MedStar St. Mary's Hospital

As the command center for every system in the body, a healthy brain requires a lot of blood to stay functional; in fact, every minute, it makes use of ¼ of the blood pumped by the heart. A diminished blood supply (for example, caused by a blood clot) starves the brain of oxygen, and brain tissue begins to die—a condition we recognize as stroke. Stroke is the fifth most common cause of death in the United States (and number two worldwide). It occurs suddenly and often leaves very little time for effective medical intervention. This deadly byproduct of cardiovascular disease affects over two million Americans each year, and 150,000 of those affected do not survive. Among the survivors, nearly eight million Americans must live with the aftereffects: often irreversible damage that impacts their daily lives. And stroke is not necessarily a disease of older age—risk factors are increasing across all age groups, particularly younger adults. Our best defense is prevention. Time Is Brain What causes a stroke? There are two types of stroke: Ischemic stroke is similar to heart attack: an artery supplying the brain with blood is blocked, usually by a clot, resulting in tissue death. Ischemic stroke is four times more common than hemorrhagic stroke. In hemorrhagic stroke, a blood vessel in the brain ruptures and bleeds. Brain tissue is damaged as blood accumulates where it doesn’t belong. The moment that a stroke begins, the clock is ticking. Damage sweeps very rapidly through the affected area of the brain, so the faster medical attention can be given, the more likely we are to save brain function and avoid devastating consequences for the patient. Without treatment, brain tissue can be damaged beyond repair in about 4½ hours. Surviving stroke victims may suffer from paralysis, numbness, or weakness on one side of the body, creating difficulty in walking and use of the hands. Stroke can also affect speech, swallowing, memory, learning, and emotional health. Stroke recovery is typically very slow and often limited. The brain cannot heal the injured tissue—stroke damage is permanent. In many cases, some areas of surviving brain tissue can learn new skills and compensate. But that rewiring typically takes six to eight months—and full functional recovery is rare. The moment that stroke strikes, the clock is ticking. The more quickly it is treated, the less likely the patient will experience serious consequences. Dr. Yongwoo Kim explains the signs. https://bit.ly/3ekbpXD via @MedStarWHC Click to Tweet Symptoms of Stroke: BE FAST In some patients, a small blood clot may cause what we refer to as a mini-stroke or a transient ischemic attack (TIA), which behaves almost the same way that a larger stroke does. However, mini-stroke symptoms may subside very quickly, often in as little as five minutes. TIA is a warning sign that a larger stroke may be imminent. Consider it a medical emergency and get the medical attention needed to prevent a larger event. If or when that larger event occurs, urgent action is vital to preserve brain tissue. Stroke rarely produces pain, so look instead for these five classic stroke symptoms that happen suddenly. Use the acronym BE FAST to remember what to look for. The BE FAST Checklist Call 911 immediately if any of these stroke symptoms suddenly occurs: B—Balance: leaning, staggering, or difficulty walking E—Eyes: any visual impairment of one or both eyes, including visual field narrowing, blurry or double vision, or one eye not moving normally F—Face: drooping on one side or a lopsided smile A—Arms: weakness on one side, such as inability to fully raise the arm or hold onto something S—Speech: speech is slurred or hard to understand, or the patient is inarticulate, unable to make meaningful conversation T—Time: act immediately if you see or experience one or more of the symptoms above. Call 911 and get to a hospital as quickly as possible, where emergency treatment can begin. Treatment For a stroke victim who reaches the hospital quickly, treatment involves recanalization—opening vessels to restore blood flow. We first complete a thorough neurological exam, and may order emergency radiology imaging studies. We use CT and MRI to confirm stroke and assess any bleeding damage. We treat quickly, potentially using both drugs and surgery to clear a blocked blood vessel, depending on location and severity. When a blood clot causes a small blockage, we use thrombolytic medications, also known as tPA or clot-busters, to get the blood flowing again. We perform surgery to stop bleeding in the case of hemorrhagic stroke, when a larger artery has ruptured. In some cases, catheterization alone may be effective—we can potentially pass a thin tube through a large blood vessel and navigate it to the site of the blockage. Because about one in four stroke patients will suffer another stroke within five years, we typically prescribe antithrombotic medications such as aspirin to prevent clotting that may cause additional strokes. And after treatment and initial recovery, rehabilitation is typically recommended, to help the patient strengthen weakened muscles and improve swallowing, speech, and other critical functions. Patients are in the best possible hands here at MedStar Washington Hospital Center. We are a Comprehensive Stroke Center, with an advanced care team that includes highly trained neurologists, neurosurgeons, emergency physicians, nurses, and rehabilitation professionals. Many of our team members participate in key research in the area of stroke. The Hospital Center makes use of the latest and most effective medications, and offers advanced imaging technology focused specifically on diagnosing