Morton’s Neuroma – Symptoms, Causes, Treatment

What is Morton’s Neuroma?

Morton’s Neuroma is a painful swelling of the nerve running either between the second and third toes or the third and fourth toes. It is often part of a bursa (a soft tissue swelling, often found asymptomatically in feet) and some swelling around the nerve. It is called Morton’s Neuroma because it was first written up in the medical literature by Thomas Morton in 1867. The word neuroma is the medical term used for swelling on a nerve. It is not sinister but can often cause disproportionate pain in the forefoot.

What are the Symptoms of Morton’s Neuroma?

  • Pain in the forefoot
  • Numbness or tingling in the toes
  • Feeling as if you are walking on a pebble
  • Feeling if there is something inside your shoe

What are the Causes of Morton’s Neuroma?

No one knows!

There are theories about tight-fitting shoes, particularly ladies’ footwear, repetitive low-grade trauma, such as the frequent wearing of high-heeled shoes, and rarely, injury. However, if this was the case, many more sportsmen would have a neuroma. Most cases are idiopathic.

What are the Risk Factors of Morton’s Neuroma?

Not really!

We know it occurs more frequently in women, probably because of footwear. Still, lots of ladies wear fashionable shoes and never have any problems! The shape of the feet does not increase the likelihood of developing a neuroma. There are no genetic factors.

Can I Prevent It From Occurring?

As we do not know the cause, we can do little to prevent it from occurring. Of course, if you feel pain in certain (tight fitting) shoes, it would be a good idea to try another pair of shoes!

How is Morton’s Neuroma Diagnosed?

It is largely a clinical diagnosis and is best assessed by a foot and ankle surgeon familiar with diagnosing and treating these.

X-rays are important to exclude a bony cause for the forefoot pain.

Scanning with the ultrasound machine or the MRI scanner does not always confirm the presence, nor can it confidently exclude a neuroma.

Does Morton’s Neuroma Cause Any Lasting Harm?

Not at all, but usually, it becomes enough of a problem that people seek help for the pain. 

What is the Treatment for Morton’s Neuroma?

First, seek advice from a foot and ankle surgeon to confirm the correct diagnosis. Once the diagnosis is established, the treatment options are: 

  • Simple painkillers, such as anti-inflammatories
  • Insoles
  • Injection of Cortisone
  • Surgery to remove the painful nerve

Although a neuroma is painful, there is no need to rush into surgery, and simple measures should always be tried first. Your surgeon will discuss this with you.

What are the Surgical Options for Morton’s Neuroma?

Several options are suggested in the literature. Again, your foot and ankle surgeon will discuss this with you. The most predictable procedure is a short, day-case operation to excise the Neuroma. This will often leave some numbness along the side of the two toes, but to most patients, this is an acceptable compromise to be free of the restrictive pain.

The Foot and Ankle Clinic at the Dubai Burjeel Hospital for Advanced Surgery would be delighted to see and help with your foot pain and discuss available treatments. The first step is to get the correct diagnosis and formulate a treatment plan that you are comfortable with.


Our Orthopedic Expert Foot & Ankle Expert


Dr. Andrew Foggitt

Consultant Orthopedic Foot & Ankle Surgeon

Burjeel Hospital for Advanced Surgery, Dubai

Dry Eyes – Symptoms, Causes & Treatment

What are Dry Eyes?

Dry eyes are a condition in which the eye does not produce enough tears. Tears are essential because they keep the eye lubricated and moist. The result is that it becomes red and irritated and can even lead to a loss of vision if left untreated.

What Causes of Dry Eyes?

Dry eyes are a common complaint among many people, but several underlying causes exist. The most common cause is the result of decreased tear production. This is often due to a deficiency in one or more components that make up tears: mucus, water, and oil. The most common cause of decreased tear production is meibomian gland dysfunction (MGD), which occurs when the meibomian glands do not produce enough oil to keep your eyes moist.

Environmental Conditions: Wind and cold weather can make your eyes dry, and prolonged usage of mobile phones, tablets, and computers can also cause this condition and make you uncomfortable.

A decrease in tear production can also be caused by health conditions like diabetes or autoimmune disorders such as Sjogren’s syndrome, in which the immune system attacks the tear glands and reduces tear production.

Tear production can be affected by several other factors, including:

Age: As we age, our tear glands begin to slow down. This is often why most people experience dry eyes as they age.

Contact Lens: Contact lenses can irritate and damage your eye’s surface, leading to dryness.

Medications: Some medications, like allergy eye drops or steroid ointments, may cause your eyes to feel dry and irritated.

What are the Symptoms?

The symptoms can vary from person to person, but they typically include:

  • Eye discomfort
  • Eye irritation or pain
  • A gritty feeling in your eyes
  • Difficulty focusing on near objects
  • Burning sensation in the eye
  • An itchy or scratchy feeling in the eyes
  • A foreign body sensation (feeling like something is in your eye)

How is it Diagnosed?

Dry eye is diagnosed using a comprehensive eye exam. The Ophthalmologist will take a thorough medical history and perform an eye examination. The eye doctor may use any of these tests to diagnose the condition:

Visual Acuity Test – This test measures how well you can see at a distance and near.

Punctate Corneal Staining – This test looks for white spots on the surface of your cornea, which can indicate dryness or infection.

Schirmer Test – This test measures how much liquid you produce when you blink. It’s used to help diagnose dry eyes caused by insufficient tear production.

Tear Film Break-Up Time (TBUT) – To measure TBUT, fluorescein strips are instilled into the patient’s tear film. The patient is asked not to blink while the tear film is observed under a broad beam of blue illumination. A short tear break-up time is a sign of a poor tear film; the longer it takes, the more stable the tear film.

What is the Treatment for Dry Eyes?

The first step in treating the condition is to ensure that you address all the possible causes of your symptoms. This means ensuring that your eyelids are clean and free of debris, that you don’t have any allergies or irritants in your environment, and that you aren’t spending too much time staring at a computer screen or other devices.

Suppose these steps do not help to alleviate your symptoms. In that case, you may want to consider using artificial tears or other prescription eye drops. These drops contain lubricating agents that help keep the eyes moist and comfortable.

If the problem persists, it’s likely time for further evaluation by an ophthalmologist specializing in treating dry eyes.

How to Prevent Dry Eyes?

The best way to prevent it is by keeping your eye area clean and healthy. This can be done by regularly washing the area with gentle, non-irritating soap and then rinsing it with water.

To keep your eyes hydrated, drink plenty of water throughout the day. You should also avoid smoking and drinking alcohol, as these can dry your eyes. You should also avoid wearing contact lenses for long periods as this can cause your eyes to become dry.

If you are experiencing dry eye symptoms such as burning, itching, or redness in both eyes at any time during the day, it is recommended to consult an eye doctor

Dry eyes are a common problem that can be treated. If you are experiencing any of the symptoms of dry eye, consult with our experienced Ophthalmologist, who provides treatment for dry eyes and any other ocular diseases.


Our Expert Ophthalmologist


Dr. Shobhana Pariyani Krishna

Specialist Ophthalmology

Burjeel MHPC Health Center, Abu Dhabi

Idiopathic Intracranial Hypertension – Symptoms, Causes & Treatment

What is Idiopathic Intracranial Hypertension? 

Idiopathic intracranial hypertension, or IIH, is a condition that causes increased pressure inside the skull. This pressure can cause severe headaches and vision problems. It is also known as pseudotumor cerebri and benign intracranial hypertension. IIH is a rare but essential disease associated with significant morbidity.  

The condition was first described in 1897, though its cause remains unknown. About 2 per 100,000 people have newly affected annually, most commonly affecting women aged 20–50. Females are affected about 20 times more often than males. 

The pathophysiology of IIH involves dysregulation of CSF dynamics and venous sinus pressure. After circulating through the body, CSF usually is reabsorbed into the body through blood vessels; however, if too much fluid is produced or not enough is reabsorbed, the CSF can build up and cause pressure within the skull, which is an enclosed space. 

What Causes Idiopathic Intracranial Hypertension? 

The exact cause of idiopathic intracranial hypertension is unknown. Still, it’s thought that several factors can cause the increased pressure 

  • Obesity 
  • Head trauma or injury 
  • Birth control pills and certain medicines

Who is at Risk for Idiopathic Intracranial Hypertension? 

