Expert: Dr. Victor Dolan, DC, DACBSP - 7/28/2009

Question
I hurt my shoulder about 2 weeks ago moving some heavy stuff around and on friday i was at work lifting some heavy boxes and my arm felt funny well today is monday and i have a weird bulge in my bicep and its all bruised up. What is the treatment for this?

Answer
possible bicep tear, sports injury, workers compensation, staten island workers compensation, surgery, work comp






Hello Chris,


I am sorry to hear of your injury.

".....i have a weird bulge in my bicep and its all bruised up.....",  bruising, 'black and blues' are a common result of any injury.  Sometimes the bruise, contusion, injury is severe enough to also include swelling- the bulge you describe.  By mail, without examining the actual bulge, 'swelling', lump - - - it is difficult to ascertain if it is just a contusion/ sprain/ strain of the muscle; or possibly a tear that even requires surgical repair!

You may have fatigued/ overworked the shoulder/ arm a couple of weeks prior to the 'final straw', the injury incident.  You state, "....i was at work lifting some heavy boxes and my arm felt funny ....";  DID you hurt yourself at work?  Whenever you hurt yourself at work, it is good practice to complete an injury report/ incident report/ do the paperwork required by your particular job/ company.

Many younger employees HATE to fill out the forms and report to a supervisor that they have suffered an injury.  Many people are afraid of repercussion, many are afraid of appearing weak or whiny.  I always recommend filling out the paper work.  Sometimes we hurt ourselves today, it seems minor, and a week or two later-- we cannot get out of bed due to pain, or have a severe infection, or some type of complication DUE TO THE INJURY at work, a week ago!- Now perhaps there is time lost from work, perhaps treatment with  associated time and cost.  If proper documentation is provided initially, the employee who is hurt at work can protect their job, take time off to heal, get appropriate treatment to heal.  If this happened at work- did you fill out the proper paperwork?  If not, could you talk to your supervisor and complete the proper documents now?  I always tell my Staten Island Workers Compensation patients: 'Do the paperwork!'

Let us go from mild to severe.  First of all, given your description- a lot of bruising and some swelling - - - you need to see a licensed health professional for an evaluation.  Whether you choose a health provider that is a Doctor of Chiropractic or a Doctor of Medicine--- please see SOMEONE.  I would recommend a sports injury specialist, orthopedist, rehabilitation expert, or perhaps a physiatrist.  You may not realize this, but just as the Medical Doctor has different specialties, so do Chiropractic Doctors have additional credentials, see: http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf .

Your injury may need little more then some stretching, some proteolytic enzymes to aid inflammation, hot or cold application and some time to heal.  Your injury could, and this is less likely, even need surgical repair.

"A muscle tear may be partial or complete and caused either by a direct blow or by overexertion. There are three degrees of muscle ruptures. A first-degree strain involves less than 5 percent of the muscle. You may notice only mild pain and not lose much strength or range of motion. We sometimes refer to these mild tears as pulled muscles.

A second-degree tear is a greater rupture that stops short of a complete tear. Any contraction of the torn muscle will cause pain. With either a first- or second-degree tear, you may feel a defect of the muscle - a bump or an indentation - at the site of the most pain. You should be able to partially contract the muscle, but you may not be able to walk or stand without pain or a limp.

A third-degree rupture is a complete tear across the width of the muscle. You will be unable to contract the muscle. This is what happens when someone suddenly drops while sprinting. The torn end of the muscle may ball up and form a large lump under the skin, and a great deal of internal bleeding occurs. Severely torn muscles may require surgery to heal properly.
    http://www.sportsdoctor.com/articles/muscle.html  "

So  where do you fall in the above  ^^^ range ?  You can see the increasing need for examination/ treatment with the increasing severity.

http://www.youtube.com/watch?v=q_nIfVwZ1RU
http://www.youtube.com/watch?v=vdPqza00czQ&feature=related


I give informational handout sheets to my Staten Island Work Comp patients, perhaps this will be helpful to you:




P.R.I.C.E. =  
 
P  protection.   R rest.   I  ice.   C  compression.   E  elevation.


Hurt  yourself ??  injury/ trauma/  bruise/ not even sure - - a broken bone ??

You should certainly get to the Doctor or trained health professional to be examined  if you think it  is  bad  enough.     

BUT  in  the  meantime,  some  simple  steps  may  help.   

PRICE.

The  PRICE  protocol will usually help just about any musculoskeletal injury.

P = Protection;  protect the area from further injury- stop what you are doing, can you
     pad  or bandage the area ? Tape the area? Do something to protect the area !

R = Rest;  rest the area as much as possible, if a part is damaged, give the body time to
       repair the area

I = Ice;  ice is a potent anti-inflammatory; it will slow swelling, help with pain control
     (ice is analgesic), place ice over cloth over the injured area for 5, 10 minutes, off the
     injured area for 30 minutes; then back on again

C = Compression;  to help prevent swelling compression may be helpful- for example
      if it is an ankle, wrap the ankle with an ace bandage and ice the area.  Many body
      parts may not be applicable to compression.

E = Elevation; again to fight swelling and pain, raising the injured body part above the
      heart may be helpful- ie raise an ankle or knee, you lay down, raise the injured part

PRICE  may  help :    Sprains,  Strains,  musculo-skeletal injury,  bruise,  contusion
Sometimes  a slip, trip, fall, heavy lift, athletic injury, or a motor vehicle accident can cause a bump or bruise, sprain or strain.  Sometimes also involved with the injury is a vertebral subluxation (or other joint subluxation) (subluxation is a mechanical problem- of any joint- and requires a mechanical correction).  In the spine, a sprain/strain  is a misalignment,  a ‘kink’ in the joint, a stretch of the muscles, tendons and/ or ligaments:- more properly termed a Vertebral Subluxation.   Sometimes symptoms can come immediately, sometimes days, weeks or even months later!- Well after the actual trauma !!!

