A Simple Guide to Tenosynovitis
----------------------------------------------------
What is Tenosynovitis?
-----------------------------------------
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?
-----------------------------------------------
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?
-------------------------------------------------------------------
Symptoms:
--------------
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?
-------------------------------------------------
Fibrosis and rupture of the inflamed tendon may occur leading to loss of function.
What is the Treatment of Tenosynovitis?
----------------------------------------------------------------
Conservative treatment:
-----------------------
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 :
------------------
Surgical opening of the synovial sheath may be necessary for tendon release.
What is the prognosis of Tenosynovitis?
----------------------------------------------------------
Prognosis is usually good although recurrence may occur after cortisone injection.
Surgery usually give excellent results.
Showing posts with label painkillers. Show all posts
Showing posts with label painkillers. Show all posts
Sunday, September 21, 2008
Saturday, July 26, 2008
A Simple Guide to Plantar Fascilitis
A Simple Guide to Plantar Fascilitis
----------------------------------------------------
What is Plantar Fascilitis?
-----------------------------------------
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?
-----------------------------------------------
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?
---------------------------------------------------------------------------------
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?
----------------------------------------------------------------
Conservative treatment:
-----------------------
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?
----------------------------------------------------------
Prognosis is usually good although healing is slow and takes up to 1-2 years.
What is the prevention of Plantar Fascilitis?
-------------------------------------------------
Avoid certain weight bearing exercises like jogging or brisk walking
Use heel cups, cushions, tapes, pads in foot wear
Lose Weight
----------------------------------------------------
What is Plantar Fascilitis?
-----------------------------------------
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?
-----------------------------------------------
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?
---------------------------------------------------------------------------------
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?
----------------------------------------------------------------
Conservative treatment:
-----------------------
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?
----------------------------------------------------------
Prognosis is usually good although healing is slow and takes up to 1-2 years.
What is the prevention of Plantar Fascilitis?
-------------------------------------------------
Avoid certain weight bearing exercises like jogging or brisk walking
Use heel cups, cushions, tapes, pads in foot wear
Lose Weight
Thursday, July 24, 2008
A Simple Guide to Knee cap Dislocation
A Simple Guide to Knee cap Dislocation
----------------------------------------------------
What is Knee cap Dislocation?
---------------------------------------------------------
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?
----------------------------------------------------------------------
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?
-------------------------------------------------------------------
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?
-------------------------------------------------------------
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?
----------------------------------------------------------------
Conservative treatment:
-----------------------
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:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
Surgery:
--------------
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?
----------------------------------------------------------
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?
------------------------------------------------------------
1.proper technique when exercising.
2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.
3.Wearing a knee guard
----------------------------------------------------
What is Knee cap Dislocation?
---------------------------------------------------------
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?
----------------------------------------------------------------------
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?
-------------------------------------------------------------------
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?
-------------------------------------------------------------
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?
----------------------------------------------------------------
Conservative treatment:
-----------------------
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:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
Surgery:
--------------
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?
----------------------------------------------------------
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?
------------------------------------------------------------
1.proper technique when exercising.
2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.
3.Wearing a knee guard
Tuesday, July 22, 2008
A Simple Guide to Frozen Shoulder
A Simple Guide to Frozen Shoulder
----------------------------------------------------
What is Frozen Shoulder?
-----------------------------------------
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?
-----------------------------------------------
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?
-----------------------------------------------------------------------
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?
-------------------------------------------------------------------
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?
----------------------------------------------------------------
Conservative treatment:
-----------------------
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?
----------------------------------------------------------
Prognosis depends on the underlying cause.
In most cases frozen shoulder may resolve itself with time
----------------------------------------------------
What is Frozen Shoulder?
-----------------------------------------
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?
-----------------------------------------------
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?
-----------------------------------------------------------------------
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?
-------------------------------------------------------------------
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?
----------------------------------------------------------------
Conservative treatment:
-----------------------
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?
----------------------------------------------------------
Prognosis depends on the underlying cause.
In most cases frozen shoulder may resolve itself with time
Thursday, July 17, 2008
A Simple Guide to Prolapsed Intervertebral Disc
A Simple Guide to Prolapsed Intervertebral Disc
---------------------------------------------------------------
What is Prolapsed Intervertebral Disc?
-------------------------------------------------------
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?
---------------------------------------------------------------
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?
-----------------------------------------------------------------------------
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?
----------------------------------------------------------------------------
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?