In most cases, it affects people between 20 and 40 years old who are female. However, it also affects some children and men. It is unclear why this condition occurs or how to prevent it from happening again. People at risk for idiopathic intracranial hypertension include

  • People who are overweight 
  • Have a history of head trauma 
  • Have a genetic predisposition to the condition

What are the Symptoms of Idiopathic Intracranial Hypertension? 

The symptoms of idiopathic intracranial hypertension (IIH) can vary from person to person. In addition to headaches, the most common symptoms include: 

  • Pain in the back of the head or neck 
  • Blurred vision or loss of vision
  • Dizziness or vertigo 
  • Double vision 
  • Trouble focusing on the eyes
  • Nausea or vomiting 
  • A stiff neck 

How is IIH Diagnosed? 

TTo diagnose IIH, a Neurologist will perform a physical examination after taking the patient’s medical history.

Comprehensive Eye Exam. The doctor may order a comprehensive eye exam, including checking for papilledema ((swelling of the part of the optic nerve (optic discs)). Suppose there’s a strong suspicion of IIH based on symptoms and the exam results. MRI of the brain as well as MRA of the head and/or CT cerebral venography should be requested as part of the required investigations.

A Lumbar Puncture (Spinal Tap). During this procedure, the doctors insert a needle into the lower back , in the lumbar region. During a lumbar puncture, a needle is inserted into the space between two lumbar bones (vertebrae) to remove a sample of cerebrospinal fluid. The amount of fluid removed will be measured (measurement of CSF pressure.), which allows doctors to determine whether the patient has excess cerebrospinal fluid in the head or not. The test is diagnostic and therapeutic as well. 

What are the Complications of IIH? 

The complications of idiopathic intracranial hypertension are numerous and can be dangerous. The most common complication of IIH is papilledema—swelling of the optic disk caused by increased pressure inside the skull. Papilledema can cause vision loss if left untreated, but it usually resolves once IIH is treated.

How is Idiopathic Intracranial Hypertension Treated? 

Idiopathic intracranial hypertension (IIH) is treated with medications and lifestyle changes. 

First, the doctor will prescribe medications to help relieve the pressure around the brain and on the optic nerve. 

Sometimes, an individual may need surgery to treat idiopathic intracranial hypertension. Surgery is done to remove excess cerebrospinal fluid from around the brain and spinal cord. 

Individuals who have signs of IIH must see a doctor immediately. Untreated IIH can cause permanent vision damage, so it’s essential to find out what’s causing the symptoms and get treatment as soon as possible. Our expert Neurologists at Burjeel Hospital, Abu Dhabi, provide comprehensive care for patients with IIH and offer specialized treatments including medications and surgery to help manage this condition. 


Our Expert


Dr. Atta Ghassan Al Khaznaji

Head of Neurology Department | Specialist Neurology

Burjeel Hospital, Abu Dhabi

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Pain Clinic at the Burjeel Hospital for Advanced Surgery

Pain Clinic

Most people experience pain at least once in their lifetime, whether in the form of back pain, knee pain or shoulder pain. Often, the disorders are fortunately benign and disappear after a brief period of rest, exercise and the observation of a few behavioral rules. If the pain does not disappear, the Pain Clinic team of specialists at the Burjeel Hospital for Advanced Surgery, Dubai, will accompany you with the help of proven treatment measures for the pain.

Pain is maintained by complex mechanisms and can have disastrous consequences on social, family and professional life. Patients referred to Pain Clinic should quickly receive a standardized assessment based on a holistic approach and a personalized self-management plan.

The Pain Clinic at the Burjeel Hospital for Advanced Surgery, Dubai, offers a global and comprehensive approach, from initial assessment to treatment of all types of orthopedic pain due to from sports injuries, varied conditions and all other day-to-day activities.

Here’s more you need to know about our Pain Clinic!

Our muscles, joints, ligaments and other parts are subjected to multiple stresses and can become the sites of ailments often due to sports injuries, monotonous load, age or other related factors. Our orthopedic surgeons team specializes in Sports Medicine and has expertise and experience in treating all kinds of Orthopedic pain through a modern diagnostic and therapeutic approach.

The Burjeel Hospital for Advanced Surgery’s Pain Clinic team directs patients to the most appropriate care as needed. The coaching encourages patients to take control of their pain care plan gradually. The goal is to develop a care plan tailored to each patient’s specific needs based on evidence-based recommendations.

The first step is a correct diagnosis through a clinical examination and appropriate radiological and neurological screening, after which a treatment adjusted as needed can be initiated. Pain treatment options range from conservative treatment (including invasive pain treatment) to conventional surgical techniques, including various microsurgical, percutaneous and minimally invasive interventions.

In addition to the classic stabilization technique (dorsal or ventral), we use dynamic implants. The objective of each treatment is as short a rehabilitation as possible, a rapid return to professional activity and the minimization of the damage.

Burjeel Hospital for Advanced Surgery has a team of certified Orthopedic Surgeons and pain specialists experienced in treating varied conditions and injuries and related structures. Our team has the expertise in treating all forms of sports injuries, ranging from shoulders, ankles, knees, elbows to spinal injuries. The different spine conditions include lumbar and cervical disc herniation, narrow lumbar canal, narrow cervical canal, etc.

Palette of Treatments

  • Muscle tears
  • Repetitive injuries
  • Tendon or Ligament injury
  • Achilles tendonitis
  • Wrist fracture
  • Scapula fracture
  • Clavicle fracture
  • Ankle fracture
  • Runners’ knee
  • Tennis or golfers Elbow
  • Rotator Cuff Injury
  • Revision of failed ACL Reconstruction Surgery
  • RSLAP Repair

Types of Pain Due to Sports Injuries Treated at the Pain Clinic

Different spinal pain conditions are treated at the pain clinic. If you recognize yourself in any of the spinal pain examples below, contact us at to book an appointment to get a precise diagnosis and a therapy proposal.

Muscle Tears

Muscle tears or fiber breakage can be caused by a blow or contusion or by a sudden muscle contraction. It consists of the rupture of the fibers that make up the muscle. It generally affects muscles of the lower limbs such as the gastrocnemius, the hamstrings and the quadriceps. Its severity is given fundamentally by the number of muscle fibers torn in the injury. The main symptom is sudden, sharp, localized pain. It is one of the most frequent injuries in all types of sports.

Ankle Sprain

This injury is very common in sports practice but also in daily activity. In most cases, it occurs due to an inward foot movement that causes tension in the ligaments. The sprain can be mild when there are micro-tears in the ligaments, moderate when there is a partial tear, and severe when the ligaments are completely torn. The most common symptoms are bruising and pain.

It occurs mainly in impact sports or in which the practice is carried out on unstable surfaces.

Tendinopathies

Popularly known as tendinitis, they consist of chronic inflammation of the tendon, that is, over a long period, giving rise to micro-tears in the tendon tissue.  Tendonitis can lead to different sports injuries, such as:

  • Achilles tendons
  • lateral epicondylitis (tennis elbow)
  • medial epicondylitis (golfer’s elbow)
  • patellar tendonitis (jumper’s knee) or
  • patellofemoral pain syndrome (runner’s knee)

Although none of these three injuries is exclusive to athletes, lateral epicondylitis is common in people who play racket sports. Medial epicondylitis is common in golfers or athletes who play racket sports or do weight training. Patellar tendinitis occurs in people who play sports that involve repeated jumping, such as basketball and volleyball. It happens when the tendon connecting your shinbone to your kneecap becomes inflamed. Runner’s knee occurs when your kneecap has veered off the patellar groove.

Fractures

Perhaps the most serious injury that can affect the bone. The most frequent causes of fractures are falls or excessive muscular activity that lasts over time. In addition to fractures, bone injuries include others, such as those caused by overload, which can inflame the periosteum (tissue that covers the bone) and lead to breakage.

In most cases, immobilization, rest and rehabilitation are required, as well as surgery in the most severe cases. In both cases, it requires a subsequent progressive recovery.

Knee Ligament Injuries

Ligaments are the fibrous tissue that joins bones together. Those that are most frequently injured are those of the knee, where we find the following ligaments:

  • Collateral medial.
  • Collateral lateral.
  • Rear cross.
  • Former crusader.

When the tear or rupture of one of the ligaments occurs, there is localized inflammation with severe pain and a sensation that the knee gives way when pressure is exerted on it.

