Common Conditions Treated by Dr. Mahooti

Shoulder / Upper Arm Pain

 Do you have a shoulder pain or neck pain? Take your finger and point to the epicenter of your pain. If you point to the region between your shoulder blades, upper back or neck (between the shoulder joint and the base of skull/ear), odds are your symptoms are caused by a problem in your cervical spine (you neck) – and not the shoulder itself. If the above meets the description of your symptoms, see “Neck Pain” below.

Dr. Mahooti is an expert in non-surgical treatments for common shoulder problems: 

• Generalized shoulder pain
• Osteoarthritis
• Frozen shoulder (aka “Adhesive Capsulitis)
• Impingement syndrome
• Rotator Cuff tendinitis / tendinopathy 
• Rotator Cuff tears (especially partial thickness)
• Biceps Tendinitis / Tendinopathy
• Bursitis
• Calcific tendinitis / tendinopathy
• Labrum tears 
• Upper arm pain
• Shoulder pain after vaccination (“SIRVA”: Shoulder Injury Related to Vaccine Administration)
• Cervical myofascial pain (see “Neck Pain”)
• “Nobody can figure out what is causing my shoulder pain”

Upper Arm pain and tightness between the elbow and the shoulder has several causes: a tight muscle, pinched nerve, or referred pain from your neck, shoulder, or elbow..   

• • “Referred pain” is pain perceived in a particular area that is actually caused by a problem in different area. Pinched nerves (“Nerve Entrapments”) or Myofascial Trigger Points are common examples. 

Neck Pain:

Conditions Treated by Dr. Mahooti

• Dr. Mahooti can often help patients with cervical myofascial trigger points: tight, painful muscle “knots” in the upper back, adjacent to the shoulder blade(s), or in the neck.   The trapezius, levator scapula, and rhomboid muscles are commonly affected. 
• Cervical myofascial pain can be caused by a variety of underlying factors:  arthritis and/or bulging discs in the cervical spine, poor posture, weak upper back / shoulder-blade muscles etc.  Sometimes an underlying cause is not easily identified.  
• Fortunately, many cases can be treated effectively with Therapeutic Needling, physical therapy exercises, and/or treatment of the underlying cause.

 Conditions Not Treated by Dr. Mahooti

• Patients with cervical spine arthritis or bulging discs in the neck (or back), or numbness or tingling radiating down the arm from the neck/shoulder region are best served by a spine specialist or interventional pain management physician.  Your PCP can help guide you to such physicians.
• If you have pain and tightness in the neck / upper back muscles and do not have numbness or tingling down your arm, Dr. Mahooti may be able to help you with Therapeutic Needling, which is done in conjunction with a physical therapy and/or home exercise program. 

 

Elbow / Forearm

Common conditions treated by Dr. Mahooti

• “Tennis elbow” (outer elbow pain) 
• “Golfer’s elbow” (inner elbow pain) 
• Olecranon bursitis (swelling in the back of the elbow)
• Forearm muscle pain / tightness
• DeQuervain’s Tenosynovitis (pain along tendons at base of thumb/wrist)
• Nerve Entrapments – can often be treated effectively with  Ultrasound Guided Hydrodissection / Decompression Injection
• Radial tunnel syndrome / posterior interosseous nerve entrapment
• Superficial radial nerve entrapment (Wartenberg’s syndrome)
• Pronator teres syndrome (median nerve compression)
• Anterior interosseous nerve entrapment
• Cubital tunnel syndrome (ulnar nerve at elbow)
• Lateral or medial antebrachial cutaneous nerve entrapment

 

• “Tennis elbow” (outer elbow pain) and “Golfer’s elbow” (inner elbow pain) are among Dr. Mahooti’s favorite and most rewarding conditions to treat. Despite the name, the vast majority of cases are not caused by playing tennis or golf.  
• Both issues can be very painful and significantly impact a person’s daily life – picking up a coffee mug, pouring beverages, typing or mousing, opening doors, and even getting dressed can cause significant pain. 
• Fortunately, most patients respond remarkably well to Therapeutic Needling, along with a home exercise program that includes appropriate stretches, massage, and specific strengthening exercises. 
• Cortisone injections are traditionally offered and some patients respond well to them, but studies consistently show they provide only short term pain relief – and may harm the tendon, especially when repeated. 
• Physical Therapy is typically recommended if patients do not respond to Therapeutic Needling and home exercises.  
• Nitroglycerin patches stimulate blood flow and have been shown to provide pain relief for elbow tendinopathies. 
• PRP is a consideration when symptoms do not improve after above treatments.