----------------------------------------------------------------------------------
Conservative treatment:
-----------------------
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:
-----------------------
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:
--------------
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?
-------------------------------------------------------------------------
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?
----------------------------------------------------------------
Avoidance of postural strain on the back
Wear a corset
Exercises to strengthen the back muscles.
---------------------------------------------------------------
What is Prolapsed Intervertebral Disc?
-------------------------------------------------------
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?
---------------------------------------------------------------
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?
-----------------------------------------------------------------------------
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?
----------------------------------------------------------------------------
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?
----------------------------------------------------------------------------------
Conservative treatment:
-----------------------
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:
-----------------------
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:
--------------
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?
-------------------------------------------------------------------------
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?
----------------------------------------------------------------
Avoidance of postural strain on the back
Wear a corset
Exercises to strengthen the back muscles.
Tuesday, February 12, 2008
A Simple Guide to Cervical Spondylosis
A Simple Guide to Cervical Spondylosis
---------------------------------------------
What is Cervical Spondylosis?
----------------------------------
Cervical Spondylosis is a degenerative disease of the joints of the cervical spine(neck), causing pain in the neck and nerve root irritation.
Who get Cervical Spondylosis?
-------------------------------------
Every one can get Cervical Spondylosis.
The age of onset is usually in the late 40 or early 50.
It is also more common in men than women.
It is worst in the lower cervical spine.
What are the causes of Cervical Spondylosis?
-----------------------------------------------
The causes of Cervical Spondylosis are:
1.Age Degeneration of the cervical spine due to usage such as bending the head to read or write.
The weight of the skull also serves to compress the vertebrae of the cervical spine as well as the intervertebral discs causing narrowing of disc space and bone protrusions called osteophytes which becomes worse with age.
2.Trauma and injury such as whip lash injury, head injuries can also indirectly injure the vertebra of the neck and cause intervertebral disc protrusions.
3. Congenital abnormality of the cervical spine such as incomplete formation of the vertebra and disc.
What are the Symptoms of Cervical Spondylosis?
-------------------------------------------------------
1.The onset is usually gradual with occasional neck pain over weeks or months.
2.There may be a history of trauma to the neck or prolonged neck strain.
3.Early morning neck stiffness and pain may occur,then wears off during the day.
4.The pain may radiate to the shoulder or upper limb.
Pain can be persistent in some cases.
5.Numbness, paresthesia even weakness of the arm and hands may occur due to compression of the neck nerve root.
6.Headaches may be common due to pressure on the neck muscles giving rise to pain to the occiptal region.
7.Neck movements may be restricted in all directions. There may be creaking sounds of the neck on movement.
8.Muscle weakness of the upper and/or lower limb with muscle wasting
Pain may be aggravated by stress, poor general health, prolonged period of the neck in one position.
How is Cervical Spondylosis diagnosed?
-----------------------------------------
Confirmation is usually by an xray of the cervical spine which may show:
Typical cervical vertebra degeneration,
Disc space narrowing
Osteophytic changes
Narrowing of the exit foramina
Subluxations of the vertebra
Sclerosis of the vertebral margins
Lordosis of the spine
How to treat Cervical Spondylosis?
------------------------------------
Not every patient suffer the same degree of symptoms
1. mild requiring only exercises or mild pain killers.
2. more severe require:
a.Neck collars
b.physiotherapy -cervical traction, shortwave diathermy, neck exercises
c.NSAIDs painkillers
d.surgery for cord compression,intractable root symptoms,vertebral artery compression,weakness of arms or legs
3. All cases require:
protection of neck from muscle strain
avoidance of excessive bending and turning of neck
maintenance of good posture
avoidance of emotional stress
What is the prognosis of Cervical Spondylosis?
------------------------------------------------
Symptoms comes and go.
With exercise and NSAIDS, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.
Injury and stress can aggravate the condition.
There is no cure.
---------------------------------------------
What is Cervical Spondylosis?
----------------------------------
Cervical Spondylosis is a degenerative disease of the joints of the cervical spine(neck), causing pain in the neck and nerve root irritation.
Who get Cervical Spondylosis?
-------------------------------------
Every one can get Cervical Spondylosis.
The age of onset is usually in the late 40 or early 50.
It is also more common in men than women.
It is worst in the lower cervical spine.
What are the causes of Cervical Spondylosis?
-----------------------------------------------
The causes of Cervical Spondylosis are:
1.Age Degeneration of the cervical spine due to usage such as bending the head to read or write.
