Physicians Lindsey and Kirsten are back with a new topic. They discuss the concept of life space, the area in which one conducts life activities. Studies have demonstrated that larger life space positively affects health. Lindsey and Kirsten discuss the benefits of a larger life space and explore how to obtain these benefits even when life space is limited.

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In this episode we discuss shoulder pathology including impingement, adhesive capsulitis, arthritis of the shoulder, and rotator cuff injuries with physical therapist Lindsey Sandbeck. We review what to expect from a PT evaluation, as well as non-operative and post-operative physical therapy. Lindsey provides insight into strategies to optimize recovery from shoulder injuries and surgery.

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Dizziness

Dizziness can come in different forms: vertigo, lightheadedness, disequilibrium.

Vertigo:  False movement, room spinning.  Feels as if you are moving when you are not.  

Benign Paroxysmal Positional Vertigo:  acute, occurs with certain movements, lasts seconds to minutes

Dix-Hallpike to diagnose 

Vestibular rehab/physical therapy to treat - Epley Maneuver

Meniere’s Disease: vertigo, with hearing loss and ringing in ears

Labyrinthitis

Central vertigo: can be more worrisome, exam looks for signs of stroke or other pathology. May need brain imaging. 

Lightheadedness: feeling like one could pass out, pre-syncope

Cardiac causes: arrhythmias, valve disease

Orthostatic hypotension

Disequilibrium: sense of imbalance

Changes in nerve sensation can contribute: peripheral neuropathy, knee replacements

Vision and auditory impairment can also contribute

Diagnosis: monofilament testing, vibration sensory testing, gait speed, get up and go test, Romberg test all help evaluate

Treatable causes: B12 deficiency, thyroid disease, uncontrolled diabetes, medications that can be stopped (older anti-histamines)

Treatment: Adaptations (change in glasses, hearing aids), practice balance - physical therapy, strengthening

Persistent Postural Perceptual Dizziness (PPPD): persistent dizziness that worsens with motion or upright position, present > 3 months

Often follows BPPV or labyrinthitis

Anxiety, depression often present concomitantly

Treatment: Evaluate medications, consider medication to help with anxiety, depression

Health Pearl: For people who have been fully vaccinated for COVID-19, we discuss CDC guidelines and ways to safely expand activities. 

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