 

Hand / Wrist 

Common conditions treated by Dr. Mahooti

• Carpal tunnel syndrome (numbness and tingling, often at nighttime, in the palm of your hand and/or thumb, index, middle and half of your ring finger)
• DeQuervain’s tenosynovitis (pain and swelling along the thumb-side of your wrist)
• Thumb pain / Osteoarthritis
• Trigger finger / thumb

 

Hip / Buttock / Thigh 

“Hip pain” means different things to different people.  Some people describe pain in the front part of the hip (the groin), while others point to the outer side of the hip, the buttock, and the low back.  Other people call it “sciatica” (which is a symptom, not a diagnosis), which has multiple causes.  Oftentimes one problem in the hip area creates a snowball effect that results in pain and dysfunction throughout the entire hip region. Imaging studies (X-Rays, MRIs) can help determine the likely cause(s), as can diagnostic/therapeutic injections. 

 

Myofascial Trigger Points –  are tight, tender muscle “knots” that are almost always present in people with pain in the hip, buttock, and thigh pain.  Sometimes the Trigger Points are the cause of the problem, other times they are the result of an underlying problem, as described below.  Dr. Mahooti is a national expert on Myofascial Trigger Point pain and treatment with Therapeutic Needling.  

Groin (Front of the Hip)

If your pain is deep in the front of your hip or groin, it’s often (but not always) related to problems inside the hip joint itself.  Common causes include:

• Myofascial Trigger Points in your thigh (quadriceps, adductors, pelvis muscles) can cause groin pain.
• Hip Osteoarthritis – wear and tear of the joint cartilage causing stiffness and aching in the groin, especially when walking or getting up from a chair.
• Hip Labral Tear – injury or fraying of the cartilage rim around the hip socket, leading to catching, clicking, or sharp groin pain.   Note:  Labral tears do not necessarily cause hip pain. Nearly 70% of people over the age of 40 who do not have hip pain will have a labral tear on MRI.  Labral tears are often incidentally found on MRI in people who do not have hip pain.  have no hip pain, and most people with hip osteoarthritis
• Hip Impingement (Femoroacetabular Impingement, “FAI”) – occurs when the ball and/or socket of the hip (femoroacetabular) joint is misshapen and over time often results in hip pain, labral tears, and osteoarthritis.
• Acute Muscle Strain / Injury – acute strain or injury of the muscles in around your hip and thigh (Hip Flexors, Adductors) 
• Referred Pain from the Lumbar Spine – sometimes, a pinched nerve, arthritis, and/or bulging discs can cause pain that feels like it’s coming from the hip joint.

   

Outer Hip (Side of the Hip)

Pain on the outer side of the hip and thigh is usually (but not always) from structures around the hip joint.  

Common causes:

• Myofascial Trigger Points along the buttock and outer thigh (vastus lateralis and IT band) can often cause outer hip pain.
• Trochanteric Bursitis (“Hip Bursitis”) – is often described as inflammation of a fluid-filled sac over the bony point of the outer hip. However, hip bursitis is a misnomer; bursal fluid is rarely evident on diagnostic ultrasound.  Most cases are due to hip tendinopathy, or referred from Myofascial Trigger Points along the thigh or buttock muscles that refer pain to the outer hip.
• Gluteus Medius / Minimus Tendinopathy (“Hip Tendonitis”) – strain or degeneration of the hip stabilizer tendons; may hurt when walking, climbing stairs, or standing on one leg.
• Nerve Entrapments in the hip region are probably more common cause of hip pain than is currently recognized.
• Referred Pain from the Lower Back – sometimes, a pinched nerve, arthritis, and/or bulging discs can cause pain that feels like it’s coming from the hip joint.

   

Buttock (Back of the Hip)

Pain felt deep in the buttock may come from the spine, sacroiliac joint, nerves (in the buttock itself), or muscles and fascia (“myofascial pain”).

Common causes:

• Myofascial Trigger Points in the buttock, thigh, or lower back can all cause buttock pain.
• Piriformis Syndrome – spasm, weakness, and/or tightness of the piriformis muscle can result in irritation of the sciatic nerve as it courses through the deep buttock muscles, resulting in buttock and posterior thigh pain, tingling, burning, or numbness.  If the neurologic symptoms go below the knee to the foot or toes, it suggests a pinched nerve in the lower back at the nerve root, called “lumbar radiculopathy,” which is derived from the term radicle, which means the root. (i.e. in math, the “square root” of a number is also called the “radicle”.)  
• Sacroiliac (SI) Joint Dysfunction / Arthritis– irritation or stiffness where the spine meets the pelvis, often producing one-sided lower back, buttock pain or posterior thigh pain.
• Hamstring Tendinopathy – pain where the hamstring attaches to the sitting bone, often worse when sitting for long periods.
• Deep Gluteal Pain Syndrome – a term used to described chronic, persistent buttock pain that does not respond to standard treatments.  Entrapped nerves, irritated tendons, and other potential causes are possible. 
• Referred Pain from the Lumbar Spine (Sciatica) – nerve irritation in the lower back can cause aching, burning, or shooting pain through the buttock and down the leg.