The weight of the skull also serves to compress the vertebrae of the cervical spine as well as the intervertebral discs causing narrowing of disc space and bone protrusions called osteophytes which becomes worse with age.
2.Trauma and injury such as whip lash injury, head injuries can also indirectly injure the vertebra of the neck and cause intervertebral disc protrusions.
3. Congenital abnormality of the cervical spine such as incomplete formation of the vertebra and disc.
What are the Symptoms of Cervical Spondylosis?
-------------------------------------------------------
1.The onset is usually gradual with occasional neck pain over weeks or months.
2.There may be a history of trauma to the neck or prolonged neck strain.
3.Early morning neck stiffness and pain may occur,then wears off during the day.
4.The pain may radiate to the shoulder or upper limb.
Pain can be persistent in some cases.
5.Numbness, paresthesia even weakness of the arm and hands may occur due to compression of the neck nerve root.
6.Headaches may be common due to pressure on the neck muscles giving rise to pain to the occiptal region.
7.Neck movements may be restricted in all directions. There may be creaking sounds of the neck on movement.
8.Muscle weakness of the upper and/or lower limb with muscle wasting
Pain may be aggravated by stress, poor general health, prolonged period of the neck in one position.
How is Cervical Spondylosis diagnosed?
-----------------------------------------
Confirmation is usually by an xray of the cervical spine which may show:
Typical cervical vertebra degeneration,
Disc space narrowing
Osteophytic changes
Narrowing of the exit foramina
Subluxations of the vertebra
Sclerosis of the vertebral margins
Lordosis of the spine
How to treat Cervical Spondylosis?
------------------------------------
Not every patient suffer the same degree of symptoms
1. mild requiring only exercises or mild pain killers.
2. more severe require:
a.Neck collars
b.physiotherapy -cervical traction, shortwave diathermy, neck exercises
c.NSAIDs painkillers
d.surgery for cord compression,intractable root symptoms,vertebral artery compression,weakness of arms or legs
3. All cases require:
protection of neck from muscle strain
avoidance of excessive bending and turning of neck
maintenance of good posture
avoidance of emotional stress
What is the prognosis of Cervical Spondylosis?
------------------------------------------------
Symptoms comes and go.
With exercise and NSAIDS, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.
Injury and stress can aggravate the condition.
There is no cure.
Saturday, November 3, 2007
A Simple Guide to Headache
A Simple Guide to Headache
---------------------------------
What is Headache?
----------------------
Headache is a very common complaint, not an illness.
It literally means pain in the head.
What are the Common Types of Headaches?
--------------------------------------------------
Tension headache:
-----------------
as defined by the International Headache Society is characterised by:
1.bilateral location
2.pressing/tightening (non-pulsating) quality
3. mild to moderate in intensity
4. not aggravated by routine physical activity like walking or climbing stairs.
It is the most common headache and may be associated with contractions of head and neck muscles due to physical or mental stress. The headache is made worse by changes in the environment, drugs, or factors unique to the individual.
It can also be classified into 2 side types:
episodic (<>
chronic (> 14 days a month on average and <>
Treatment can be divided into:
pharmaceutical
non pharmaceutical
Pharmaceutial:
can be divided into acute and prophylactic.
In acute treament simple painkillers is usually effective.
In prophylactive treatment,antidepressants like amitriptyline usually help in the prevention of tension headache.
Medicines should always be given at low doses and titrated up to therapeutic doses to minimise side effects.
Non-pharmaceutical:
1. rest
2. removal of aggravating factors.
3. relaxation exercises
Migraine:
-----------
is defined as a heavy throbbing pain usually over one side of the scalp, forehead and about the eye, caused by abnormally dilated blood vessels.
Migraine may be accompanied by nausea, vomiting or sensitivity to loud noises or bright lights.
It is also triggered by certain factors unique to the individual such as:
1.menstruation,
2.alcohol,
3.anxiety,
4.loud noises,
5.bright lights
A validated 3 items questionaire covering
1. disability
2. nausea
3. sensitivity to lights
should given to every patient to screen the severity of the migraine.
Treatment again is divided into:
phamaceutical
non-pharmaceutical.
Pharmacetical:
can be divided into acute and prophylactic.
In acute treament simple painkillers like paracetamol is usually effective in mild cases.
Non-steroidal anti-inflamatory drugs should be tried if paracetamol fails.
If NSAIDs are ineffective then migraine-specific drugs like triptans or ergotamine which act to constrict blood vessel should be tried.
