A Simple Guide to Tenosynovitis

A Simple Guide to Tenosynovitis
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What is Tenosynovitis?
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Tenosynovitis is the inflammation and swelling of the tendon sheaths (called the synovium) and the enclosed tendons.

It can occur together with tendinitis(inflammation of the tendons).

It can also cause stenosing tenosynovitis (tightening inflammation of the tendon sheaths).


What are the cause of Tenosynovitis?
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The cause of Tenosynovitis is unknown.

Some possible causes are:
1.Injury or trauma to the tendon

2.Repetitive usage of fingers and wrist joints

3.Arthritis of the joints may predispose to tenosynovitis

4.Systemic diseases such as multiple sclerosis ,amyloidosis, rheumatoid arthritis

5.Tenosynovitis occurs in families, and

6.It is generally seen more often in males than in females


What are the symptoms and signs of Tenosynovitis?
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Symptoms:
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1.Pain on movement of the tendon

2.Swelling of part of the tendon affected

3.Stenosis of the tendon sheath may be present

4.Stiffness of the tendon - inability to stretch

5.Pain is felt most beneath the bone of involved joints

Signs:

1.swelling over the involved tendon

2.Passive stretching of the tendon is painful.

3.There may be local tenderness of the inflamed tendon.

4.The tendons sheaths are usually swollen and thickened

5.The tendons may become stuck in the narrowed tendon sheaths (Trigger Finger)

6.There may be crepitations felt over the tendon as it moves across the sheaths


What is the complications of Tenosynovitis?
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Fibrosis and rupture of the inflamed tendon may occur leading to loss of function.


What is the Treatment of Tenosynovitis?
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Conservative treatment:
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1.rest of the tendon

2.Cold or ice may help reduce inflammation

3.Splints over the hand, wrist and elbow may help to rest the tendons

4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

5.Muscle relaxant to relax muscles

6.injection of local anesthetic and long acting steroid into the affected sheath or tendon nodule may help to reduce inflammation

7.Surgery :
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Surgical opening of the synovial sheath may be necessary for tendon release.


What is the prognosis of Tenosynovitis?
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Prognosis is usually good although recurrence may occur after cortisone injection.

Surgery usually give excellent results.

A Simple Guide to Plantar Fascilitis

A Simple Guide to Plantar Fascilitis
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What is Plantar Fascilitis?
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Plantar Fascilitis (also known as Painful Heel Syndrome) is a inflammation of the plantar fascia (which stretch from the calcaneum to the toes) characterised by the pain in the heel especially in the morning and weight bearing exrcises.

It is more common in women.

What are the cause of Plantar Fascilitis?
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The cause of plantar Fascilitis is the non-specific inflammation of the plantar fascia as a result of repetitive injury to the fascia.

In some cases the plantar fasilitis occurs as a result of a calcaneal spur impinging on the fascia.

Both heels can be affected.

What are the symptoms and signs of Plantar Fascilitis?
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Symptoms:

1.Pain in the heel of one or both feet

2.Pain usually is worse in the morning on getting and stepping on the floor.

3.Certain weight bearing exercises like jogging or brisk walking makes the pain worse

4.Pain is described as constant and aching

5. Pain is felt most beneath the calcaneal bone but may be present in the area of the medial arch.

Signs:

1.local tenderness in the calcaneal bone area of the heel.

2. Pain is aggravated by direct pressure.

3. It can become more painful by movement which put thethe fascia under strain such as dorsiflexion of the toes or ankles.

4.Xrays of the heel usually show no abnormally. Sometimes there is calcaneal spur which may be due to traction of the muscle or fascia on the calcaneum bone.

A stress fracture may need to be ruled out in chronic cases.


What is the Treatment of Plantar Fascilitis?
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Conservative treatment:
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Initial phase:

1.rest of the heel-avoid jogging or strenous exercises

2.Cold or ice may help reduce inflammation

3.Heel cups, cushions, tapes, pads may help to reduce the pain

4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

5.Muscle relaxant to relax muscles

6.injection of local anesthetic and long acting steroid into the tender area of the plantar fascia may help to relieve pain.

7.Usage of a short leg walking cast for a few weeks help to avoid exertion on the inflamed fascia.

8.A cushion lined night splint which hold the foot in slight dorsiflexion is helpful.

