Musculoskeletal Pain Musculoskeletal pain can be caused by diseases of the bones, joints, muscles, tendons, ligaments, bursae or a combination of these conditions. Bone pain is usually deep or penetrating. It is usually the result of a traumatic injury. Less frequently it occurs in problems related to protest material, in cases of infection of the bone (osteomyelitis), hormonal disorders and/or tumors. Muscular pain (known as myalgia) is generally less intense than bone pain, although it can be limiting, especially if it results from a muscle spasm (continuous painful muscle contraction), also known as cramp. Muscle pain can also be manifested by hardened muscle cords/painful points (trigger points) /, located predominantly in the cervical region, gluten region, and/or pelvic waist. All of us have latent trigger points that can be activated in case of overload or incorrect posture. The pain in the tendon and ligament is generally less intense than the bone pain, usually worsens when the affected tendon or ligament are elongated or moved and relieves with rest. The most common injury is sprain. The pain in the bursae (small bags filled with liquid that provides a protective cushioning of the joints) and a pain that worsens with movement and relieves with rest. It appears in situations of trauma, excessive joint overload, gout or infection. Joint pain (called arthralgia) may or may not be accompanied by inflammation (called arthritis). Arthritis-related pain can be acute (e.g., when caused by infection, injury or gout) or chronic (e.g., when caused by rheumatoid arthritis or osteoarthritis), although with periods of exacerbation. Other signs/symptoms usually co-exist (heat, swelling and redness). Sometimes the pain originates in structures close to the joint, such as ligaments, tendons and bursa. Fibromyalgia pain is a generalized pain with hypersensitivity to the palpation of specific painful points (muscles, tendons or ligaments). It is also accompanied by other symptoms such as: general fatigue, poor quality sleep, among others. Sometimes, a pain that appears to be musculoskeletal is actually caused by a disease in another organic system. For example, shoulder pain can be caused by a disorder that affects the lungs, spleen, or gall bladder. Back pain can be caused by a kidney stone, abdominal aortic aneurysm, inflammation of the pancreas, or, in women, by pelvic disorders. Arm pain may be associated with a heart attack (myocardial infarction).

Medicação analgésica, anti-inflamatória, Opióides Medication As such, a correct diagnosis and assessment of the patient are essential to initiate a pharmacological treatment appropriate to the patient's characteristics and pain. Currently, to treat pain, there is a wide variety of non-opioid analgesics, such as non-steroidal anti-inflammatory drugs, weak opioids (e.g. Tramadol, Codeine) and, lastly, potent opioids, such as Oxycodone, Fentanyl and Morphine. In addition, there are a number of drugs called Co-analgesics as anticonvulsants and antidepressants that help us to complete this treatment, according to the pain and the patient. SERVICES

A Esclerose Múltipla (EM) trata-se de uma doença neurológica crónica, mais comum no adulto jovem, e que surge habitualmente na terceira década de vida, com o dobro da frequência no sexo feminino. Multiple Sclerosis Multiple Sclerosis (MS) is a chronic neurological disease, more common in young adults, which usually appears in the third decade of life, with twice the frequency in women. Most cases are diagnosed between the ages of 20 and 50, although it can affect people between the ages of 2 and 75. Although it is not a fatal disease, it is very disabling, significantly affecting all aspects of patients' lives. This disease affects the central nervous system. The nerve fibers of cells in the nervous system are lined with a sheath called myelin, which is essential for stimuli to be properly propagated. In multiple sclerosis myelin is destroyed, thus preventing proper communication between the brain and the body. On the other hand, the inflammatory process that occurs in this disease damages the nerve cells themselves, causing permanent loss of several functions, depending on the affected territories. The exact cause of this disease is not known, but it is admitted that several factors of a genetic, immunological, viral, bacterial, environmental nature (diet, industrial toxins present in the soil or water), reduced levels of vitamin D, allergies, physical trauma, etc. Symptoms The first symptoms may be of a sensitive nature, such as loss of sensation or tingling that start at one end and extend to the entire limb over 3 or 4 days. These symptoms can last for 1 to 2 weeks and then gradually disappear. MS can initially manifest itself in other ways, with blurred vision, double vision, motor deficits, tremors, difficulty in walking, balance changes, speech difficulties, memory and concentration problems, fatigue, or even paralysis and complete loss of vision. The symptoms will always be dependent on the areas of the nervous system where the loss of myelin occurs and the consequent inability to transmit nerve stimuli. These symptoms can progress in several ways, as described above, appearing and disappearing