Diagnosis

Dr. Pelino and associates offer a variety of different therapeutic options to suit your daily or active needs.  Having the years of extensive education and experience in various therapeutic treatments, will help us diagnose and find the right treatment(s) that will work for you and your body to regain your optimal physical health.

Dr. Pelino has had the pleasure of treating all levels of sports and active enthusiasts – From the amateur athlete who wants to perform their best, to professional athletes where performance is their life – From the person who suffers from body stress because of their everyday life, to Hollywood celebrities that are performing stunts requiring them to be in top shape just to stay alive.

If you have any of the following conditions, your body is under stress.  We will work together to relieve this body burden and restore you to the health desire.

Top 10 Conditions

A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain. Nine areas of the head and neck have these pain-sensitive structures, which are the cranium (the periosteum of the skull), muscles, nerves, arteries and veins, subcutaneous tissues, eyes, ears, sinuses and mucous membranes.

Neck pain (or cervicalgia) is a common problem, with two-thirds of the population having neck pain at some point in their lives.  Neck pain, although felt in the neck, can be caused by numerous other spinal problems. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the nerves emanating from the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back.

The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The top three joints in the neck allow for most movement of your neck and head. The lower joints in the neck and those of the upper back create a supportive structure for your head to sit on. If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.  Neck pain may also arise from many other physical and emotional health problems.

Lateral view of the human spine demonstrating the architecture of the skull base and first vertebra relevant to brainstem and cranial nerves associated to normal function of shoulder movement.

Frozen shoulder, medically referred to as adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.

This graphic shows a spin off of Leonardo daVinci’s virtuvian male in a clever skeletal form and is relevant to the arc motion exhibited by sufferers of frozen shoulder syndrome.

Adhesive capsulitis is a painful and disabling condition that often causes great frustration for patients and caregivers due to slow recovery. Movement of the shoulder is severely restricted. Pain is usually constant, worse at night, and when the weather is colder; and along with the restricted movement can make even small tasks impossible. Certain movements or bumps can cause sudden onset of tremendous pain and cramping that can last several minutes.

This condition, for which an exact cause is unknown, can last from five months to three years or more and is thought in some cases to be caused by injury or trauma to the area. It is believed that it may have an autoimmune component, with the body attacking healthy tissue in the capsule. There is also a lack of fluid in the joint, further restricting movement.

In addition to difficulty with everyday tasks, people who suffer from adhesive capsulitis usually experience problems sleeping for extended periods due to pain that is worse at night and restricted movement/positions. The condition also can lead to depression, pain, and problems in the neck and back.

Risk factors for frozen shoulder include diabetes, stroke, accidents, lung disease, connective tissue disorders, and heart disease. The condition very rarely appears in people under 40.

Treatment may be painful and taxing and consists of physical therapy, medication, massage therapy, Structural Integration (also called Rolfing®), hydrodilatation or surgery. A doctor may also perform manipulation under anesthesia, which breaks up the adhesions and scar tissue in the joint to help restore some range of motion. Pain and inflammation can be controlled with analgesics and NSAIDs. The condition tends to be self-limiting: it usually resolves over time without surgery, but this may take up to two years. Most people regain about 90% of shoulder motion over time. People who suffer from adhesive capsulitis may have extreme difficulty working and going about normal life activities for several months or longer

Golfer’s elbow, or medial epicondylitis, is an inflammatory condition of the medial epicondyle of the elbow. It is in some ways similar to tennis elbow.

The anterior forearm contains several muscles that are involved with flexing the fingers and thumb, and flexing and pronating the wrist. The tendons of these muscles come together in a common tendinous sheath, which is inserted into the medial epicondyle of the humerus at the elbow joint. In response to minor injury, or sometimes for no obvious reason at all, this point of insertion becomes inflamed.

Lateral epicondylitis or lateral epicondylalgia, known colloquially as tennis elbow, shooter’s elbow, and archer’s elbow or simply lateral elbow pain, is a condition where the outer part of the elbow becomes sore and tender. Since the pathogenesis of this condition is still unknown, there is no single agreed name. While the common name “tennis elbow” suggests a strong link to racquet sports, this condition can also be caused by sports such as swimming and climbing, the work of manual workers and waiters, as well as activities of daily living.

Tennis elbow is an overuse injury occurring in the lateral side of the elbow region, but more specifically it occurs at the common extensor tendon that originates from the lateral epicondyle. The acute pain that a person might feel occurs as one fully extends the arm.

In one study, data was collected from 113 patients who had tennis elbow, and the main factor common to them all was overexertion. Sportspersons as well as those who used the same repetitive motion for many years, especially in their profession, suffered from tennis elbow. It was also common in individuals who performed motions they were unaccustomed to. The data also mentioned that the majority of patients suffered tennis elbow in their right arms.