Mobilisation phase:

Physiotherapy such as traction of the fascia and heel cord, shortwave diathermy may help once there is no pain

Surgery is usually not indicated in plantar fascilitis.

Rarely surgery is used to remove the calcaneal spur and to release the plantar fascia at its attachment to the calcaneum bone.


What is the prognosis of Plantar Fascilitis?
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Prognosis is usually good although healing is slow and takes up to 1-2 years.


What is the prevention of Plantar Fascilitis?
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Avoid certain weight bearing exercises like jogging or brisk walking

Use heel cups, cushions, tapes, pads in foot wear

Lose Weight

A Simple Guide to Knee cap Dislocation

A Simple Guide to Knee cap Dislocation
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What is Knee cap Dislocation?
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Knee cap Dislocation is when the knee cap (patella) moves or slides out of place. This usually occurs on the outer side of the knee.


What are the causes of Knee cap Dislocation?
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1.Dislocated knee caps most often occur in people with loose joint ligaments.

It can occur due to sudden strain on the knee ligaments causing the kneecap to protrude out of its loose ligaments.

2.Dislocation of the knee cap may also occur due to trauma.

A sudden blow to the medial part of the knee can cause the knee cap to dislocate laterally.

3.People who are prone to dislocated knee caps usually have loose ligaments with hyperflexion of the wrists or flat feet.

This condition is usually inherited and are more common in women than in men.


What are the symptoms and signs of Knee cap Dislocation?
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Symptoms:

1.Knee cap is displaced to the lateral position

2.knee swelling and effusion due to displacement of the knee cap.

3.Knee pain and tenderness is present.

4.The knee is usually held in slight flexion.

5.There is difficulty in lifting the leg

6. Patient usually walks with a limp.

Signs:

1.Tenderness and swelling of the knee

2.Knee cap is displaced to the outside or lateral part of the knee

3.In most cases the knee cap may have returned to the central position of the knee but there is still tenderness and swelling.

4.The knee cap can move excessively from right to left.(hypermobile)

How to investigate the cause of Knee cap Dislocation?
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1.examination of the knee would confirm presence of the dislocated knee cap.

There is lateral displacement of the knee cap and swelling of the knee.
Movement of the knee may be painful.

2.A knee x-ray should be done to exclude any fracture especially in the case of injury or in the elderly.

A skyline view of the knee should show the shift of the patella laterally.

3.MRI of the knee can be done to see any damage in the cartilage or meniscus of the knee.


What is the Treatment of Knee cap Dislocation?
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Conservative treatment:
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1. Most cases of knee dislocation can treated by simple reduction of the dislocated knee cap.

The heel of the leg is lifted to extend the knee and flex the hip thus relaxing the quadriceps muscles(front muscles of the thigh)

Gentle pressure is exerted on the knee cap to place it to its normal position.

The knee is then immobilized for 2-3 weeks.

Quadriceps exercises are begun as soon as possible to build back your muscle strength and improve the knee's range of motion.

Drug Therapy:
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1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

2.Muscle relaxant to relax muscles

Surgery:
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Surgery is required if:

1.the knee remains unstable

2.Injury of the knee cap cause a partial rupture of the medial retinaculum and supporting ligaments of the knee cap.
This can cause recurrent episodes of subluxation or dislocation of knee cap.

Surgery is done to stabilize the knee cap.
Reconstruction of the quadriceps extensor muscles is done to tighten the ligaments surrounding the knee cap.


What is the prognosis of Knee cap Dislocation?
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Prognosis using conservative methods is fair.

Recurrences are quite common.

Preventative measures such as knee guard, quadriceps exercises, avoidance of sudden turns and twisting of the knee may help.

Prognosis after surgery is usually good as there is tightening of the knee cap ligaments and the quadriceps muscles.


What is the Prevention of Knee cap Dislocation?
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1.proper technique when exercising.

2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.

3.Wearing a knee guard

A Simple Guide to Frozen Shoulder

A Simple Guide to Frozen Shoulder
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What is Frozen Shoulder?
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Frozen Shoulder (also known as adhesive capsulitis) is a disorder of the shoulder characterised by the slow onset of pain and restriction of movement.

It tends to be chronic and full recovery may take several months.

It is more common in women and diabetes.

Incidence is about 2 in a 1000.