Spinal Conditions

Back pain occurs in patients in various ways: from moderate discomfort to intense pain in the dorsal and/or lumbar region and sometimes in the legs, which can seriously hinder movement.

Cervical Pain occurs in the upper back area, such as the nape, shoulder area, and lateral neck area often progresses to the shoulder blades and can even present as a headache. It is a very common pain in young people often caused by maintaining incorrect postures or by sports practices. However, it can also occur due to a problem in the vertebrae, spinal discs, or a muscle complication, such as contractures.

When a patient presents back pain, it is recommended that other possible pathologies such as cardiac or pulmonary pathologies be ruled out. The causes that generate it are varied, including osteoarthritis, herniated disc, and narrow spinal canal, among others.

Pain Therapy at the Pain Clinic

The basis of each therapy is as precise diagnostic clarification as possible in cooperation with colleagues in the practices and the various specialties represented in the hospital.

Back pain can be felt in many ways due to different causes. The cause and therapy must, therefore, always be determined individually. We have a team of highly trained professionals with knowledge of pain techniques and procedures such as:

Pharmacological Treatments

Pharmacological treatments consist of the oral administration of specific drugs according to the pathology to be treated and the pathological history of the patient.

Pain medication provides daily relief without treating the condition. Inflammation medications are reserved for periods of crisis. They can be given systemically (tablets and suppositories are as effective as intramuscular injections) or locally, in the form of corticosteroid injections.

Joint and Spinal Injections

This intra-articular administration is applied to patients with osteoarthritis, tendinitis, bursitis or some patients with rheumatic diseases.

Targeted infiltration of painful structures, pain-carrying nerve fibers, facet joints, and nerve root envelopment under X-ray or CT guidance can often successfully eliminate severe pain. In addition to treatment, infiltrations are also used for diagnosis and determining the causes.

Radiofrequency

Radiofrequency is a procedure that uses high-frequency current through a needle to exert its therapeutic action on different joints or nerves.

Radiofrequency therapy allows the pain associated with irritated osteoarthritic facet joints to be lastingly and gently eliminated, the procedure can be carried out as part of outpatient treatment, and after a few hours, the patient can leave the hospital. Iliosacral joint and pelvic pain are often treated in the same way.

Rehabilitation

Rehabilitation, including physiotherapy, balneotherapy, tractions, occupational therapy, corset, neck brace, etc., is particularly important for pain. The means of rehabilitation differ according to the objective sought: to stop a congestive attack of osteoarthritis more quickly, strengthen the damaged bone, and reduce pain and daily discomfort. Physiotherapy, also known as physical therapy, is a science responsible for using all physical agents.

A surgical procedure is justified if pain is resistant to medical treatment for more than six months and affects the patient’s daily activities.

A Brief Overview of the Surgical Procedures Offered at the Pain Clinic

The Pain Clinic of Burjeel Hospital for Advanced Surgery has a team of Orthopedic surgeons specializing in treating osteoarticular disorders. The extensive expertise of our specialists in sports surgery has supported many athletes in sports practice.

Here’s a summary of the surgical procedures carried out at the Pain Clinic in the context of sports surgery.

Sports Surgery for Ankle Injuries

  • Rupture of the Achilles tendon: The surgery involves reinserting the torn ends of the tendon.
  • Ankle instability and ankle sprains: Sprains are the daily lot of athletes. They do not necessarily require surgical intervention, but in the case of repeated sprains leading to proven instability, surgery can be considered.
  • Previous ankle conflict: Generally, surgery is unnecessary, but if non-surgical treatments fail to stop the pain, it can be considered.

Sports Surgery Related to Shoulder Injuries

  • Instability of the shoulder: The shoulder can be dislocated. This type of trauma is benign and does not require surgery. However, as for the ankle, repeated dislocations can indicate instability, which can be the subject of an operation.
  • Pathologies of the rotator cuff: These are the tendons that give the shoulder its exceptional mobility. Certain movements can seriously damage this system: tendonitis and tears can threaten the athlete.

Sports Surgery Related to Knee Injuries

  • Sprains of the knee: This is a frequent trauma whose severity can be variable. A simple stretching of the ligament will not necessarily require surgery, but if it leads to serious issues, such as patellar instability, surgery is considered.
  • Ligament Injuries: Depending on the nature of the affected ligament (interior or posterior), the management will be different. Consulting sports and knee surgery specialists is essential for a good diagnosis.
  • Meniscal pathologies: Like the ligaments, the meniscus is a fundamental element of the knee that may be subjected to various traumas. Meniscal lesions are often tears that will usually undergo meniscectomy or meniscal suturing under arthroscopy.

Thanks to technological advancements and the use of minimally invasive techniques, there are shorter recovery periods than traditional surgeries. 

Although results vary from person to person, many of the above procedures successfully relieve most or all of the pain and symptoms caused by the different sports injuries.

Burjeel Hospital for Advanced Surgery is a reference to pain care in Dubai, having a board-certified team of Orthopedic Surgeons with unparalleled expertise in treating a wide range of conditions and sports injuries. A highly qualified team is at your service with several qualified and complementary professionals who work in synergy to offer you the optimal care necessary to recover your health as quickly as possible.

Shoulder Pain – Symptoms, Causes & Treatment (Surgery)

For some time now, have you had recurrent or permanent shoulder pain? Know that this is a frequent pain: the shoulder is the most mobile of our joints, involved in many daily activities. These pains usually occur in the second half of life but can also affect younger people. When this unpleasant sensation has been present for a longer period and is recurring, affecting your daily activities, it is time to consult an Orthopedic Surgeon.

The shoulder joint is made of 4 joints whose stability and movement depend on four tendons that form the rotator cuff (supraspinatus, infraspinatus, subscapularis, and teres minor). The various joints, tendons, muscles and bursa involved in the shoulder movement characterize the different types of shoulder pain.

If you’re concerned, here’s a detailed explanation of the symptoms and causes of shoulder pain and the surgical and non-surgical treatment options!

Symptoms of Shoulder Pain

Rupture of the Rotator Cuff

Symptoms of a rotator cuff tear depend on the cause of the tear. They are quite discreet, with limited arm abduction if it is a trophic rupture (spontaneous or following repetitive strain injuries). In the event of a traumatic rupture (following a force or violent shock), the symptoms are much more severe, with pain in the shoulder stump and maximum functional impotence.

Slap Shoulder Injury

The SLAP lesion usually produces pain in the shoulder with certain gestures or movements. Clicking sensations may also be felt in certain positions. Shoulder examination with a SLAP lesion shows pain anteriorly or laterally. The shoulder is more or less unstable, and the patient feels a loss of strength in the shoulder and arm, combined with a loss of speed when throwing.

Shoulder Tendonitis

Symptoms of shoulder tendonitis are a pain when extending the arm, getting worse over time. It can also be felt at rest. Sometimes this pain may be accompanied by swelling in the shoulder joint. In addition, the patient may feel a cracking sensation in the joint and stiffness and loss of strength in the arm.

Tendinitis of the Tendons of the Triceps / Biceps

Symptoms of biceps tendinitis include pain in the front of the shoulder joint that extends to the arm and aggravates when bending, stretching, or pressing the tendon. For triceps tendinitis, the pain is located at the back of the elbow.

Shoulder Instability

Symptoms of shoulder instability are sharp, disabling pain during everyday movement. The patient also feels giving way in the shoulder joint, accompanied by cracking/popping sounds.

Shoulder Osteoarthritis

The symptoms of shoulder osteoarthritis are discreet at the beginning of the pathology but intensify over time. The patient feels intermittent pain in the shoulder, especially during rotations, as well as temporary blockages of the joint, accompanied by cracking and progressive stiffness.

Acromioclavicular Arthritis

The symptoms of acromioclavicular osteoarthritis are pain radiating to the neck and the trapezius, present in a virulent way at night because of the prolonged lateral position. This pain is also felt during adduction movements. In addition, it is accompanied by a loss of mobility and disabling stiffness in daily life.

Shoulder Fracture (Humerus + Scapula)

Symptoms of a shoulder fracture include severe pain (occurring during trauma) and an audible cracking sound. Immediately, the patient feels a consequent decrease in shoulder mobility. The shoulder is deformed and swollen, and the pain continues, even at rest.

Clavicle Fracture

Symptoms of clavicle fracture are sharp pain and audible cracking upon trauma. The patient cannot lift or move his arm at all. The area around the collarbone is swollen and has a bump. Bleeding is present, signs of an open fracture.

