregnancy e.g. Rubella, German measles, Chicken Pox and Herpes as well as exposure to toxins, decrease blood flow from mother to baby across the placenta. Risks for CP after delivery include problems that affect the baby’s brain, such as an infection in the brain (encephalitis) or around the brain (meningitis), brain trauma, severe jaundice which is the presence of extremely high levels of bilirubin that causes the yellowing of eyes in new born as well as near drowning which would cause decreased oxygen to the brain.

 What are the signs of Cerebral Palsy?

The degree of the brain injury will determine the range of severity of the impairments. The main symptoms and signs in Cerebral Palsy are muscular and movement problems. These may be associated with:

• variation in muscle tones – either too stiff or too floppy
• poor coordination and balance,
• overdeveloped or underdeveloped muscles
• delays in the development of gross and fine motor functions
• involuntary movement
• limited range of movement
• difficulty producing speech

Other impairments that may accompany a diagnosis of CP include seizure disorder, intellectual development disorder, learning disabilities, eye movement dysfunction, mouth movement dysfunction and gastrointestinal impairment.

How can parents get help?

It is recommended that parents consult with a medical doctor, preferably a paediatrician who will assess the child for one or more of the signs mentioned above. The paediatrician’s assessment will include a discussion about the child’s development as well as the mother’s medical history during the pregnancy. He/she will examine the child’s posture, movement, muscle tone, motor skills and reflexes. A diagnosis of Cerebral Palsy will require several assessments to determine the child’s developmental needs. Additionally, a comprehensive diagnosis is not usually completed until the child turns 2 years old as some symptoms may not be apparent before that age.

Following the diagnosis, the paediatrician will recommend a team of medical professionals that includes:

A Physiatrist/Rehabilitation Doctor– who will treat the child’s physical problems by using oral antispasticity agents such as muscle injection to decrease the stiffness such as botulinum toxin injections and phenol injections; and intrathecal baclofen pump management to improve function and decrease pain.

An orthopaedic doctor will treat problems with muscle, tendon, or bone development.

A neurosurgeon will treat problems relating to the brain, spinal cord or the spinal nerves to decrease stiffness.

Based on the severity of the child’s medical diagnosis, continued care by a team of therapists with specialized training may be recommended. The team of therapists may include:

Physical Therapist/Physiotherapist

Occupational therapist

Speech, language and swallow therapist

Nutritionist

Otolaryngologist (Hearing doctor)

Ophalmologist (Eye Doctor)