What are the causes of Frozen Shoulder?
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The exact cause is unknown but several conditions has been blamed:

1.bicipital tenosynovitis- inflammation of the biceps muscles and tendon limmiting its movements

2.rotator cuff tendonitis - inflammation of the rotator cuff muscles which surrounds the shoulder with resultant adhesions and stiffness causing limitation of movement

3.reflex sympathetic dystrophy- a disturbance in the sympatheic nervous system cause pain ine the shoulder joint and hypersensitivity of the muscles surrounding the joint. There is swelling of the arm followed by atrophy of the muscles

4.trauma - injury to the joint may cause tightening of the injured muscles around the shoulder joint.

5.Surgery of the shoulder, breast and lung may also cause frozen shoulder because of the pain resulting from the movement of the shoulder and hence stiffness of the muscles.

What is the natural progression of frozen shoulder in most cases?
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Frozen shoulder is a disabiliting disease which can last from 5 months to 4 years.

There is chronic inflammation of the muscles surrounding the joint with adhesios formed between joint and muscles causing restriction of movement of the joint.

There is also reduced fluid in the joint further restricting movement.

Stage one("freezing" or painful stage):
There is a slow onset of pain which becomes worse and stiffening of the joint occurs.

This lasts 5 weeks to 9 months.

Stage two("frozen" or adhesive stage):
There is a slow but steady improvement in pain, but the stiffness persists.

This lasts 4 -9 months.

Stage three("thawing" or recovery):
There is a gradual return to normalcy in the shoulder motion.

This lasts 5 -26 months.

What are the symptoms and signs of Frozen Shoulder?
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Symptoms:

1.Pain in the shoulder radiating down the deltoid muscle and anterior aspect of the arm

2.Pain usually is worse at night especially lying on the affected shoulder

3.Certain movements makes the pain worse

4.Pain is described as constant, dull and aching

5.complaints of stiffness of the shoulder

6.inability to wear a shirt or blouse because of restricted movements

Signs:

1.apprehensive patient who holds the arm protectively

2.Generalised tenderness of rotator cuff and biceps muscles

3.Limited shoulder movement

4.Range of muscle movement is reduced in all directions

5.Arthrogram or MRI of shoulder can be done to confirm the diagnosis and exclude a posterior shoulder dislocation..

What is the Treatment of Frozen Shoulder?
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Conservative treatment:
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Initial phase:
1.rest of the shoulder

2.moist heat

3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

4.Muscle relaxant to relax muscles

5.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.

Mobilisation phase:
1.Physiotherapy such as traction, shortwave diathermy

2.gradual mobilisation and exercises to loosen the tight muscles surrounding the shoulder

Maintenance phase:
1.Continual exercises of the shoulder muscles

2.Avoidance of strain on the muscles of the shoulder

Manipulation of the frozen shoulder may be done under anaethesia to break the adhesions and restore some movement.

Surgery is usually not indicated in frozen shoulder.
Rarely surgery is used to cut the adhesions.

What is the prognosis of Frozen Shoulder?
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Prognosis depends on the underlying cause.

In most cases frozen shoulder may resolve itself with time

A Simple Guide to Prolapsed Intervertebral Disc

A Simple Guide to Prolapsed Intervertebral Disc
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What is Prolapsed Intervertebral Disc?
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Prolapsed Intervertebral Disc is the prolapse of the intervertebral disc(which is the disc between 2 vertebrae) as a result of protrusion of the nucleus pulposus out of its weakened ligamentous ring(annulus fibrosus).

It may protrude in a posterior or postero-lateral direction causing pressure to the nerve roots especially at S1, L5 and L4 vertebrae.

What are the causes of Prolapsed Intervertebral Disc?
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1.Degeneration of the posterior longitudal ligaments and annulus fibrosus occurs with age resulting in the disc being pushed out between the weakened ligaments.

2.Trauma -direct injury to disc, heavy lifting, sneezing can cuse the disc to pop out of the weakened ligaments and prolapse partially or completely.

3.Spinal tumour rarely pushes the disc out of its intervertebral space

What are the symptoms and signs of Prolapsed Intervertebral Disc?
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Symptoms:
1.Low Backache with pain in the lumbar region

2.Sciatica or pain shooting down 1 leg

3.Pain usually follows
severe bending
lifting heavy objects
injury
sneezing or coughing

4.Pain may so bad that the person cannot stand erect.