In some cases anti-emetic drugs like stemetil to prevent vomiting is given together with the migraine medication.
In prophylactic treatment, the goals are to:
1. reduce frequency,severity and duration
2.improve function and reduce disability
3.improve responsiveness to treatment of acute attacks
Medicines used include:
betablockers
Calcium channel blockers
Serotonin receptor antagonists
Antidressants
Anticonvulsants
Angiotensin blockers
NSAIDs
Non-pharmaceuticals:
1.resting in a cool, dark and quiet room.
2.relaxation exercises
3.Solving the triggering factors also help.
4.Oestogen containing oral cotraceptives should avoided in menstrual migraine.
During pregnancy or lactation treatment should be non-pharmaceutical when possible. If necessary paracetamol is the safest drug for women during pregnancy or lactation.
Cluster headaches
----------------------
is defined as pain which occurs in runs with tearing pain over the forehead or behind the eye(s) with flushing of the face.
There are aura of stars,flashing lights etc associated with this headache.
The cause is beleived to be due to histamine release from ingestion of certain foods like cheese, seafood,alcohol etc.
It is more common in males.
Treatment is by
1.strong painkillers
2.avoidance of food triggers
3.rest.
What are Secondary headaches?
---------------------------------------
It is diagnosed by its close relation to a disorder that is known to cause headache.
The headache improves or disappear after successful treatment or spontaneous resolution of the causative illness.
1.Sinus headaches:
----------------------
are due to acute sinus inflammation attacks.
Pain is over the frontal forehead and the upper cheeks.
It may be associated with fever and heavy mucus production.
Treatment is by
1.antibiotics for the sinus infection,
2.antihistamines to reduce mucus production
3.painkillers
4.rest.
2.Referred headaches:
---------------------------
these are caused by by referred pain from disorders of structures around the head. Common ones are
1. earaches,
2. toothache causing pain over an entire part of the face and
3. temporomandibular joint dysfunction from mechanical pain from the jaw joint.
4. temporal arteritis, a rare inflammatory blood vessel condition causing persistent headache at the temporal artery. There is possible complication of blindness secondary to anterior ischemic optic neuropathy. The headache usually resolves or improves with 3 days of high dose steroid treatment.
3.Meningitis / Encephalitis headaches:
---------------------------------------------
caused by infection of the brain tissue (encephalitis) or the membranes surrounding the brain (meningitis).
Headache is the most common symptom. The pain is diffuse and progressive with fever, a painful stiff neck and other symptoms such as drowsiness, seizures and neurological problems including weakness and numbness.
This type of headache needs immediate hospital treatment.
4.Cerebrovascular Accidents (haemorrhagic stroke):
-------------------------------------------------------------
a stroke happens when a blood vessel in the brain is blocked or bursts.
Bleeding in the brain causes a sudden severe headache.
There is also associated loss of consciousness and other neurological signs such as weakness, numbness and seizures.
This type of headache needs immediate hospital treatment.
5.Brain Tumour:
------------------
is rare and causes a gradual headache lasting for weeks.
It is localised and associated with nausea, vomiting, loss of appetite and loss of weight.
It is worse in the morning and aggravated by coughing or leaning forward.
By the time neurological symptoms appear such as seizures, numbness, weakness or blindness, the brain tumour has already grown to an advanced stage.
Treatment includes surgery, chemotherapy or radiotherapy.
6. Other causes of secondary headaches are:
a.post traumatic headache following a head injury
b.whiplash injury
c.cerebral venous thrombosis
d. idiopathic intracranial hypertension
e. hydrocephalus
f. sleep apnea
g.cardiac cephalgia
h.acute glaucoma
Simple Treatment of Headache
-------------------------------------
Consume a painkiller.
Lie down in a dark, quiet room.
Use muscle relaxation techniques or a gentle massage.
For tension headaches, try a warm bath.
For migraines, put an ice bag or cold towel on your temple.
If the headache do not improve, go for a complete investigation of the headache.
What are the investigations done in Headache?
-------------------------------------------------------
You should be investigated for your headache if the headache has:
1. associated fever and and change in mental state.
2. numbness of part of the body or with paralysis.
3. associated fits.
4. sudden onset of severe headache
5. lasted for more than a day even after taking painkillers.
6. increased headache frequency.
