Neck and back pain may be everyday problems, but if the pain prolongs or progresses, it may be the sign of something more serious. Singapore General Hospital experts make no bones about this and 4 other common bone/joint disorders.
1. Neck & Back
What it is
Neck and back pains are due to prolonged periods of sitting down, inaction and lack of exercise. Neck pain is also caused by injuries to the neck muscles, ligaments, nerves, bones and joints, prolonged wear and tear, and in some cases, infections, tumours and degenerative diseases like osteoarthritis. There is usually no cause for alarm unless you have a history of violent trauma and cancer, constant and progressive pain, bladder/bowel symptoms, limitation of movement, tenderness, structural deformities of the spine, neurological deficits and crippling diseases like AIDS.
Who gets it
Neck and back pain are common complaints of sedentary workers.
Solution
A thorough assessment is needed in cases of persistent neck and back pains. Neck pain is treated with a combination of rest, medication, immobilisation, physical therapy, exercise and activity modifications. In severe cases, surgery may be required to reduce pressure on the spinal cord or nerve. The solutions for back pain include bed rest, local applications (plasters, hot/cold packs etc), medications, corsets, physiotherapy, manual therapy (massage, mobilisation and manipulation) and acupuncture. Many new techniques have been developed to alleviate neck and back pains. Examples include nucleoplasty, joint and nerve injections and minimally invasive keyhole surgery.
2. Scoliosis
What it is
Scoliosis is an abnormal curvature of the spine. There are many types of scoliosis, the most common being idiopathic scoliosis or scoliosis without a known cause. Another symptom is the imbalance of body parts such as the shoulder, ribs, hip and waist. Scoliosis usually appears as a C- or S-shaped curve.
Who gets it
All women. Women with a family history of the condition are more susceptible.
Solution
Treatments include observation, bracing and surgery. Observation refers to monitoring by the physician while bracing is the use of a supportive corset to arrest the progression of the curvature and achieve some curve correction. Surgery is usually recommended when the angle is greater than 40 degrees.
3. Osteoarthritis
What it is
Osteoarthritis is a joint disease, which arises from wear and tear of the joint surfaces. The most common cause of osteoathritis is the ageing process. Another cause is joint damage due to prior injury, infection or severe inflammation. Prolonged and excessive use of a joint can also lead to an early onset of osteoathritis. The most common symptom is pain when there is movement on the affected joint. Some examples are neck pain, back pain and finger joint pain. There may also be tenderness in the affected area, bony enlargement of the finger joints and deformities like bowing of the knees and deviation of the terminal digits.
Who gets it
Women above 55. Women with a family member with osteoarthritis also stand a high chance of contracting this condition.
Solution
The first line of treatment includes weight reduction, muscle-strengthening exercises, insoles, support devices for movement, joint protection advice and occupational therapy. The second is oral and topical drugs and/or intra-articular agents (formulas injected into joints). Surgery is performed if the pain persists despite other treatments or there are severe deformities.
4. Osteoporosis
What it is
Osteoporosis occurs when there is a decrease in the mass and strength of the bone. The patient becomes vulnerable to fractures of the spine, hips and wrists. Normally, new bone is formed constantly to replace the absorbed bone till about the age of 35. This is when the body starts to lose very small amounts of bone mass. After menopause, women will lose bone mass much more rapidly, resulting in reduced bone strength. Other causes of osteoporosis include poorly controlled diabetes, uncontrolled thyroid disease, prolonged use of certain drugs, surgical removal of ovaries, excessive alcohol, caffeine consumption and smoking, lack of exercise, low calcium intake and kidney and intestine disorders. Osteoporosis has no obvious symptoms. Patients usually find out they have osteoporosis when they fracture a bone. If the spine collapses, a stooped posture (hunchback) may be assumed. If the patient falls, certain body parts like the hips, spine and wrists may be fractured or broken, leading to severe pain and disabilities.
Who gets it
Menopausal women stand a higher chance of getting osteoporosis. Although it generally affects women above 65, women as young as 40 are getting it.
Solution
Prevention is the key to treating osteoporosis. Measures include prevention of falls, adequate calcium intake, avoidance of smoking and heavy alcohol intake, reduction of caffeine, adequate weight bearing exercises, and control of diabetes and thyroid diseases. Treatments include hormone replacement therapy and drugs like anabolic steroids and calcitriol. Surgery is also considered in severe cases of bone fracture. A new procedure called percutaneous vertebroplasty, where bone cement is injected into the bone to provide additional support to brittle bones, offers immediate pain relief and stability, and prevents further collapse. In addition, a new technique called percutaneous kyphoplasty can restore the height lost by a fractured vertebra and reduce the severity of the hunching.
5. Repetitive Strain Injury
What it is
Repetitive strain injury (RSI) is a collective term to refer to injuries to the muscles, joints or nerves caused by repetitive movements of a body part. The muscle or joint becomes overused, resulting in repeated microtrauma and inflammation. RSI usually occurs in the arm and hand. Some of the more common conditions include carpal tunnel syndrome, tendinitis and trigger finger. Each condition affects a different part of the arm/hand. For example, carpal tunnel syndrome affects the median nerve in the wrist while trigger finger affects the fibrous flexor pulleys of the fingers. Patients may suffer from pain or tenderness in the muscles or joints, tingling or numbness in the hand or arm, and loss of strength or sensation in the hand. At the same time, underused body parts become weak and injure easily in the course of time.
Who gets it
Women whose jobs and lifestyles require them to do repetitive actions.
Some examples include clerks, guitarists and mums who constantly carry their children.
Solution
The first thing to do is remove the patient from the environment or stop the offending activities and allow the patient to rest. Other treatments include painkillers, anti-inflammatory medicines, steroid injections, hot and cold packs, elastic supports, splints, electrical stimulation and chiropractic or deep tissue massages. More severe cases may even require surgery. If the RSI was caused by the work environment, it is advisable to customise your workstation to allow ease of motion and prevent awkward movements and postures. For example, have typing notes at eye level.