5.pain is worse when sitting

6.weakness, numbness, difficulty in moving the leg

Signs:
1.Muscle spasm especially spinal extensor muscles

2.Movement of the back and affected led painful and restricted

3.Patient tend to stand stiffly or with slight sciatic scoliosis on the affected side

4.Straight leg raising test is usually restricted on the affected side.

5.Neurological signs such as paraesthesia commonly present on the affected side.

6.Sensory and motor deficit may be present in the affected side

7.Loss of reflex and weakness may help to localise the site of prolapse:
L4 root:
Pain in the medial buttock, lateral thigh, medial tibia and big toe
weakness of big toe and foot dorsiflexion
patella jerk is diminished

L5 root:
Pain in hip, groin,posterolateral thigh, lateral calf and dorsal surface of foot
weakness of the big toe and foot dorsiflexion
no change in patella or ankle reflexes

S1 root:
pain in posterior part of thigh, lower calf border and sole of foot
weakness of knee flexors and plantar flexors
ankle jerk is diminished


How to investigate the cause of Prolapsed Intervertebral Disc?
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1.Full medical history especially of injuries, type of work, onset of pain,radiation to legs,

2. Full medical examination especially of movement of the back ,any deformity of the spine, straight leg raising test

3. X-ray of the Spine: to exclude osteoarthritis, injury, narrowing of disc space, bone tumor,

4.MRI of spine for slipped disc

5.bone scan for osteoporosis

A definite diagnosis can then be made and the cause of the pain treated.


What is the Treatment of Prolapsed Intervertebral Disc?
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Conservative treatment:
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Initial phase:
1.Bed rest with a hard board below the mattress- straighten the back
2.Physiotherapy such as traction, shortwave diathermy

Mobilisation phase:
1.Wearing a corset to strengthen the back and help the traction of the spinal bones
2.gradual mobilisation and exercises to strengthen the spinal extensor muscles

Maintenance phase:
1.Exercises to strengthen the back muscles.
2.Wear a corset
3.Avoidance of postural strain on the back

Drug Therapy:
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1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
3.Extradural injection of local anesthetic and long acting steroid may help to relieve the pain

Surgery:
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Surgery is required if there are:
1.persistent pain and neurological symptoms remain after conservative treatment
2.progressive neurological symptoms
3.Disc has protruded more than 75% out of its intervertebral space as seen on MRI

Surgery consists of:
1.laminectomy - removal of the disc and prolapsed material.
2.microdiscectomy- insertion of a titanium disc to replace the removed prolapsed disc

Finally treatment of the underlying cause(eg.space occupying spinal tumors) is important.

What is the prognosis of Prolapsed Intervertebral Disc?
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Prognosis depends on the underlying cause.

Preventative measures are important in preventing recurrences of the prolapse of the intervertebral disc.

What is the Prevention of Prolapsed Intervertebral Disc?
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Avoidance of postural strain on the back

Wear a corset

Exercises to strengthen the back muscles.

A Simple Guide to Backache

A Simple Guide to Backache
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What is Backache?
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Backache is a symptom, not an illness.
It is one of the most common complaints.

The complaint may be:
1.Constant aching, pain or stiffness that occurs anywhere along your spine, from the base of the neck to the hips.

2.Sharp pain in the neck, upper back, or lower back, especially after lifting heavy objects or other strenuous activity.

3.Chronic ache in the middle or lower back, especially after sitting or standing for long period of time.

Who suffer from Backache?
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About 80 per cent of people will experience back pain at some point in their lives.
More men suffer from it than women.
Backache is most common among people in their middle age.
Backache also occurs among young people aged between 16 - 24
Backache can also be hereditary (example: ankylosing spondylosis)

What causes Backache?
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Acute Backache
Acute backache may occur due to
1.back strain from the lifting of a heavy object,

2.from a fall,

3.violent jerk as a car suddenly stops.

4.fracture of the spine or the dislocation of a vertebral disc

Chronic Backache
Chronic backache may be caused by

1.Osteoarthritis with degeneration of the spinal column when one vertebra slips forward on the one immediately below it

2. slipped disc. The discs act as cushions between two vertebral bones but due to degeneration in old age, or in cases when the spine has been injured before, a slipped disc may occur.