Acromioclavicular Dislocation

The symptoms of an acromioclavicular dislocation are pain and functional impotence, accompanied by hematoma, swelling and deformity of the shoulder, with a protrusion – under the skin – of the clavicle. The pain is throbbing in chronic forms, with jumps and cracks.

Capsulitis of the Shoulder

Symptoms of capsulitis of the shoulder appear gradually. After the first painful phase, the joint stiffens, limiting the movements of daily life. Subsequently, when the pathology worsens, the pain becomes more intense, occurring even at rest and accompanied by blockage of the shoulder.

Causes of Shoulder Pain

Your shoulder pain can have many causes, including:

  • The consequence of a trauma when the pain follows a sprain, a tear, a dislocation, a tendon rupture or a fracture
  • Inflammation of the rotator cuff or the rotator cuff tear: this pathology is the most common cause of shoulder pain; it can develop through a natural wear effect linked to aging or following repeated overhead movements linked to a sport or your profession
  • SLAP injury is one of the causes of shoulder pain in athletes who use their arms above their heads. It produces pain and limitation of sports activity.
  • Shoulder instability caused by your sports practice: in fact, certain sports result in the appearance of shoulder instability, in particular those which involve throwing or arming (volleyball, tennis, throwing of javelin, etc.). Even if you are young and healthy, these activities can eventually lead to pain
  • An inflammatory or degenerative pathology of the shoulder, such as osteoarthritis or rheumatoid arthritis
  • Bursitis (inflammatory lesion of the bursae) or calcification of the tendons of the rotator cuff

Diagnosis of Shoulder Pain

Following your pain, you have decided to consult your doctor. A clinical examination of your shoulder is carried out to find the cause of your pain and make a diagnosis.

It starts with questioning to know the history and a clinical examination that gives an idea of ​​the lesions that can explain the pain. Additional examinations are then carried out, in which a patient is certainly asked to perform x-rays. In some cases, ultrasound and MRI may be indicated. The imaging assessment confirms the diagnosis and guides towards the right treatment.

Treatment of Shoulder Pain

The initial form of treatment for shoulder pain is non-surgical. Conservative treatment consists of medications and physiotherapy. Exercises to improve shoulder mobility are also recommended. They are basically pendulum exercises and passive mobility of the shoulder and scapula. Despite intensive treatment, sometimes weeks to months go by in which patients do not entirely abandon the manifestation of discomfort and experience that the muscle impingement syndrome has improved. The treatment is based on the following three objectives:

  • Restore  joint function
  • Regain all muscle strength
  • Eliminate the pain

In certain cases where no improvement in pain is achieved from the aforementioned treatments of physiotherapy, mobility, medications, etc., surgical treatment may be recommended. In any case, the patient can help mitigate shoulder pain or get rid of it by following the guidelines indicated by the doctor at all times.

Surgical Treatment of Shoulder Pain

Shoulder surgery offers specific gestures according to the different ailments from which the shoulder joint suffers. It may be a rotator cuff tear repair, a total or reverse shoulder replacement, stabilization of the shoulder, etc. Each therapeutic objective defines an adequate surgical strategy.

Rotator Cuff Tear Repair

In a rotator cuff tear, tendons which allow the good mobility of the shoulder break following frequent friction against the bone of the acromion. The surgical operation is then an adequate restorative solution in which the patient undergoes an arthroscopic repair of the shoulder tendons.

A rotator cuff repair surgery involves docking the ruptured tendon at its natural location around the head of the humerus. This gesture is performed under arthroscopy, i.e. without opening the shoulder joint.

Arthroscopy respects all the anatomical structures and allows access to the joint without attacking the muscles. This technique has proven advantages over traditional surgery, such as minimized blood loss and accelerated post-operative recovery.

Several small incisions of 5mm each are made around the shoulder. An arthroscope, i.e. a small camera, is introduced through one of them to visualize the entire joint and, in particular, the ruptured tendon. Tiny instruments are introduced through the other incisions to perform the surgical procedure.

SLAP Lesion Repair

The evidence mentions SLAP Type II as the most difficult for arthroscopic repair. The patient with SLAP injury should be recommended a stage of Physiotherapy before and after surgery.

Although the surgical method is complex, labral tears must be repaired by arthroscopy, in which the labrum is re-anchored to the edge of the glenoid fossa.

Depending on the different types of SLAP tears and other factors (age, level of activity, other detected injuries, etc.), the surgeon identifies the best method to repair the SLAP tear after arthroscopic surgery. The method may require removing the torn part of the articular labrum or reattaching it using sutures. In some cases, suture repair is not required. Instead, the biceps tendon attachment is done to relieve shoulder pain.

Bicep Surgery

The practice of intensive sport sometimes leads to injuries, such as tendinopathy, that can go as far as the rupture of the biceps. This trauma requires biceps surgery to recover normal mobility.

Biceps surgery is performed by arthroscopy. The gesture depends on the type of lesion but is often that of tenotomy, more or less a tenodesis, depending on the patient’s age and activity. The tenotomy consists of performing a simple section of the long portion of the biceps, while Tenodesis involves fixing the tendon in place at the humerus level and removing its intra-articular part.

Reverse Total Shoulder Replacement and Total Shoulder Replacement Surgeries

A shoulder replacement surgery is recommended to treat shoulder osteoarthritis, which is the wear and tear of the cartilage, accompanied by changes in the bones of the humerus and the scapula, causing loss of mobility and pain. Since cartilage wear is irreversible, anti-inflammatories and painkillers may also end up being ineffective. This is when the question of surgery arises.

The shoulder replacement surgery aims to remove worn areas of bone and cartilage and replace them with artificial pieces.

A shoulder replacement surgery may be a total should prosthesis which respects all of the shoulder tendons in which the ball replaces the head of the humerus and articulates with the glenoid. The second case is the reversible total shoulder replacement when the tendons are ruptured, usually in older patients. The shape of this prosthesis makes it possible to actuate the deltoid muscle, which is present and functional in the vast majority of cases, making it possible to compensate for ruptured tendons.

Shoulder Hemiarthroplasty

Shoulder hemiarthroplasty involves replacing the diseased and degenerated part of the shoulder joint while leaving the functional one intact. Hemiarthroplasty meets the dual requirement of using minimal invasive techniques respecting the soft tissues (muscles, tendons and ligaments) and less voluminous implants, preserving the maximum of the patient’s bone.

Arthroscopy (Bankart Repair) for Shoulder Dislocation

Surgical treatment of shoulder instability is aimed at repairing and tightening the primary stabilizing structures of the shoulder to achieve a stable shoulder. It is usually performed by arthroscopic surgery. A repair of the anterior labral injury or Bankart injury and re-tensioning of the inferior glenohumeral ligament is performed. Bone anchors are used to achieve the fixation and tension of these structures.

Surgical treatment of shoulder instability has a high rate of good results with low risks of operative complications.

Arthroscopy for Acromioclavicular

Acromioclavicular stabilization surgery is recommended in patients with acromioclavicular dislocation. This involves returning the clavicle to its natural level arthroscopically. The principle is to lower the clavicle to connect it to the coracoid by a system of resistant threads tied together. However, the surgery can be complex if it is performed away from the trauma that requires replacing the ruptured ligaments with new ligaments.

If you or your loved one have recurrent or permanent shoulder pain and want to consult an Orthopedic Surgeon, contact the Burjeel Hospital for Advanced Surgery, Dubai. The Orthopedic Surgeons team at the Burjeel Hospital for Advanced Surgery has a distinguished history in complex surgical and nonsurgical procedures. Certified and Fellowship-trained, they are the leading experts in performing complex shoulder surgeries and treating all upper limb conditions. Call +971 800 55 or visit our website to book an appointment today!

Multiple Sclerosis

About Multiple Sclerosis

Multiple sclerosis is a disease that commonly affects young adults, but it can also occur in children and adolescents. MS causes different symptoms related to central nervous system dysfunction. It happens when the body’s immune system attacks and damages nerve cells and their connections in the brain and spinal cord. This process is called an “autoimmune response.” The primary pathology is the destruction of the layer of protein called myelin which forms the protective sheath around nerves. Myelin destruction results in a delay in transmitting signals through the nervous system.

Symptoms of Multiple Sclerosis

Multiple Sclerosis can cause different symptoms but not necessary for every patient to have all these symptoms.