neurological problems. We are equipped to act in the shortest amount of time to achieve the best possible results for our stroke patients. Prevention, the Best Medicine Traditional stroke risks include high blood pressure, high LDL cholesterol, atrial fibrillation, diabetes, tobacco use, advanced age, and a prior stroke history. And recently, the COVID-19 virus has caused life-threatening clotting in some patients as well. Managing your health and adopting a healthy lifestyle are the best ways to prevent stroke—and prevention is significantly better than treatment. Control weight gain—try to maintain a belly circumference of less than 34 inches. Exercise at moderate intensity for at least 30 minutes, three days per week. Avoid tobacco and illicit drugs. Drink alcohol in moderation. Eat nutritionally balanced meals that include more fruits and vegetables than meat and that minimize sodium and fat. Take all recommended precautions against COVID-19—mask up, practice social distancing, avoid crowds, isolate when ill, and get vaccinated. Schedule regular checkups with your primary care physician, who will work with you to manage any underlying conditions such as high blood pressure, diabetes, atrial fibrillation, or clotting disorders. Know the warning signs. Download our stroke checklist. Download now

We use our shoulders to do just about everything, from pushing and pulling to lifting and carrying. That’s why it’s common to feel tension—or even pain—in our shoulder joints, especially after doing the same motions over and over again. While shoulder pain caused by an injury or trauma should be treated by a doctor specializing in orthopedics, there are stretches and exercises you can do at home to get rid of shoulder pain. Exercises that target the shoulders and surrounding muscles can strengthen and stabilize the joint, helping to relieve tightness, improve range of motion, and prevent injury. Do you have #ShoulderPain? On the #LiveWellHealthy blog, Dr. Kuri shares 5 stretches and 7 exercises to relieve tightness, strengthen and stabilize your shoulder, and prevent injury: https://bit.ly/33zhfin. Click to Tweet Common causes of shoulder pain. Proper shoulder movement requires supporting muscle groups to work together in a coordinated fashion. While shoulder pain can be caused by direct trauma to the shoulder, if the muscles and soft tissues that support the shoulder weaken, become stiff, or are injured, our shoulders become susceptible to injury. There are a variety of causes of shoulder pain, but most conditions can be broken down into the following categories: Degenerative conditions that occur gradually over time as a result of wear and tear, such as arthritis. Chronic or overuse conditions that result from repetitive overhead motion such as throwing a baseball or painting the walls of a house. Acute injury and trauma after a direct blow to the shoulder or sudden forceful stretch during a fall, car accident, or other unexpected event. Request an Appointment Why it’s important to stretch your shoulders. Stretching gets your blood flow circulating so you can safely and gradually improve motion and perform shoulder exercises. Shoulder exercises strengthen your shoulder muscles and encourage proper shoulder function, which helps you to: Improve flexibility Increase range of motion Stabilize the joint Prevent future injury Reduce muscle soreness Exercises and stretches that can relieve shoulder pain. These five easy shoulder stretches, along with a few exercises, can help you relieve shoulder pain at home with minimal equipment. Consider performing these stretches and exercises three to four days a week to maintain and improve shoulder motion, and gradually progress to the strengthening exercises to improve function. If you feel pain, stop the exercise and call a doctor specializing in orthopedics. Stretches. 1. Pendulum Lean forward, placing your right hand on a counter or table for support. Allow your left arm to hang relaxed at your side. Gently swing your left arm forward and backward, side-to-side, and in a circular motion. Repeat the motion 10 times. Switch arms and repeat the sequence. Repetitions: 2 sets of 10 on each side Tip: Keep your back straight and your knees slightly bent. 2. Crossover arm stretch With relaxed shoulders, gently pull your left arm across your chest. Hold your upper left arm using your right hand, pulling it until you feel the stretch at the back of your shoulder. Hold it for 30 seconds and then release it for 30 seconds. Perform the stretch three more times. Repeat with the opposite arm. Repetitions: 4 on each side Tip: Avoid putting pressure on your elbow. 3. Table and wall slides Place both hands on a long table in front of you while sitting down and upright. Slide your hands together forwards along the table to gently stretch overhead as you lean forward. Hold the movement for 5 seconds once you reach your maximum stretch, then slowly return to the upright position. As you progress, move to a wall and try the overhead stretch while standing, using the wall to slide your hands along. Repetitions: 3 sets of 10 slides Tip: To make sliding easier, hold a towel or walk your fingers along the surface. 4. Passive internal and external rotation stretch Internal rotation Hold a yardstick, golf club, or other light stick behind your back with your left hand. Lightly grasp the end of the stick with your right hand. Gently pull the stick horizontally with your right hand until you feel a stretch in the front of your shoulder. Hold the stretch for 30 seconds. Release for 30 seconds. Repeat on the opposite side. External rotation Grasp a broomstick, yardstick, golf club, or other light stick with your left hand in front of your body and the other end of the stick with your right hand. Push the stick horizontally with your right hand until you feel the stretch in the back of your shoulder. Hold the stretch for 30 seconds and then relax for 30 seconds. Repeat on the other side. Repetitions: 4 of each on both sides Tip: Keep hips facing forward and avoid leaning or twisting while pushing or pulling the stick. 