or progressing gradually. The evolution to complete paralysis is rare, although many patients will need assistance in walking, given the presence of fatigue, weakness and imbalance. Treatment Multiple sclerosis has no cure and the available drugs can only "modify" or delay its evolution, reduce the frequency and severity of outbreaks, reduce the accumulation of damaged areas in the nervous system and help patients deal with symptoms. The definition of the best treatment for each case will always depend on a medical evaluation. The most commonly used groups of drugs include corticosteroids, which help to fight inflammation and interferons, which reduce the risk of multiple sclerosis outbreaks, while also reducing their severity and the damage caused by them. In the most severe forms, medicines of another nature, such as cytostatics, can be used. All of these treatments can be complemented with other types of support, defined according to the difficulties experienced by each patient. Objectives of a rehabilitation program: Sensitive- motor re- education Relief from pain and spasticity Training of speech disorders, swallowing, vision, cognitive changes General physical reconditioning Functional training and day-to-day activities Improvement of gait, balance and coordination Bladder training Teaching and counselling of support products (orthotics, splints, etc.) Return to work activities , daily life and sports activities

Síndrome do Túnel Cárpico. Dedo em gatilho. Doença de Dupuytren. Tenossinovite de Quervain Hands and fingers Carpal tunnel syndrome Carpal tunnel syndrome occurs when pressure build-up within the carpal tunnel causes nerve compression. When the compression is sufficiently high, it causes changes in nerve function, which causes numbness / tingling, pain in the hand and fingers and, consequently, muscle weakness. In most situations, numbness / tingling affects the thumb, forefinger, middle and part of the ring. The signs usually appear at night, but can appear during daily activities, such as driving or reading a newspaper. Patients notice that they have reduced grip strength and may drop objects from their hands. In the most severe cases, tenderness may be completely absent and the muscles at the base of the thumb atrophied (atrophy of the tenar eminence). The cause is usually unknown. Fluid retention during pregnancy can in some cases cause edema in the canal, which usually disappears after delivery. Some diseases such as hypothyroidism, rheumatoid arthritis, diabetes and kidney failure can be associated with this syndrome. Stenosing tenosynovitis (trigger finger) Stenosing tenosynovitis, commonly known as a trigger finger, involves the tendons and pulleys of the flexor tendons of the fingers. The tendons work like long cords from the muscles in the forearm and through a tunnel, with a bone base and fibrous tissue ceiling, until they reach the fingers. Inside the tunnel the tendons are wrapped in a film that allows easy sliding inside the sheath and pulleys. The trigger finger occurs when the tendon develops a lump or edema of the surrounding film. When the tendon swells, it increases in volume, and has to rub at the entrance to the tunnel (flexor tendon sheath), which causes pain, bouncing and a feeling of being trapped in the finger. When the tendon touches the sheath, there is more inflammation and more edema. This causes a vicious cycle between the trigger, inflammation and edema, which in some cases leads to a blockage, and it is not possible to bend or stretch the involved finger. The causes for the appearance of the trigger finger are not fully understood. Trauma to the palm can irritate the flexor tendons. Some diseases such as rheumatoid arthritis, gout and diabetes are associated with the appearance of a trigger finger. The trigger finger may start as a slight discomfort felt at the base of the finger. Thickening can be felt in this area. When the finger starts to become blocked and cause the shoulder or trigger, the problem may appear in the interphalangeal joint near the finger. Dupuytren's disease Dupuytren's disease is a benign pathology that is characterized by a fibrotic thickening of the palmar and digital fascia of the hand. Initially, it presents as a palpable palpable mass (Dupuytren's nodule) that can progress to contracture in flexion of the hand joints. It occurs most frequently on the 4th and 5th fingers. The decrease in range of motion affects the patient's daily activities. The pre-tendon nodules that form in the palmar flexion folds may be painless or moderately painful. As they grow, Dupuytren's nodules develop cords that extend distally and proximally and that, once thickened, shorten and lead to contracture. Quervain's tenosynovitis Tenosynovitis, tendonitis, or De Quervain's syndrome is an inflammation that affects the tendons of the wrist leading to the thumb, namely the tendons of the long abductor and short extensor of the thumb, in the area where they cross a thick fibrous sheath, which constitutes the first wrist extensor compartment. Although the causes of De Quervain's tenosynovitis are unknown, in most cases it is associated with overuse, either at home or at work, or with rheumatoid arthritis. Any activity that involves