7. appeared different from your usual type
8. been precipitated by coughing,sneezing,bending
9. associated with stiff neck and vomiting
10.appeared for the first time in middle age
Common tests:
Blood tests - for infections,raised ESR, bleeding disease
MRI of brain- to exclude brain tumours, bleeding in the brain
Lumbar puncture - used only if there is suspected infection of brain or meninges
Thursday, October 4, 2007
A Simple Guide to Backache
A Simple Guide to Backache
----------------
What is Backache?
-----------------
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?
--------------------------------
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?
----------------------------
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.
----------------
What is Backache?
-----------------
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?
--------------------------------
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?
----------------------------
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?
--------------------------------------
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?
-----------------------------------------
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?
---------------------------------------------------
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?
--------------------------------------------------
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?
-------------------------------------------
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.
Sunday, August 19, 2007
A Simple Guide to Sinusitis
A Simple Guide to Sinusitis
-----------------
What is sinusitis?
----------------
Sinusitis is a condition in which the lining of your sinuses becomes inflamed.
The sinuses are the air chambers in the bone behind your cheeks, eyebrows and jaw.
They produce mucus, a fluid that cleans bacteria and other particles out of the air you breathe. Tiny hairs called cilia sweep mucus out of your sinuses so it can drain out through your nose.
The paranasal sinuses are in direct communication with the nose.
The sinuses are normally sterile.
If the sinus openings may become blocked, the mucus becomes congested in the sinuses, resulting in stagnation of secretion and finally bacterial growth.
What causes sinusitis?
---------------------------
Anything that causes swelling in your sinuses or keeps the cilia from moving mucus can cause sinusitis.
This can occur because of changes in temperature or air pressure,
Using decongestant nasal sprays too much,
Smoking, and
Swimming or diving.
Some people have growths called polyps that block their sinus passages.
When sinusitis is caused by a bacterial or viral infection, you get a sinus infection.
Sinus infections sometimes occur after you've had a cold.
The cold virus attacks the lining of your sinuses, causing them to swell and become narrow.
Your body responds to the virus by producing more mucus, but it gets blocked in your swollen sinuses.
This built-up mucus makes a good place for bacteria to grow.
The bacteria can cause a sinus infection.
Acute sinusitis is usually bacterial in origin.
Haemophilus influenzae and Streptococcus pneumoniae are the organisms most commonly found in adults.
In children, similar organisms are seen, with the addition of Moraxella catarrhalis.
In older children and young adults, Staphylococcus aureus is an occasional finding.
In systemically impaired hosts, Candida, Aspergillus, and Phycomycetes may be the cause.
Risk factors include the following: diabetes mellitus, cancer, hepatic disease, renal failure, burns, extreme malnutrition, and immunosuppressive diseases.
What are the signs of acute sinusitis?
-------------------------------------------
Presentation of sinusitis is often nonspecific.
Patients may present with a persistent cold.
A cold that starts to get better and then gets worse may be a sign of acute sinusitis.
Pain or pressure in some areas of the face (forehead, cheeks or between the eyes) is often a sign of blocked sinus drainage and can be a sign of acute sinusitis.
Pain in your forehead that starts when you lean forward can also be a sign.
Other symptoms may include a stuffy nose.
Some patients complain of dental pain or alteration in smell.
Fever is seen in fewer than 2% of individuals with sinusitis.
Facial tenderness to palpation is present.
Complete opacification of sinus on transillumination is present.
An X-ray of the paranasal sinuses usually confirms the presence of sinusitis as opacity in the sinuses.
How is acute sinusitis treated?
------------------------------------
Your doctor may prescribe an antibiotic.
You may take an antibiotic for 10 to 14 days, but you will usually start feeling better a couple of days after you start taking it. It is important to take this medicine exactly as your doctor tells you and to continue taking it until it is gone, even after you're feeling better.
If you have sinus pain or pressure, your doctor may prescribe or recommend a decongestant to help your sinuses drain.
Painkillers may be prescribed if there is severe pain.
How to take care of sinusitis?
-----------------------------------
1.Get plenty of rest.
2.Lying down can make your sinuses feel more congested, so try lying on the side that lets you breathe the best.
3.Drink plenty of fluids.
4.Apply moist heat by holding a warm, wet towel against your face or breathing in steam through a cloth or towel.
5.Rinse your sinus passages with a saline solution.
How is chronic sinusitis treated?
---------------------------------------
In cases where the acute sinus infection does not cleared or become chronic, a sinus washout may be necessary to remove the mucus stucked in the sinuses.
This involves syringing of antiseptic solution through a hole in the septum separating the maxillary sinuses from the nose.
Sometimes syringing of frontal sinuses can be done through a tube inserted into the sinuses.