         Spinal = Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)  ;   ( subluxation COULD be any joint )
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A  subluxation  interferes with the proper functioning of the nervous system  (the master system  which controls and coordinates all function within the body)  and may cause various other conditions, symptoms and problems.


This is a serious condition identified by its five parts:

    Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.

    Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.

    Myopathology:
          Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.

    Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.

    Pathophysiology:
         Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.

The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
         Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.

          Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.  For good health- Treat the   Cause,  not just the Symptoms.  Sprain/ strain/ bump/ bruise?= may result in subluxation of the nearby joint.  CORRECT the subluxation !!!!

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine






Be careful of just 'covering up' the problem by taking pain medication.  This may take away your pain, but does not help HEAL the cause of the complaint, and my fool you into thinking that all is well- allowing further damage to be done:





PAIN    


Pain  is a  ‘red light on the dashboard’.


Pain is your body telling you that something is wrong.


That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?  

Pain,
pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?   

Pain,  
do you cover up the pain by taking a painkiller?  
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?


                     NOTICE  ON  PAIN  RELIEVERS:
 
Label changes ORDERED by FDA;  the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news  206- 207;  12-9-06) ;

The  American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement  2-26-07).

NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage  destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse.  These medications cover up the pain, and cause the problem to worsen.


Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.

Vertebral  Subluxation           (  ‘VSC’ ,    ‘subluxation’   )
Vertebral Subluxation  is  actually  a  quite  common  condition.   Doctors of Chiropractic look for pathological conditions which may require referral to other specialties,   and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system  (the master control system- ALL health disciplines learn this).  VSC- ‘Subluxation’ – can be the cause of many symptoms and conditions.

Only  a  Doctor of Chiropractic  will  evaluate  and  treat  for  VSC,   as  well  as  other  pathology.

The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.

A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.


The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.

+++++++++++++++++++



Another handout I utilize only for my Staten Island Workers Comp patients is this one:





Work   Comp   INFO   for  the   newly   injured

I  am  NOT  a  Lawyer,  and  this  is  not  legal advice,  not  a  legal  opinion,   this  is  just  general  information,
Questions ?  - call  your  attorney.

If  you  are  hurt  at  work,  BY  STATE  LAW  YOU  ARE  COVERED  BY  WORKERS   COMPENSATION   INSURANCE.     There  is  no  choice.

If  you  are  hurt  at  work,  your  private  health  insurance  IS  NOT  responsible
to pay for your treatment (whether that may be Chiropractic,  Surgery, Medical, Dental, Physical  Therapy,  Psychological, etc.).

YOU  DO  NOT  HAVE  TO  MISS  WORK   to  be  covered by compensation.
Some  people  have  open  comp  cases  for  many, many years- 10, 20 years.....
IF   YOU   ARE   HURT   AT   WORK,    BY   STATE   LAW    WORKERS  COMPENSATION  HAS  TO  PAY  FOR  YOUR  TREATMENT.... WHETHER
YOU  ARE  WORKING  OR  NOT,,,  WHETHER  YOU  MISS  ZERO  DAYS,
ONE DAY,  ONE  WEEK,  OR  ONE  YEAR .

If  you  inform  your  doctor  that  you  were  hurt  at  work.....
BY   STATE   LAW   THE  DOCTOR   HAS  TO  NOTIFY/ GO  THRU  WORKERS  COMPENSATION.

If  you  inform  your  doctor  that  you  were  NOT  hurt  at  work......
BY   STATE   LAW   THE  DOCTOR  CANNOT   GO  THRU/ NOTIFY  WORKERS
COMPENSATION.

The  above  is  a  brief  explanation  of  WORKERS  COMPENSATION.  This  explanation  is  not  prepared  by  an  attorney  or  the  Workers  Comp  Board,  is  not  legally  binding,  but  is  an  attempt  at  a  brief,  general  explanation  of  workers  comp.   For  further  or  more  detailed  explanation,  contact  your  Work  Comp  Attorney.

For  your  own  records  ( you  will  be  thankful  next  year  when  they  ask  you  questions)( start  your  own  file,,,  keep  duplicate  copies  of  everything ) :

I  was  working  on ______________________________________ (date),

I  was  at _____________________________________________ (address),

I  was  working  for ____________________________________ (employer)
________________________________________________(employer  address)

I  injured  myself ______________________________________________
______________________________________________(activity you were doing)

I  injured _____________________________________________________
___________________________________________________ ( body  parts )
NOTES:



++++++++++++++++++++++++++++++++++++++++++





You ask, "....What is the treatment for this?...."- as you can see:
#1)  depends upon severity of injury.  I recommend an examination- perhaps by your local Doctor of Chiropractic or even your family Medical Doctor.
#2)  depending upon severity of injury- treatment can range from simple rest to surgery!
#3)  if injured at work- make sure you have completed appropriate forms.
#4)  Try to PREVENT aggravating this injury, or damaging it further-- Look at your biomechanics, ergonomics; think about how you can help yourself heal before lifting!



I hope this all helps.

If you need further information, do not hesitate to RE-contact me here at AllExperts.com
http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm



Thank you for your question,
I wish you luck in returning to good health,
your Staten Island Chiropractic expert,


Dr. Victor Dolan, DC, DACBSP
Email  newsletter: . . . . .  http://drvictordolan.chiroweb.com
http://SIWorkComp.com