3.Bad posture can also lead to chronic backache such as sitting for long hours in an incorrect position. The right position is to stand up or sit up straight instead of slouching in a couch when watching TV. If the bad posture is prolonged, backache may occur.

4.sprains in the muscles of the back and

5.gynaecological problems (such as ovarian tumours,fibroids) and pregnancy.

6. Chronic infections of spine such as Tuberculosis

7. Cancer of the organs of pelvic region such as bladder or prostate

8. Cancer of the spine from primary bone marrow or secondary spread.

How can Backache be prevented?
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1.Maintain the correct posture at all times. When standing or sitting, ensure that your back is kept straight instead of a slouched position.

2.support your back and use a cushion when necessary.

3.Correct furniture can also help to prevent the occurrence of backache.
Use chairs of a proper height in relation to the table or desk.

4.Sleep on a firm mattress

5. Do not wear high heels

6. Keep your back straight when carrying heavy item.Keep the item close to the body.

7.Do not bend the back to carry heavy objects. Bend the knees and keep the back straight

8.Exercise is another good way to prevent backache by strengthening the back muscles. However, if you have had back injuries before such as a slipped disc, do be cautious when you exercise.

What to do when Backache occurs?
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1. maintain good posture and rest the back.

2.Ice packs can provide relief for backaches. Ice packs will help to reduce the swelling and inflammation.

3.Heat treatment will help improve circulation and reduce stiffness.

4.Painkiller like paracetamol may relieve pain

If pain persists, do consult a doctor.

When should you see a doctor for Backache?
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You should see a doctor under the following conditions:
1. backache is severe and acute.

2.backache starts suddenly and is severe enough to prevent you from work.

3.backache is accompanied with associated pain in legs or weakness and tingling in the legs or back.

4. painkillers and other therapies do not help to relieve pain and your backache is getting worse.

5.pain increases when you cough or bend forward at the waist. This could be a sign of a herniated disk. Try to lie flat with a pillow under your knees.

6.pain follows an injury and is accompanied by sudden loss of bladder or bowel control. If you have difficulty moving any limb, or if you feel numbness, pain, or tingling in a limb, you may have injured your spinal cord.

7.backache is accompanied by nausea, vomiting, fever, muscle weakness, pain down an arm or leg, or bowel or bladder disturbances

8.pain is still present after two to three days of rest.

9.pain lasts longer than 72 hours.

10.pain radiates into the legs,

11.other symptoms such as unexplained weight loss occur,

12.pain is in one side of the small of your back accompanied by a sick feeling and fever. You may have a kidney infection.

13.the pain in your back extends downward along the back of the leg. You may be suffering from sciatica.

14.dull pain in one area of your spine when trying to lie down or getting out of bed, especially if you are over 50 years of age. You may be suffering from osteoarthritis.

15.pain is felt in both thighs when walking. This can be a symptom of spinal stenosis (the narrowing of the lower spinal canal).

16.persistent backache may also be an indication of an undetected cancer of the colon,ovary,bladder or prostate.

How to investigate the cause of Backache?
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1.Full medical history especially of injuries, type of work, onset of pain,radiation to the arms or legs, changes in bowel or bladder habit, loss of weight

2. Full medical examination especially of movement of the back ,any deformity of the spine, abdominal swelling, straight leg raising test

3. X-ray of the Spine: to exclude fracture, osteoarthritis, dislocation,deformity, bone tumour,

4. X-ray of abdomen to exclude any tumours in the abdomen pressing against the spine

5.MRI of spine for slipped disc,tumours,fracture

6.Bone density test to exclude osteoporosis

7.Blood tests for calcium, protein,kidney function,cancer markers, RA factor

8. Urine and stool tests for blood,

A definite diagnosis can then be made and the cause of the pain treated.

What is the Treatment of Backache?
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Symptomatic:

Painkillers and muscle relaxants

Ice packs or heat treatment

Physiotherapy to strengthen muscles

Good posture and firm mattress

Avoid aggravating factors like high heels, overstretching muscles,excessive strenous activities

Curative:

The cause must be found and treated. Examples are fractures due to injury.

Causes like cancer and aged related illness(osteoarthritis) may not be cured but may improved with treatment.