In severe case of chronic sinusitis, endoscopy surgery may be done to strip the lining of the maxillary sinuses and clean the cavity of the sinuses.
A new therapy is the use of phage therapy where bacterial viruses are used to cause bacterila lysis in the sinuses.
-----------------
What is sinusitis?
----------------
Sinusitis is a condition in which the lining of your sinuses becomes inflamed.
The sinuses are the air chambers in the bone behind your cheeks, eyebrows and jaw.
They produce mucus, a fluid that cleans bacteria and other particles out of the air you breathe. Tiny hairs called cilia sweep mucus out of your sinuses so it can drain out through your nose.
The paranasal sinuses are in direct communication with the nose.
The sinuses are normally sterile.
If the sinus openings may become blocked, the mucus becomes congested in the sinuses, resulting in stagnation of secretion and finally bacterial growth.
What causes sinusitis?
---------------------------
Anything that causes swelling in your sinuses or keeps the cilia from moving mucus can cause sinusitis.
This can occur because of changes in temperature or air pressure,
Using decongestant nasal sprays too much,
Smoking, and
Swimming or diving.
Some people have growths called polyps that block their sinus passages.
When sinusitis is caused by a bacterial or viral infection, you get a sinus infection.
Sinus infections sometimes occur after you've had a cold.
The cold virus attacks the lining of your sinuses, causing them to swell and become narrow.
Your body responds to the virus by producing more mucus, but it gets blocked in your swollen sinuses.
This built-up mucus makes a good place for bacteria to grow.
The bacteria can cause a sinus infection.
Acute sinusitis is usually bacterial in origin.
Haemophilus influenzae and Streptococcus pneumoniae are the organisms most commonly found in adults.
In children, similar organisms are seen, with the addition of Moraxella catarrhalis.
In older children and young adults, Staphylococcus aureus is an occasional finding.
In systemically impaired hosts, Candida, Aspergillus, and Phycomycetes may be the cause.
Risk factors include the following: diabetes mellitus, cancer, hepatic disease, renal failure, burns, extreme malnutrition, and immunosuppressive diseases.
What are the signs of acute sinusitis?
-------------------------------------------
Presentation of sinusitis is often nonspecific.
Patients may present with a persistent cold.
A cold that starts to get better and then gets worse may be a sign of acute sinusitis.
Pain or pressure in some areas of the face (forehead, cheeks or between the eyes) is often a sign of blocked sinus drainage and can be a sign of acute sinusitis.
Pain in your forehead that starts when you lean forward can also be a sign.
Other symptoms may include a stuffy nose.
Some patients complain of dental pain or alteration in smell.
Fever is seen in fewer than 2% of individuals with sinusitis.
Facial tenderness to palpation is present.
Complete opacification of sinus on transillumination is present.
An X-ray of the paranasal sinuses usually confirms the presence of sinusitis as opacity in the sinuses.
How is acute sinusitis treated?
------------------------------------
Your doctor may prescribe an antibiotic.
You may take an antibiotic for 10 to 14 days, but you will usually start feeling better a couple of days after you start taking it. It is important to take this medicine exactly as your doctor tells you and to continue taking it until it is gone, even after you're feeling better.
If you have sinus pain or pressure, your doctor may prescribe or recommend a decongestant to help your sinuses drain.
Painkillers may be prescribed if there is severe pain.
How to take care of sinusitis?
-----------------------------------
1.Get plenty of rest.
2.Lying down can make your sinuses feel more congested, so try lying on the side that lets you breathe the best.
3.Drink plenty of fluids.
4.Apply moist heat by holding a warm, wet towel against your face or breathing in steam through a cloth or towel.
5.Rinse your sinus passages with a saline solution.
How is chronic sinusitis treated?
---------------------------------------
In cases where the acute sinus infection does not cleared or become chronic, a sinus washout may be necessary to remove the mucus stucked in the sinuses.
This involves syringing of antiseptic solution through a hole in the septum separating the maxillary sinuses from the nose.
Sometimes syringing of frontal sinuses can be done through a tube inserted into the sinuses.
In severe case of chronic sinusitis, endoscopy surgery may be done to strip the lining of the maxillary sinuses and clean the cavity of the sinuses.
A new therapy is the use of phage therapy where bacterial viruses are used to cause bacterila lysis in the sinuses.
Friday, August 17, 2007
A Simple Guide to Shingles
A Simple Guide to Shingles
-----------------------------
What is Shingles?