repetitive movement of the wrist and hand such as gardening, playing golf or tennis or picking up a baby, for example, can trigger and / or aggravate the symptoms. Prolonged vicious positions or situations of overload can also be at its origin. In addition, there are physiological conditions that predispose to the development of this pathology, such as pregnancy, the puerperium or in patients who have had a previous wrist fracture. The main symptom of De Quervain's tendonitis is pain in the outer edge of the wrist. The pain can start suddenly or insidiously and initially appears at the base of the thumb, in the area that corresponds to the first extensor compartment. Often the pain radiates towards the thumb or forearm, and it is sometimes difficult for the patient to locate a specific point of pain. De Quervain's tendonitis is curable with appropriate treatment, which consists of eliminating inflammation of the affected tendons, thus providing pain relief and recovery of mobility and function. Objectives of a rehabilitation program: Improving mobility and joint movement Relief from pain and inflammation Teaching and counselling of support products (orthotics, splints, etc.) Return to work activities , daily life and sports activities Ask our Flyers for your Hometraining at the doctor's appointment

O Acidente vascular cerebral (AVC) é um distúrbio cerebral adquirido após oclusão de um vaso ou perfusão inadequada no parênquima cerebral. Stroke Stroke is a brain disorder acquired after occlusion of a vessel or inadequate perfusion in the brain parenchyma. Stroke is the leading cause of death in Portugal. Worldwide, it is estimated that: one in six people will have a stroke; every second a person suffers a stroke; and every 6 seconds the stroke is responsible for the death of someone. According to the Portuguese Society of Stroke, Portugal is, in Western Europe, the country with the highest mortality rate, especially in the population under 65 years of age. Risk factors for stroke include age, sex, obesity, diabetes, high blood pressure, hypercolest sedentary lifestyle. Symptoms In general, it is simple to recognize a stroke using the 5 F's rule. These symptoms can appear in isolation or in combination: Face : the face can suddenly become asymmetrical, looking like a "corner of the mouth" or one of the eyelids is drooping. These signs can be better perceived if the affected person tries to smile. Strength : it is common for an arm or leg to suddenly lose strength or to experience a sudden lack of balance. Speech : speech may seem strange or incomprehensible and speech does not make sense. Often, the person does not seem to understand what is said to him. Sudden lack of vision: Sudden loss of vision in one or both eyes is a common symptom in a stroke, as is double vision. Severe headache : likewise, it is important to value a sudden and very intense headache, different from the usual pattern and with no apparent cause. Other problems may arise, such as urinary retention, pain, depression, fatigue and increased muscle tone (spas. Functional limitations resulting from stroke are usually difficulties in walking and cognitive performance such as loss of memory, attention and perception visuospatial, difficulties in communication, not being present. As a result of these disabilities, many individuals may have difficulty using public transport as a previous professional. Some will need supervision. What is the treatment for stroke? The most useful drugs for the treatment and prevention of stroke are antihypertensive agents, antiplatelet agents and anticoagulants. Taken together, these three classes of drugs improve circulation and ensure a better supply of blood, oxygen and nutrients to brain cells. The choice of the best combination of drugs should always be made by the doctor. In some cases, surgery may be instrumental in unblocking a clogged artery. How to prevent a stroke? It is important to control all the components of our health, regularly checking blood pressure and cholesterol, not smoking or consuming alcohol or excess salt, maintaining a healthy diet and exercising. What is the recovery after a stroke? Recovery from a stroke takes time. About a third of patients recover significantly in the first month, but many patients will experience sequelae throughout their lives. Recovery will depend on the location and extent of the stroke, but also on the time that has elapsed, which is why it is crucial to call the Hospital immediately when a stroke is suspected. Physiotherapy and lifestyle changes are important aspects for recovery. Maintaining a positive attitude, professional and family support are important parts so that everything can run as smoothly as possible. Objectives of a rehabilitation program: Sensitive- motor re- education Relief from pain and spasticity Training of speech disorders, swallowing, vision, cognitive changes General physical reconditioning Functional training and day-to-day activities Improvement of gait, balance and coordination Prevention of vicious postures and contractures Teaching and reducing cardio-vascular risk factors Teaching and counselling of support products (orthotics, splints, etc.) Return to work activities , daily life and sports activities