 

Thigh (Quadriceps, Hamstrings, Adductors)

Your thigh is between your hip and your knee. Essentially all the conditions that affect your hip, low back, and knee can also cause thigh pain.

Other common causes include:  

• Acute injuries / strains of the thigh muscles 
• “Pulled muscle” (strain, tear):  hamstring, quadriceps, adductor
• Contusion (bruise)
• Adductor strain (“pulled groin”) 

• Nerve entrapments (e.g. Meralgia Paresthetica)

 

Myofascial trigger points are a common, overlooked cause of thigh pain. They can develop “out of nowhere” in three basic ways:

1. Sudden onset, no injury (“acute”): During a routine activity such as walking, gardening, housekeeping you develop sudden pain (tightness, stiffness)in a body part (hip, thigh, shoulder…)
2. Delayed onset (“subacute”):  After a routine activity (you may have overdone it a bit) or a new activity (yardwork, hiking, exercising, playing a sport).
3. Post-injury:  in the weeks or months after an injury, you develop persistent pain, stiffness, instability, weakness and/or a number of other symptoms that may be “hard to describe”.  You may have been told you have “scar tissue” or made to feel it is all “in your head” because all your diagnostic tests and “unremarkable” or normal. 

 

Knee / Calf / Shin

Knee pain is the most common presenting problem in orthopedic specialty care. Lots of things can go wrong with your knee.  Fortunately, most of them can be treated effectively non-surgically (including meniscus tears and ligament injuries). Even if your symptoms do not precisely match the following list of common knee conditions treated by Dr. Mahooti, he will help figure out the cause of the problem and guide you with the best available treatment options.

Front of the Knee (Anterior)

• Knee-cap pain
• Patellofemoral pain (“Runner’s Knee”)
• Patellar tendon pain (tendinitis or tendinopathy)
• Pes anserine bursitis
• Osteoarthritis affecting the front of the joint
• Chronic Osgood–Schlatter–type pain at the tibial tubercle

Inner Knee Pain (Medial)

• Medial meniscus tears
• Medial collateral ligament (MCL) sprains
• Pes anserine bursitis (can also be felt slightly forward of the inner knee)
• Medial compartment osteoarthritis

Outer Knee Pain (Lateral)

• Iliotibial (IT) Band Syndrome
• Lateral meniscus tears
• Lateral collateral ligament (LCL) sprains
• Lateral compartment osteoarthritis

Pain Behind the Knee (Posterior)

• “Baker’s cyst” (fullness or swelling in the back of the knee)
• Hamstring-related pain
• Posterior joint swelling or effusion
• Posterior meniscus tears
• Osteoarthritis with fluid buildup (“effusion”)

General or Multi-Area Knee Pain

• Swelling or joint effusion
• Acute injuries (sprains, strains, falls, sports injuries)
• Persistent pain after an injury or surgery
• Post-surgical knee pain (knee replacement, ligament or meniscus surgery)
• “Nobody can figure out what’s wrong with my knee”

 

Lower Leg / Calf / Shin

Lower leg pain can be referred from problems in the low back, hip, knee, or ankle. It can also be caused by myofascial trigger points.

Common lower leg conditions treated by Dr. Mahooti

 

• Myofascial Trigger Points
• Shin splints
• Running / exertional leg pain
• Tendinitis / Tendinopathy / Bursitis
• Stress fractures
• Nerve entrapments (common peroneal nerve, superficial peroneal nerve, tarsal tunnel syndrome)
• Stress fractures
• Calf pain / tightness
• Achilles tendinitis / tendinopathy
• Achilles tears

 

Ankle / Heel

• Ankle injuries 
• Ankle sprains
• Chronic ankle pain
• Osteoarthritis
• Tendinitis / Tendinopathy (peroneal, tibialis anterior, tibialis posterior…)
• Heel Pain
• Achilles pain (Tendinitis / Tendinopathy)
• Achilles tears
• Plantar Fasciitis
• Heel spurs
• Stress Fractures
• Nerve entrapments (tarsal tunnel syndrome, superficial peroneal nerve, Baxter’s nerve…)

 

What is a Sports Medicine Physician?

Sports Medicine Physicians are primary care physicians (Family Physician, Internist, or Pediatrician), Emergency Medicine physicians, or Physiatrists who undergo specialty training (“Fellowship”) in non-surgical sports medicine. They are not surgeons – but often work with Orthopedic Surgeons. Sports Medicine Physicians…

• Specialize in diagnosing and treating muscle, joint, tendon, and nerve injuries caused by athletics, exercise, work, or everyday life.  

• Focus on restoring movement, reducing pain, and helping you return to the activities you love as quickly and safely as possible.

• Provide guidance on wellness, performance, nutrition, and the medical care of active individuals

• Perform a wide variety of injections and minimally-invasive procedures, often under image guidance (ultrasound)