--------------------
Shingles or Herpes zoster is a condition where a crop of blisters caused by the varicella zoster virus form a band across one side of the chest, abdomen or face.
What is the cause of shingles?
----------------------------------
The same virus that causes chicken pox causes shingles.
The chickenpox virus remains in a dormant state in certain nerve cells of the body from months to many years, and then reactivates, causing shingles.
This infection is due to a temporary decrease in the body's resistance, allowing the virus to start multiplying and to move along nerve fibres towards the skin.
Who are the People at risk of getting Shingles?
-------------------------------------------------------
About 1 in 10 people who had chickenpox as children will develop shingles as adults.
The disease occurs
1.more often in older people (over 50 years old) because the immune response is believed to be weaker in older people.
2.Trauma or possibly stress may also contribute to an attack of shingles.
3.Weakened Immune system people like those with cancer, eg. Leukaemia, lymphoma, undergoing chemotherapy or radiation therapy for cancer, patients with organ transplants and taking drugs to ward off transplant rejection and patients with diseases that lowers the immune system eg. AIDS.
What are the symptoms of shingles?
-------------------------------------------
The first symptom is a burning pain or tingling and extreme sensitivity in one area of the skin.
This may be present for one to three days before a red rash occurs.
A group of blisters then forms on a red base which looks like chicken pox lesions.
The blisters generally last for two to three weeks, during which time they accumulate pus and then crust over and begin to disappear.
The pain may last longer for a month or longer.
A slight discoloration or scarring of the skin is also possible.
How severe is the pain of Shingles?
-----------------------------------------
The pain is usually severe enough for the doctor to prescribe painkillers.
A long-lasting painful complication of shingles called post-herpetic neuralgia occurs in some older patients.
This may last long after the shingles have healed.
For these people the slightest touch or contact with clothing can be unbearable.
Where do shingles appear on the body?
----------------------------------------------
Shingles generally affect only one side of the body.
Most commonly, blisters will appear on the chest or abdomen, including the buttocks and genitalia, and even the face.
If the blisters involve the eye region, permanent eye damage can result.
Your doctor will refer you immediately to an eye specialist when such a complication develops.
What are the complications of Shingles?
------------------------------------------------
Post-herpetic neuralgia, a condition in which either constant or episodic pain persists for a long time after the skin has healed.
About 50% of affected patients are over the age of 60 years.
The chronic pain is believed to be due the damage to nerve endings.
People who suffer this long-term pain may experience psychological suffering such as depression, insomnia and weight loss.
Infection of the blisters by bacteria can also cause delayed healing of the skin.
Antibiotic treatment is needed.
If the shingles affects the forehead, sometimes inflammation of ophthalmic nerve of the eye may occur. It may cause severe pain in the eye and cause blindness. Damage to the cornea may also occur.
If the shingles affect the the ear, it may cause pain, tinnitus (buzzing sound in the ear), dizziness, loss of hearing or an increased risk of spread to the brain.
In patients with weakened immune systems, there may be high fever and spread of the disease all over the body.
Is shingles contagious?
---------------------------
Shingles is much less contagious than chicken pox.
People with shingles can spread the virus if blisters are broken to someone who has never had chicken pox or who is already ill.
The people who are at risk include babies and those who already are ill such as cancer patients.
These people will develop chickenpox.
How severe is the pain of Shingles?
----------------------------------------
The pain is usually severe enough for the doctor to prescribe painkillers.
A long-lasting painful complication of shingles called post-herpetic neuralgia occurs in some older patients. This may last long after the shingles have healed.
For these people the slightest touch or contact with clothing can be unbearable.
Does Shingles cause much scarring?
-----------------------------------
Shingles can result in scarring if the blisters are infected or if the patients have used toxic home remedies on the blisters.
Some Chinese physicians believe that a snake in the skin causes the disease and the head of the snake must be burned with chemicals in order to stop the snake from growing.
How is shingles treated?
-----------------------------
In most cases Shingles clears on its own in a few weeks and seldom recurs.
Treatment consists of painkillers, as well as cool compresses to help dry the blisters.
Antibiotics are given if there is bacterial infection.
The antiviral drug, acyclovir, may be given especially for patients with eye involvement or who are very ill.
It is useful only if it is started early in the disease.
The earlier it is taken after the disease begins the better the effect.
The drug might prevent post-herpetic neuralgia.
Post-herpetic neuralgia can be treated with painkillers and high doses of tranquilisers at night.