  • Numbness, tingling, and feeling like “pins and needles.”
  • Muscle weakness or spasms
  • Vision problems, eye pain, and odd eye movements
  • Dizziness or imbalance
  • Trouble walking or speaking
  • Problems controlling bowels or bladder
  • Sensitivity to heat, which makes symptoms worse
  • Foggy mind 
  • Fatigue

Forms of Multiple Sclerosis

  • Relapsing-Remitting – This means the symptoms of MS come and go. When the symptoms flare up, it is called an “attack” or “relapse.” These attacks can last for days to weeks and usually get better slowly. In between attacks, people often feel pretty normal. But some people have problems that last even after an attack gets better. Relapsing-remitting is the most common type of MS.
  • Secondary Progressive – Some people who start relapsing-remitting MS get to a point where the symptoms steadily worsen even when they do not have attacks. This is called “secondary progressive” MS.
  • Primary Progressive – This means the symptoms steadily get worse from the beginning.

Diagnosis of Multiple Sclerosis

The most common required test is Magnetic resonance imaging (MRI) of the brain and spinal cord. MRI is an imaging test that creates pictures of the inside of your body. This test can show whether your brain or spinal cord show signs of MS. Even so, this test might not be able to show right away if you have MS. In many cases, doctors can diagnose MS only after seeing how symptoms and test results change over time.

Other additional tests may be needed to diagnose MS. These might include:

  • A lumbar puncture (sometimes called a “spinal tap”) – During this procedure, a doctor puts a thin needle into your lower back and removes a small amount of spinal fluid. Then they check the fluid for signs of MS.
  • A test called “evoked potentials” or “evoked responses” – Is a way for the doctor to look at the electrical signals in your brain and spinal cord. It involves sticking small “electrodes” to your skin. The doctor can then measure the nerve signals in your brain while you look at lights, listen to sounds, or feel a mild electrical current.
  • In other cases, blood tests are needed to check for diseases that can be similar to MS.

Treatment of Multiple Sclerosis

Currently, there is no curative treatment. However, medications are available to slow disease progression, prevent flare-ups, and control symptoms. There are different medicines to treat MS depending on the type of MS.

  • Treating attacks – High doses treat acute attacks of corticosteroids commonly used as an intravenous infusion to reduce inflammation quickly.
  • Preventing attacks – People who suffer a relapsing-remitting form of MS are advised to use medications that reduce the possibility of relapsing.

These are called disease-modifying therapies (DMTs). Many drugs are available in different forms: oral, subcutaneous shots, intramuscular shots, and intravenous infusions. In certain cases, disease-modifying therapy might also help some people with secondary progressive or primary progressive MS. Choosing the best suitable medicine usually occurs after a discussion between the doctor and the patient regarding the more convenient and effective option in his case.

Apart from DMTs, other medications may be needed to treat symptoms of MS. Physical therapy and rehabilitation also play a crucial role in the management of MS.

Multiple Sclerosis and Pregnancy

Special considerations are taken while treating women with MS who are of childbearing age. Women planning for pregnancy should tell their doctor to choose the suitable medicine as many drugs used in treating MS can affect the pregnancy or can not be used during breastfeeding.

How to Reduce Flare-Ups (Relapses)

In addition to disease-modifying therapies, which effectively reduce relapses, a healthy lifestyle is very important. Eating a healthy balanced diet, quitting smoking, drinking plenty of water, and getting daily exercise to stay fit and active. 

Multiple Sclerosis Outcome

Patients with MS are advised to stay positive. Although not curative, available disease-modifying therapies can alter the negative impact of the disease. Most people with MS continue to have productive, active lives. Research is going on, and almost every year, a new MS drug is approved, giving hope to MS patients and their families. 


Our Expert


Dr. Mohamed Salah Ahmed Gamea

Specialist Neurology

Burjeel Hospital, Abu Dhabi

Stroke – Risk Factors & Prevention

Stroke is the leading cause of adult disability and the world’s second leading cause of death. It is the second leading cause of disability in the UAE, after traffic accidents. Every year, 8,000 to 10,000 patients in the UAE suffer from stroke, equating to one every hour.

The good news is that there are treatments that can significantly reduce the damage caused by a stroke. However, you must recognize the symptoms and get to a hospital as soon as possible. 

Getting treatment within 6 hours can save your life.

What Exactly is a Stroke?

A stroke, also known as a “brain attack,” occurs when blood flow to the brain is disrupted. When it occurs, brain cells in direct proximity begin to die due to a lack of oxygen and nutrients.

What Exactly Causes a Stroke?

There are two types of stroke. The first type is, ischemic stroke, is caused by a blood clot blocking or plugging a blood vessel or artery in the brain. Ischemic strokes are responsible for roughly 80% of all strokes. The second type is, known as a hemorrhagic stroke, is caused by a blood vessel in the brain breaking and leaking into the brain. Hemorrhagic strokes account for roughly 20% of all strokes.

What are the Signs and Symptoms of a Stroke?

The symptoms are distinct because they occur quickly.

  • Numbness or weakness of the face, arm, or leg that occurs suddenly (especially on one side of the body)
  • Unexpected confusion, difficulty speaking or understanding speech
  • Sudden difficulty seeing in one or both eyes
  • Sudden difficulty walking, dizziness, loss of balance, or coordination
  • Unknown cause of a severe headache

What are the Risk Factors?

Certain risk factors increase a person’s chances of having a stroke.

  • Blood pressure is high.
  • Type 2 diabetes
  • High cholesterol levels
  • Obesity is a problem.
  • Using cigarettes
  • Consumption of alcoholic beverages
  • Atrioventricular fibrillation
  • Obstructive sleep apnea
  • Physical Idleness
  • Stenosis of the carotid artery

Why Should You Act Fast?

Time is the brain. Because a one-minute delay in treatment results in the death of 1.9 million neurons, “time lost is brain lost.” The most common type which is, ischemic stroke, can be treated with tPA, which dissolves blood clots obstructing blood flow to the brain. There is a 6-hour window to begin the treatment.

What is the Benefit of Treatment?

According to the National Institute of Neurological Disorders and Stroke (NINDS) five-year study, stroke patients who received t-PA within four and a half hours of the onset of symptoms were at least 30% more likely to recover with little or no disability after three months.

What Role Does Endovascular Intervention Play in Stroke?

Suppose a patient’s symptoms appear within 12 hours of onset and have a large artery block. In that case, they should undergo mechanical thrombectomy, which has a 50% chance of recovery with little or no disability after three months (2019 Guidelines for Management of AIS).

What Precisely is Mechanical Thrombectomy?

Mechanical thrombectomy is an endovascular procedure that removes a thrombus (clot) obstructing the blood vessels that supply the brain. This procedure restores blood flow quickly.

How Can I Lower My Chances of Having a Stroke?

Quit smoking if you smoke. Get your blood pressure, heart disease, diabetes, and cholesterol under control if you have them. Start a healthy diet and exercise regularly if you are overweight. Screening tests such as Carotid vertebral Doppler, 2D Echo, and ECG are available.

Stroke is a serious and potentially life-threatening medical condition. The faster you receive treatment, the better your chances are of a full recovery.

At Burjeel Hospital, we provide comprehensive care for stroke 24/7. Our expert neurologist treats stroke patients with cutting-edge technology and state-of-the-art facilities to ensure they receive the best treatment possible. We are committed to providing our patients with excellent service and quality care so they can recover quickly and live their lives to the fullest.


Our Expert


Dr. Halprashanth D.S

Consultant Neurology

Burjeel Hospital, Abu Dhabi

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Bunions – Symptoms, Causes & Treatment

What is a Bunion? 

A bunion is a bony prominence on the side of the big toe; it is usually isolated but can occasionally be associated with other problems in the foot.

What are the Common Symptoms of a Bunion? 

The most common symptom of bunions may include: 

  • Pain or discomfort in the ball of your foot 
  • Pain or discomfort at the base of your big toe 
  • Tenderness around the joint between your big toe and second toe, 
  • especially when you stand on it or move it back and forth (this is called hallux limitus) 
  • A bump on the side of your big toe at its joint with your foot (the head of bone at this joint may be enlarged) 

What Causes a Bunion? 

There is often no cause, but sometimes very tight-fitting fashion shoes can cause them. People with stretchy ligaments (hypermobility) are more likely to have bunions.

What are the Risk Factors of Bunions? 