Runge is usually credited for the first description in 1873 of the condition. The term tennis elbow was first used in 1883 by Major in his paper “Lawn-tennis elbow”.

Carpal tunnel syndrome (CTS) is an entrapment median neuropathy, causing paresthesia, pain, numbness, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel. The National Center for Biotechnology Information and highly cited literature say the most common cause of CTS is typing

The main symptom of CTS is intermittent numbness of the thumb, index, long and radial half of the ring finger. The numbness often occurs at night, with the hypothesis that the wrists are held flexed during sleep. Recent literature suggests that sleep positioning, such as sleeping on one’s side, might be an associated factor. It can be relieved by wearing a wrist splint that prevents flexion. Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction.

Pain in carpal tunnel syndrome is primarily numbness that is so intense that it wakes one from sleep. Pain in electrophysiologically verified CTS is associated with misinterpretation of nociception and depression.

If you have carpal tunnel syndrome as a diagnosis, the resolve is often if not always further up the nervous system towards the elbow shoulder and neck.

Look beyond the wrist and hand for your solution.

Low back pain or lumbago is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is more common. It can be acute, sub-acute or chronic in duration. With conservative measures, the symptoms of low back pain typically show significant improvement within a few weeks from onset.

Knee pain is a common complaint for many people. There are several factors that can cause knee pain. Awareness and knowledge of the causes of knee pain lead to a more accurate diagnosis. Management of knee pain is in the accurate diagnosis and effective treatment for that diagnosis. Knee pain can be either referred pain or related to the knee joint itself.

Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis. The suffix “osis” implies a pathology of chronic degeneration without inflammation. Since tendons and ligaments do not contain blood vessels, they do not actually become inflamed. Instead, injury to the tendon is usually the result of an accumulation over time of microscopic tears at the cellular level.

The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. It has been reported that plantar fasciitis occurs in two million Americans a year and in 10% of the U.S. population over a lifetime. It is commonly associated with long periods of weight bearing. Among non-athletic populations, it is associated with a high body mass index. The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is an increased probability of knee pains, especially among runners.

A Soft tissue injury (STI) is the damage of muscles, ligaments and tendons throughout the body. Common soft tissue injuries usually occur from a sprain, strain, a one off blow resulting in a contusion or overuse of a particular part of the body. Soft tissue injuries can result in pain,swelling, bruising and loss of function (Lovering, 2008).

When you participate in sports and physical fitness activities, you can injure the soft tissues of your body. Even simple everyday activities can damage these ligaments, tendons, and muscles.

Some of the soft-tissue injuries you are most likely to experience include:

  • Sprains
  • Strains
  • Contusions
  • Tendonitis
  • Bursitis
  • Stress Injuries
  • Fibromyalgia

What is Fibromyalgia?

Fibromyalgia syndrome is a common and chronic disorder characterized by widespread muscle pain, fatigue, and multiple tender points. The word fibromyalgia comes from the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia). Tender points are specific places on the body—on the neck, shoulders, back, hips, and upper and lower extremities—where people with fibromyalgia feel pain in response to slight pressure.

Although fibromyalgia is often considered an arthritis related condition, it is not truly a form of arthritis (a disease of the joints) because it does not cause inflammation or damage to the joints, muscles, or other tissues. Like arthritis, however, fibromyalgia can cause significant pain and fatigue, and it can interfere with a person’s ability to carry on daily activities. Also like arthritis, fibromyalgia is considered a rheumatic condition.

You may wonder what exactly rheumatic means. Even physicians do not always agree on whether a disease is considered rheumatic. If you look up the word in the dictionary, you’ll find it comes from the Greek word rheum, which means flux—not an explanation that gives you a better understanding. In medicine, however, the term rheumatic means a medical condition that impairs the joints and/or soft tissues and causes chronic pain.

Fibromyalgia is a syndrome rather than a disease. Unlike a disease, which is a medical condition with a specific cause or causes and recognizable signs and symptoms, a syndrome is a collection of signs, symptoms, and medical problems that tend to occur together but are not related to a specific, identifiable cause.

Reference: About.com

My Commitment to Your Health

" I work with people. You begin as a patient and we work together to make you whole. A person that can physically reach the goals you set out for yourself. I am a coach, a mentor, a guide. We will work together along your journey to reach these goals. To run your first marathon, to get a personal best at the next Ironman, to run your first 5km, to bike again, to complete a GranFondo cycling event, to play catch with your grandson. These are dreams. They are possible. Let's work together."

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