-----------------------------
What is Shingles?
--------------------
Shingles or Herpes zoster is a condition where a crop of blisters caused by the varicella zoster virus form a band across one side of the chest, abdomen or face.
What is the cause of shingles?
----------------------------------
The same virus that causes chicken pox causes shingles.
The chickenpox virus remains in a dormant state in certain nerve cells of the body from months to many years, and then reactivates, causing shingles.
This infection is due to a temporary decrease in the body's resistance, allowing the virus to start multiplying and to move along nerve fibres towards the skin.
Who are the People at risk of getting Shingles?
-------------------------------------------------------
About 1 in 10 people who had chickenpox as children will develop shingles as adults.
The disease occurs
1.more often in older people (over 50 years old) because the immune response is believed to be weaker in older people.
2.Trauma or possibly stress may also contribute to an attack of shingles.
3.Weakened Immune system people like those with cancer, eg. Leukaemia, lymphoma, undergoing chemotherapy or radiation therapy for cancer, patients with organ transplants and taking drugs to ward off transplant rejection and patients with diseases that lowers the immune system eg. AIDS.
What are the symptoms of shingles?
-------------------------------------------
The first symptom is a burning pain or tingling and extreme sensitivity in one area of the skin.
This may be present for one to three days before a red rash occurs.
A group of blisters then forms on a red base which looks like chicken pox lesions.
The blisters generally last for two to three weeks, during which time they accumulate pus and then crust over and begin to disappear.
The pain may last longer for a month or longer.
A slight discoloration or scarring of the skin is also possible.
How severe is the pain of Shingles?
-----------------------------------------
The pain is usually severe enough for the doctor to prescribe painkillers.
A long-lasting painful complication of shingles called post-herpetic neuralgia occurs in some older patients.
This may last long after the shingles have healed.
For these people the slightest touch or contact with clothing can be unbearable.
Where do shingles appear on the body?
----------------------------------------------
Shingles generally affect only one side of the body.
Most commonly, blisters will appear on the chest or abdomen, including the buttocks and genitalia, and even the face.
If the blisters involve the eye region, permanent eye damage can result.
Your doctor will refer you immediately to an eye specialist when such a complication develops.
What are the complications of Shingles?
------------------------------------------------
Post-herpetic neuralgia, a condition in which either constant or episodic pain persists for a long time after the skin has healed.
About 50% of affected patients are over the age of 60 years.
The chronic pain is believed to be due the damage to nerve endings.
People who suffer this long-term pain may experience psychological suffering such as depression, insomnia and weight loss.
Infection of the blisters by bacteria can also cause delayed healing of the skin.
Antibiotic treatment is needed.
If the shingles affects the forehead, sometimes inflammation of ophthalmic nerve of the eye may occur. It may cause severe pain in the eye and cause blindness. Damage to the cornea may also occur.
If the shingles affect the the ear, it may cause pain, tinnitus (buzzing sound in the ear), dizziness, loss of hearing or an increased risk of spread to the brain.
In patients with weakened immune systems, there may be high fever and spread of the disease all over the body.
Is shingles contagious?
---------------------------
Shingles is much less contagious than chicken pox.
People with shingles can spread the virus if blisters are broken to someone who has never had chicken pox or who is already ill.
The people who are at risk include babies and those who already are ill such as cancer patients.
These people will develop chickenpox.
How severe is the pain of Shingles?
----------------------------------------
The pain is usually severe enough for the doctor to prescribe painkillers.
A long-lasting painful complication of shingles called post-herpetic neuralgia occurs in some older patients. This may last long after the shingles have healed.
For these people the slightest touch or contact with clothing can be unbearable.
Does Shingles cause much scarring?
-----------------------------------
Shingles can result in scarring if the blisters are infected or if the patients have used toxic home remedies on the blisters.
Some Chinese physicians believe that a snake in the skin causes the disease and the head of the snake must be burned with chemicals in order to stop the snake from growing.
How is shingles treated?
-----------------------------
In most cases Shingles clears on its own in a few weeks and seldom recurs.
Treatment consists of painkillers, as well as cool compresses to help dry the blisters.
Antibiotics are given if there is bacterial infection.
The antiviral drug, acyclovir, may be given especially for patients with eye involvement or who are very ill.
It is useful only if it is started early in the disease.
The earlier it is taken after the disease begins the better the effect.
The drug might prevent post-herpetic neuralgia.
Post-herpetic neuralgia can be treated with painkillers and high doses of tranquilisers at night.
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