The risk factors of bunions include: 

  • The shape of your foot. People with an arch higher than the ball of the foot are at a higher risk for developing bunions. 
  • Women. Women are more likely to get bunions than men because they tend to wear shoes that are too narrow and high-heeled, putting pressure on the toes and causing them to turn inward. 
  • Age. As we age, our feet become less flexible and more prone to injury and deformity. 

Other risk factors include,  

  • Tight shoes 
  • Previous injury or surgery on the foot 
  • Arthritis (especially rheumatoid arthritis) 
  • Overweight 

What are the Complications of a Bunion? 

Apart from causing discomfort in your toes and feet, if left untreated, it can lead to other complications, including, 

Bursitis is one of the most common complications of bunions. It occurs when the bursa, tiny fluid-filled sacs that cushion between tendons and bones, become inflamed. This can lead to pain and tenderness at the bottom of your foot just above the heel. 

Hammer’s toes occur when a toe bends upward, causing it to curl under the other toes to reach them more easily when walking. A bunion can cause or simply be caused by wearing shoes that do not fit properly. Hammer toes can cause pain, making it difficult for your feet to function properly. 

Metatarsalgia is another complication of bunions in which inflammation occurs underneath one or more of your metatarsal bones—the five long bones on top of each foot connecting them with your toes. It can cause pain in any part of the foot where there is bone under the skin; however, most often, it occurs near where the big toe connects with its first joint on top of each foot (called proximal interphalangeal joints). 

How to Prevent Bunions? 

If you’re worried that you might be at risk for bunions, there are a few ways to help prevent them from developing. Here are some tips: 

  • Wear shoes that fit properly. 
  • Avoid wearing high heels, as they can cause your toes to stick further than normal. 
  • Wear shoes with a wide-toe box and low heels. 
  • Take frequent breaks from wearing tight shoes or high heels, even if it’s just for a few minutes once or twice a day. 
  • Try to avoid running around barefoot as much as possible. 

When Should I Seek Help for a Bunion?

Lots of people have bunions but do not have any symptoms. If the bunion hurts, however, surgery is one of the treatment options available.

How are Bunions Treated? 

Non-Surgical Treatment for Bunions 

Physical therapists are usually the first line of defense when treating bunions. They can help you find effective stretches and exercises that can help reduce pain and inflammation. They may recommend from a variety of spacers to go between the toes, orthotics and insoles are available, too, and it is always possible to consider wider-fitting shoes, but they are not usually very fashionable. They do, of course, avoid all the risks of an operation (although those risks are small)

Surgical Treatment for Bunions 

There are several types of surgery for bunions, including osteotomy (also called open reduction and internal fixation), arthrodesis (which fuses bones), exostectomy (a procedure that removes part of a bone), resection arthroplasty (a procedure that removes part of a joint) and various combinations thereof. 

Osteotomy:

This is the most common method for correcting bunions. It involves cutting and moving the bone away from the joint to create space for the toe. The procedure can be done through a small incision or keyhole surgery (also known as minimally invasive knee surgery). 

Arthrodesis: Arthrodesis

It is a permanent fusion of two bones, which means they will never move again. It’s used when there’s too much curvature in the joint and osteotomy isn’t an option. 

Exostectomy

Exostectomy involves removing part of the bone causing pain or discomfort. It’s typically done when there’s only mild deformity and minimal arthritis in joints that have been affected by bunions over time due to wearing shoes that don’t fit properly or having an inherited condition called rheumatoid arthritis (RA). 

Resection Arthroplasty

Resection arthroplasty is used when only part of the bone needs to be removed from an area where multiple boney abnormalities are present at once (such as with hallux valgus). 

Each type of surgery aims to relieve pain and correct deformities while maintaining function in the foot’s major weight-bearing joints. 

When Should I Consider a Surgery? 

It is always sensible to try simple measures first. Still, if the toe hurts, if the skin over the bunion is rubbing, if the big toe is rubbing up against the second toe and making that sore, or if the bunion is becoming more prominent quite quickly, then surgery can be considered. Below are examples of commonly performed operations,

What Does Surgery Involve?

Surgery involves a general anesthetic or a spinal injection to numb the legs. You and the anesthetist will decide this, who will discuss the type of anesthetic with you. Either option means that most operations can be carried out as a day case, as long as there is someone at home to look after you on the night of your surgery. The operation will involve a cut over the inside of the big toe and sometimes a smaller one over the top of the toe. These will eventually fade to a faint white line, which can often take a year. One or two of the bones in the toe are then cut, re-aligned, and held with small metal screws and/or staples. The skin on the inside of the toe will then be tightened up as this will have been stretched by the bunion. Dissolvable stitches are used, so they will not need removal; a bulky dressing containing a strip of plaster cast will be used to wrap up the toe for the next two weeks.

These are examples of commonly performed operations

A post-operative shoe needs to be worn for the next six weeks. This can be removed at bedtime. You can walk in this, and you may not need crutches unless you feel unsteady.

For the first two weeks post-operatively, you will need to spend most of your time with the foot elevated on a footstool or sofa. You can move around the house, but you should not spend two weeks in bed! Like the one below, it will be applied to the toe, which must be worn at all times, except when showering, for the next four weeks.

After six weeks, the splint and shoe can be discarded, and you should then wear a loose, comfortable shoe or sandal; for the following six weeks, no impact activities should be undertaken, so you should only walk up and down stairs and not run up two steps at a time. If your right foot has been operated on, you should not drive until you can safely perform an emergency stop.   

You will be seen back in the clinic three months following your surgery, an x-ray will be taken, and if all is well, you will be allowed to restart normal activities.             

Pain Relief Following Your Surgery

During the surgery, and while your leg is numb, or you are asleep, a large volume of long-acting 

a local anesthetic will be used to try and minimize pain when you wake up. This will last between 12 and 72 hours. Still, it is vital that you take the painkillers given to you, starting on the day of your surgery and before the local anesthetic wears off. To anticipate and stay ahead, those painkillers should be taken regularly for the following two weeks, even if you have no pain. We will prescribe painkillers before you leave.

Do not stop taking them even if you have no pain! The aim here is to anticipate discomfort and stay ahead of it!

How Long Does Bunion Surgery Take? 

The procedure typically lasts between one and two hours. Still, it may take longer if you have other issues that need to be addressed in addition to your bunion. The doctor will remove loose bone fragments, repair torn ligaments, and realign the joint. Once the surgeon has finished with this part of the procedure, they will put a cast on your foot to keep everything in place while it heals. 

How Painful is Bunion Surgery? 

Bunion surgery is a fairly common procedure. It can be a quick and relatively painless way to treat your bunion, although it requires anesthesia. 

How Long Does it Take for Bunion Surgery to Heal? 

You should anticipate six weeks to heal up and five weeks to settle down, so you should anticipate three months before you feel able to start to exercise more normally. Up to that point, swimming and riding a bike will be possible.
It will take many months before all of the swellings subsides, and ladies should not be surprised if they cannot buy new shoes for six months after their surgery. This is normal!

Which Complications Can Happen?

No surgery is entirely free from risks, but the risk of complications for this type of surgery is low, and these can be discussed with you in the clinic. The risks you should be aware of are:

  • Anesthetic risks – these will be discussed with the anesthetist
  • Infection– antibiotics are given
  • Numbness – sometimes, there is a numb patch of skin on the toe
  • Recurrence – some bunions recur, and this is more likely the younger you are when you have the surgery
  • Stiffness – usually, this can be overcome with physiotherapy
  • There are many rarer complications, which can also be discussed with you in the clinic

Will I Need Physiotherapy?

Not everyone needs physiotherapy, but you will, of course, receive this if it is required.

Do Bunions Get Worse with Age? 

Yes, bunions do get worse with age. Bunions are caused by the foot’s metatarsal bones becoming misaligned, which causes the big toe to turn inward at an angle and press against the other toes. The condition can make walking, running, and wearing shoes difficult. As a person ages, their bones become less flexible, making it harder to correct a bunion on their own. This can lead to further pain and discomfort. 

A bunion is a common foot problem that affects the joint at the base of the big toe. Our foot and ankle podiatry specialists at Burjeel Hospital, Dubai provide advanced and individualized treatment for bunions to help you get back on your feet sooner. 