5. Sleeper stretch Lie down on your left side on a flat, firm surface. With your shoulder under you, bend your left arm at a 90-degree angle. Use your right arm to push your left arm down until you feel a stretch in the back of your left shoulder. Hold the movement for 30 seconds and then relax for 30 seconds. Switch sides and repeat. Repetitions: 4 on each side Tip: Avoiding pressing down on or bending your wrist. Strengthening exercises. For each exercise, use light dumbbells that allow you to perform the minimum number of eight repetitions in a set. As the exercise gets easier, progress to three sets of 12 repetitions. Add weight in one-pound increments up to five pounds. Each time you increase weight, begin with three sets of eight repetitions before progressing to 12 repetitions. 1. Scapular retraction/protraction Lie down on a table or bed on your stomach. Let your arm hang over the side with a light dumbbell in your hand.. Keep your elbow straight and squeeze your shoulder blade toward the opposite side of your body. Slowly return to the starting position and repeat. Switch sides. Repetitions: 2 sets of 10 on each side Tip: Be careful not to shrug your shoulder toward your ear. 2. Forward elevation strength Hold light dumbbells in both hands with arms outstretched in front of you. Slowly raise both hands to a slightly overhead position at the same time. Slowly return to a resting position and repeat. As you get stronger, increase your weight while lowering the number of repetitions. Repetitions: 3 sets of 8 to 12 repetitions on each side Tip: As you get stronger, widen your hand position so they are raised approximately 6 to 12 inches outside of your shoulders. 3. Trapezius strengthening Place your right knee on a bench, leaning forward to support your body with your right hand on the bench. With your left hand palm facing your body, slowly raise your left arm and rotate your hand to the thumbs-up position. Stop when your left hand reaches shoulder height and your arm is parallel to the floor. Count to five as you lower your left arm to the original position. Repeat on the opposite side. Repetitions: 3 sets of 20 on each side Tip: You can add light weight (2 to 3 lbs) to increase the difficulty as the exercise gets easier. 4. Internal and external rotation strength Internal rotation Make a loop with a 3-foot-long exercise band, tying the ends together. Attach the loop to a doorknob or other stable object. Hold the band with the hand closest to the loop with your elbow at your side and bent at a 90-degree angle. Keeping your elbow tight by your side, bring your arm across your body. Slowly return to the start position and repeat. Switch sides. External rotation Using the same 3-foot-long loop attached to a doorknob or stable object, grasp the loop with the hand furthest from the loop. Keep your elbow tight by your side and bend it at a 90-degree angle. Slowly rotate your arm outward. Return to the start position and repeat. Switch sides. Repetitions: 3 sets of 8 on each side Tip: Keep your elbow pressed into your side. You can also do this exercise laying on your side, using light dumbbells to perform a similar motion as when using the bands. 5. Bent-over horizontal abduction Lie down on a table or bed on your stomach. Let your arm hang over the side with a light dumbbell in your hand.. Keep your arm straight and slowly raise the dumbbell to eye level. Slowly return to the starting position and repeat. Switch sides. Repetitions: 3 sets of 8 on each side Tip: Use slow and controlled movement when lowering the weight. 6. Elbow flexion Stand tall with light dumbbells in each hand. Keeping your elbows close to your sides, bring the weight toward your shoulders. Hold for two seconds and slowly lower to the starting position. Repeat. Increase weight by 1-pound increments as the exercise gets easier. Repetitions: 3 sets of 8 to 12 on each side Tip: Use slow and controlled movement when lowering the weight. 7. Elbow extension Stand tall with a light dumbbell in your left hand. Raise your left arm, bending your elbow behind your head. Support your left arm by grasping your upper arm with your right hand. Slowly straighten your elbow, bringing the weight overhead. Hold for two seconds and slowly lower to the starting position. Repeat. Increase weight by 1-pound increments as the exercise gets easier. Repetitions: 3 sets of 8 to 12 on each side Tip: Avoid arching your back by tightening your abdominal muscles. When to see a doctor for shoulder pain. If you experienced a sudden injury or trauma to your shoulder, or your shoulder pain is worsening and affecting your sleep or quality of life, don’t wait to visit an experienced orthopedic expert. A highly trained doctor specializing in orthopedics can accurately diagnose your shoulder pain and determine the best course of treatment. From non-invasive treatment options, such as icing, biologic injections, and physical therapy, to minimally invasive or complex surgery, you can count on the fellowship-trained orthopedic experts at MedStar Orthopaedic Institute at MedStar St. Mary’s Hospital to get you back to the activities you enjoy without shoulder pain. Is your shoulder pain getting worse? We can help. Visit our orthopedic experts at MedStar Orthopaedic Institute in Leonardtown. Learn More