Our Expert Foot & Ankle Surgeons


Dr. Andrew Foggitt

Consultant Orthopedic Foot & Ankle Surgeon

Burjeel Hospital, Dubai

Rotator Cuff Tear Treatment

Read on and find out everything you need to know about the rotator cuff treatment!

Causes and Risk Factors of Rotator Cuff Tear

A primary cause of tear of the rotator cuff is the natural wear and tear of tendons with age. This wear occurs from the age of 45. Statistics show that the rupture of the shoulder tendon affects 20% of people over 65 and 50% of people over 80. In addition, several factors can aggravate the natural wear of this cap, namely:

  • the current practice of a specific activity requiring a strong solicitation of the shoulder, such as in sports and other repeated activities, as mentioned above
  • smoking (resulting in the clogging of the arteries supposed to irrigate the muscles of the shoulder)
  • diseases such as diabetes
  • anatomy of the shoulder favoring natural wear

The rupture is the last phase of the subacromial syndrome. It happens when the space between the humerus head and the acromion is narrowing. The rotator cuff tendons (mainly the supraspinatus tendon) are located in this space, protected from the acromion bone by a bag. This bag is known as the subacromial bursa.

The decrease in this space has many causes. The most frequent one is the anatomical constitution of your shoulder (hook-shaped acromion, calcification of the Cossack-acromial ligament, etc.). If we add the repeated movement along the years, it produces a progressive rupture due to the collision between the supraspinatus and the acromion. On the other hand, unlike other tendons in the body, this tendon has very little self-repair capacity in the face of degenerative changes.

In addition to this slow rupture mechanism, there are also traumatic ruptures, in which the tendon ruptures after a fall with an outstretched arm: acute supraspinatus rupture. Sometimes, the rupture of the rotator cuff occurs following a simple and innocuous gesture or a false movement (more common in people over 50). This is called trophic rupture of the shoulder tendon and can also happen to athletes and sports performers.

Rotator Cuff Tear Diagnosis

The diagnosis of complete rupture of the supraspinatus tendon is initially clinical and with imaging tests. The person who presents a rotator cuff tear complains of pain in the shoulder, especially with mobilizations and often pain at night or the inability to lift the arm correctly.

The main diagnosis of tear of the rotator cuff is through a shoulder MRI. The MRI shows us the rupture of the tendon. It also gives us information about the gap or space of the rupture and if there is atrophy or loss of musculature. This also informs about the condition of other tendons, such as the subscapularis or infraspinatus.

Ultrasound is another diagnostic test that, in good hands, allows good visualization of the tendon and the rupture of the supraspinatus. ​Through it, we can obtain other fundamental data, including:

  • Affected tendon(s): Usually supraspinatus or supraspinatus accompanied by infraspinatus or subscapularis
  • State of the tissue and the tear: This information is essential to decide the treatment and if the tear is “repairable.”
  • Involvement of other structures such as articular cartilage and the long tendon of the biceps

With all this information plus the time of evolution and the symptoms, the doctor will propose a conservative treatment of the rupture (without repairing it) or a surgical repair by arthroscopy to the patient.

Rotator Cuff Tear Treatment

Usually, it is recommended to carry out a sequential treatment in 3 phases.

  • Phase 1 treatment with rehabilitation or physiotherapy
  • Phase 2 treatment with infiltrations
  • Phase 3 treatment with surgery

Non-Surgical Treatment

The aim is to recover the shoulder function (mobility and strength) as much as possible, dispensing with the ruptured tendon. The tendon will be broken, but the Orthopedic doctor will try to increase the rest of the muscles in the area to get closer to the state we had before the muscle broke.

It is recommended to start with a rehabilitation/physiotherapy treatment. There are many exercises and guidelines to recover after a partial tear in the rotator cuff. It is important to note that the exercises must be performed daily for the treatment to have an effect. Usually, it is a 6-12 week program performing cuff strengthening exercises five days a week.

The objective of the initial guideline through exercises or recovery is to achieve the correct shoulder mobility and strengthen the muscles surrounding the shoulder to achieve muscular stabilization of the shoulder. One of the causes of the rupture is the lack of synchronization or correct functioning of the articulation.

Analgesics are used for the initial pain, including corticosteroid injections, to reduce inflammation and pain. If physiotherapy has not effectively improved pain, the doctor can recommend the infiltration of hyaluronic acid.

Surgical Treatment

Shoulder arthroscopy is done in cases where it is decided to perform a rotator cuff tear repair due to the patient’s characteristics (active and in good general condition) and the tear (good tissue, little muscle shortening).

Shoulder arthroscopy is performed, and the tendon rupture is sutured using several anchors that join the tendon to the bone.

In this intervention, several surgical procedures are performed at the same time, all through 2 or 3 small incisions (less than 1cm)

  • Remove the inflamed bursa: Bursectomy
  • File the thickened acromion to increase the space in cases where it is: Acromioplasty
  • Repair the break: Cuff Suture

This repair is done by placing implants in the humerus (made of titanium or other biocompatible materials) to which strong tension-resistant sutures are attached. In cases of partial ruptures, it is often necessary to complete the tear and move the entire released tendon back to its original insertion site, which the surgeons join with one of the harpoons (implant).

In the case of total ruptures of one or two tendons, several implants are required to repair them.

At present, the new arthroscopic techniques and      anchoring systems achieve a very solid and stable fracture union, improving recovery time     , usually ranging from 2 to 4 months.

It is necessary to carry out an initial phase of rest that ranges between 2 and 4 weeks. Subsequently, physiotherapy is carried out to improve the shoulder joint’s mobility and musculature.

Irreparable Rotator Cuff Tear Treatment

When the rupture is massive, with stage 3 or 4 fatty degeneration and muscle atrophy, a latissimus dorsi flap in a motivated young patient is recommended, provided that the subscapularis tendon is present.

In a patient over 70, a biceps tenotomy is proposed after ineffective functional treatment. A biceps tenotomy is the cutting of the long biceps to reduce anterior pain under arthroscopy.

For other more complex forms, a modification of the shoulder functions by placing an inverted prosthesis is indicated. This prosthesis will use the upward forces of the deltoid muscle to transform them into rotational forces.

In case of a rotator cuff tear, the best is to consult experts with a distinguished history in complex surgical and nonsurgical procedures. The Orthopedic Surgeons team at the Burjeel Hospital for Advanced Surgery, Dubai, certified and Fellowship-trained, are the leading experts in performing complex shoulder surgeries with immense experience in treating all upper limb conditions due to arthritis or sports injuries. Call +971 800 55 or visit our website to book an appointment today!

Spine Care (Back Pain) – Symptoms, Causes & Treatments

Read on to find the causes, symptoms and treatment of back pain!

Who doesn’t have back pain? Back pain refers to intense or moderate pain or a feeling of blockage in the spine. It often lasts for months, causing chronic back pain. There are sevral kinds of pathologies that  the spine, affecting every two out of five people, in which the most prevalent cases are of lower back pain. All age groups are affected depending on the pathology in question.

In the elderly, the back pain is often degenerative, related to age and the breakdown of the intervertebral discs, complicating daily life. A sedentary lifestyle accelerates this process. In the youngest, it is often due to malformative pathologies. And in working adults, it can be due to traumatic pathologies, and the repercussions of pain and incapacity can be major, as is often the case, compromising the personal and professional life. Statistics indicate that 50% of all working adults report back pain symptoms every year.

But back pain can have many other explanations. Therefore, it is essential to determine the cause of the back pain to direct the right treatment. In this article, we will try to explain the concepts related to back pain as clearly as possible to make it easier for you to understand your back problem.

Back Pain, the Most Common Issue

Back pain is widespread, according to statistics. Indeed, this worldwide scourge has already affected nine out of ten people. Let us add that a huge population of these individuals declare having suffered from their back more than ten times during the last five years. Also, more than half of the world’s population is regularly affected by back pain.

Finally, the working population is the most affected: more than four out of five active people report having back pain during or after their working hours, according to a survey.

There are two types of back pain:

  • Mechanical back pain: The pain is more intense during the day, during an activity.
  • Inflammatory back pain: The pain is more severe in the evening and at night and generally fades during the day after morning “strengthening.”

Causes of Back Pain

A distinction must be made between localized back pain, characterized by pain from the dorsal spine, and referred back pain, which is symptomatic of another pathology affecting a neighboring organ.

As a reminder, the dorsal column is the part of the vertebral column made up of the thoracic vertebrae. It is located between the neck (cervical vertebrae) and the lower back (lumbar vertebrae). The dorsal column consists of 12 thoracic vertebrae, which are fused to the ribs.

Localized Back Pain

The pain localized at the level of the dorsal column is not a question of pain projected from another organ. There are several underlying causes:

  • The degeneration of the intervertebral discs: It can cause osteoarthritis of the back or a herniated disc: over time, the intervertebral disc becomes less flexible. It loses its role as a shock absorber and can trigger acute or even chronic back pain. In case of severe deterioration, the nucleus pulposus (gelatinous substance located in the heart of the intervertebral disc, which acts as a shock absorber and ensures the vertebrae’s movement) can penetrate the spinal canal, causing a herniated disc whose volume is very variable. These pathologies can also be linked to wear and tear when the back is overworked.
  • Chronic rheumatic and inflammatory diseases: Arthritis, spondyloarthropathy (including ankylosing spondylitis), spondylodiscitis (infection of the intervertebral discs and adjacent vertebral bodies), etc., fall in this category.
  • The vertebral fracture: It can be of traumatic origin or linked to underlying osteoporosis (vertebral compression). Trauma occurs during a brutal shock, an accident or a fall. Note that the spine protects the spinal cord, and when the latter is affected, the consequences can be fatal or lead to paraplegia or serious neurological damage.
  • Prolonged poor posture: This is particularly the case for patients who work long hours in a seated position in front of their computer. Poor posture during sleep can also cause back or neck pain.
  • Pregnancy or obesity (especially visceral.)
  • Hormonal changes: Menstrual cycles, pregnancy or menopause in women.
  • An intraspinal tumor.
  • Bone deformity diseases.
  • Paget’s disease: chronic bone disease. It causes bone hypertrophy and weakening in certain localized regions.
  • Kyphoscoliosis: deformation of the vertebral column, which causes a lateral deviation (scoliosis) and a deviation with posterior convexity (kyphosis.)
  • Spinal growth dystrophies or osteochondrosis: alteration of the structure of the vertebral disc, which affects children and adolescents. It can cause growth disturbances. Scheuermann’s disease is one of these pathologies.
  • Psychological disorders: Depression and chronic stress can cause muscle tension and back pain.

Referred Back Pain

Referred back pain is symptomatic of an attack or a disease affecting another organ. It could be:

  • A digestive disease: esophagitis, gastric or duodenal ulcer, cancer of a digestive organ (pancreas, stomach, esophagus), pancreatitis, etc.
  • A lung or pleural condition: pleurisy, lung or bronchial tumor, etc.
  • A cardiovascular disease: pericarditis, thoracic aortic aneurysm, coronary insufficiency, etc.

Symptoms of Back Pain

The pain is localized at the back and, more precisely, between the neck and the waist. The pain can be acute or, on the contrary, chronic (when it lasts more than three months). It is sometimes localized and sometimes diffuse. It is more or less intense and can look like:

  • A feeling of electric shock, stabbing or burning;
  • Tingling;
  • Back blockage;
  • Breathing discomfort;
  • A strain.

In case of back pain, consult a doctor to eliminate any underlying pathology. If the symptoms present themselves intensely, especially after a shock or a false movement, contact an Orthopedic doctor or the emergency department. It must be understood that the decision to treat (medically or surgically) depends above all on the symptoms. The nature of the lesion guides the choice of the optimal spine care treatment.

Diagnosis

The clinical examination

  • It consists of questioning the patient about the pain (location, improvement depending on the position, evolution, response to anti-inflammatories and analgesics, underlying psychological disorder or chronic disease, etc.);
  • Examination of the spine (palpation, flexion and flexibility exercises, etc.);
  • Pulmonary examination (stethoscope, breathing exercises, etc.);
  • Cardiac examination (heart rate, stethoscope, blood pressure, questioning about possible discomfort or chest pain, etc.);
  • Digestive and hepatic examination (palpation, clinical examination looking for possible jaundice, ascites or bruising, questioning about possible digestive disorders, etc.);
  • Neurological examination (study of walking, standing, muscle strength/tone, reflexes, sensitivity, motor coordination, questioning the patient about any neurological symptoms, etc.).

Imaging Examination

Imaging tests, such as X-rays, ultrasounds, CT scans and MRIs, may be required to identify the cause of the back pain.

Complementary examinations

  • Blood tests (in particular looking for biological markers of inflammation);
  • Imaging of the thoracic spine (scintigraphy, scanner, MRI, etc.);
  • Gastric imaging (fibroscopy, endoscopy, colonoscopy, etc.);
  • Cardiovascular examinations;
  • A lung ultrasound;

Treatments of Back Pain

When back pain is a disease symptom, the underlying disease should be treated. However, pain relief requires:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) or painkillers
  • The practice of regular physical activity or sport to strengthen the back and the abdominals;
  • physiotherapy and osteopathy can be effective;
  • Psychological care in the event of an underlying anxiety-depressive disorder;
  • Change certain habits, such as posture and ergonomics at work, carrying heavy loads, etc.
  • Alternative medicine: mesotherapy (micro-injections of local action products), acupuncture, etc.
  • Rest can sometimes be recommended over a short period.

Bed rest, anti-inflammatories and rehabilitation (once the acute phase has passed) can relieve back pain but cannot treat spinal fractures. If you have been diagnosed with a vertebral fracture caused by any of the varied reasons discussed above, the doctors can consider several innovative treatment options.,

Surgical Treatment for Spine Fracture

Conservative Treatment

Traditional treatment for back pain and/or vertebral fractures may include several days of bed rest, painkillers and, less commonly, a lumbar corset. Conservative treatment can reduce pain, but it cannot repair the spine.

Vertebroplasty and Kyphoplasty

The second treatment offered is vertebroplasty, which involves injecting a resin (called cement) into the vertebra. This procedure is performed under radiological control through a mini-incision of less than one cm. By hardening, this resin will suppress the micro-movements of the fracture, thus limiting the pain. It allows consolidation in a good position and avoids the appearance of a secondary deformation but does not allow the existing deformation to be corrected.

For this, Kyphoplasty is considered an evolution of the technique of straightening the vertebra. The surgeon uses an instrument such as a mechanical expander or an inflatable balloon before injecting the surgical resin. The major interest of Kyphoplasty is based on better correction of the vertebral deformity caused by the fracture

Spinal Laminectomy

Spinal Laminectomy is a decompression Surgery performed under general anesthesia by the posterior route through an incision in the lower back. There are several types of decompression surgeries ne of which is Laminectomy.

A laminectomy is a spinal decompression surgery performed on the lower part of the spine. It consists of removing part of the bone of the vertebra, the lamina, to relieve the pressure exerted on the spinal cord or one, or even several, spinal nerves.

Discectomy

A herniated lumbar disc can be the cause of sciatica by compression of a nerve root. The procedure performed to relieve symptoms is called a Discectomy, in which the herniated disc is removed but not completely, and the disc is cleaned.

During the procedure, a small incision is made over the site of the herniated disc. The surgeon then inserts the tubular retractor, which moves the muscles apart without cutting them.

The ligament that lines the back of the spine is opened, providing a view of the nerve and disc. The surgeon carefully pushes back the nerve and removes the herniated disc.

Foraminotomy

We speak of recalibration when it is a gesture limited to one level (1 disc). These procedures include a foraminotomy, which involves widening the foramen (the bony channel through which the spinal cord nerves pass) to create a larger opening and relieve the pinched nerve.

Depending on the state of health, it can be done using an open or minimally invasive surgical technique. These gestures can be combined if there are several levels to be treated.

Nucleoplasty

Nucleoplasty is another procedure recommended for disc decompression. The procedure consists of puncturing the nucleus pulposus of the affected disc through the skin with a needle or electrode, reducing the bulging of the disc and thus freeing the compressed nerve.

We hope the information we shared has helped you understand back pain’s causes and treatment options. Of course, this information will never replace the explanations given in consultation but constitute additional help. Indeed, we believe that your adherence to the treatment will largely depend on the quality of your information.

In case of back pain, the best is to consult an Orthopedic Spine Surgeon with unparalleled expertise in treating varied spine conditions and injuries. The Orthopedic Spine Surgeons at the Burjeel Hospital for Advanced Surgery, Dubai, are board-certified and experienced in minimizing the effect of neurological conditions on children and adults by providing optimal care and making informed treatment decisions.