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
Thursday, July 24, 2008
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
Monday, July 21, 2008
A Simple Guide to Dandruff
A Simple Guide to Dandruff
--------------------------------
What is Dandruff?
------------------------
Dandruff is an acute to chronic inflammatory scaly disease of the hairy areas of the scalp endowed with sebaceous glands.
As a result scales that are shedded from the the dead skin cells of the scalp are called dandruff or pityriasis capitis.
What are the Causes of Dandruff?
----------------------------------
The cause of Dandruff is not completely known but are related to three possible factors:
1.Excessive sebaceous or oil gland secretions from the skin
2.the fungus Malassezia furfur has been known to be a possible cause of dandruff.
It metabolises the oils present in sebum to a lipid byproduct oleic acid .This oleic acid can cause an inflmmation in the epithelium of the scaly resulting in the shedding of dry scales.
3. allergic reaction to chemicals in hair oils, cream or gel
Certain oily foods may trigger the production of dandruff
Stress has been known to trigger off dandruff
What are the symptoms of Dandruff?
-------------------------------------
Onset is usually gradual.
Symptoms:
1.Flaking of scales from the scalp.
2.Itchiness of the scalp
3.Redness of the skin on scalp, forehead and eyebrows
Signs:
1.Dry, rounded, greyish macular or papular lesions on the scalp.
2.The surface consists of dry scales which can be rubbed off
3.Sometimes the lesions can become crusted
4.Some lesions may become purulent with yellow exudate.
What is the Treatment of Dandruff?
-----------------------------------------
1.Dandruff shampoo such as Sebutone, Genisol, Selsun will help to remove flakes and reduce the lesions.
2.fungus infection should be treated with antifungal orally with ketoconazole
and topical antifungal lotion and shampoo such as salicylate acid lotion, nizoral or ketoconazole shampoo.
3.For more severe cases with bacterial infection a combination of hydrocortisone and tetracycline ointment can be used to remove infected crusts.
4.General hair hygiene -
shampoo hair daily
Avoid too strong hair cream or gels
What is the prognosis of Dandruff?
------------------------------------
Generally good with treatment.
However recurrences are not uncommon.
General hair hygiene is important.
--------------------------------
What is Dandruff?
------------------------
Dandruff is an acute to chronic inflammatory scaly disease of the hairy areas of the scalp endowed with sebaceous glands.
As a result scales that are shedded from the the dead skin cells of the scalp are called dandruff or pityriasis capitis.
What are the Causes of Dandruff?
----------------------------------
The cause of Dandruff is not completely known but are related to three possible factors:
1.Excessive sebaceous or oil gland secretions from the skin
2.the fungus Malassezia furfur has been known to be a possible cause of dandruff.
It metabolises the oils present in sebum to a lipid byproduct oleic acid .This oleic acid can cause an inflmmation in the epithelium of the scaly resulting in the shedding of dry scales.
3. allergic reaction to chemicals in hair oils, cream or gel
Certain oily foods may trigger the production of dandruff
Stress has been known to trigger off dandruff
What are the symptoms of Dandruff?
-------------------------------------
Onset is usually gradual.
Symptoms:
1.Flaking of scales from the scalp.
2.Itchiness of the scalp
3.Redness of the skin on scalp, forehead and eyebrows
Signs:
1.Dry, rounded, greyish macular or papular lesions on the scalp.
2.The surface consists of dry scales which can be rubbed off
3.Sometimes the lesions can become crusted
4.Some lesions may become purulent with yellow exudate.
What is the Treatment of Dandruff?
-----------------------------------------
1.Dandruff shampoo such as Sebutone, Genisol, Selsun will help to remove flakes and reduce the lesions.
2.fungus infection should be treated with antifungal orally with ketoconazole
and topical antifungal lotion and shampoo such as salicylate acid lotion, nizoral or ketoconazole shampoo.
3.For more severe cases with bacterial infection a combination of hydrocortisone and tetracycline ointment can be used to remove infected crusts.
4.General hair hygiene -
shampoo hair daily
Avoid too strong hair cream or gels
What is the prognosis of Dandruff?
------------------------------------
Generally good with treatment.
However recurrences are not uncommon.
General hair hygiene is important.
Friday, July 18, 2008
A Simple Guide to Hyperhidrosis
A Simple Guide to Hyperhidrosis
---------------------------------
What is Hyperhidrosis?
----------------------
Hyperhidrosis is the condition when a person suffers from excessive perspiration due to overactivity of the sweat glands.
This may cause a social problem in people who need to shake hands or write with sweaty palms.
Excess perspiration with foul odor may also be offensive to people around the patient
What are the causes of Hyperhidrosis?
---------------------------------------
The cause of Hyperhidrosis is usually unknown.
It has been linked to :
1.excessive sweat glands
2.psychogenic excess production of sweats under stress and nervous conditions
3.Endocrine disorder such as hyperthyroidism
4.Skin diseases with increased hydration of skin such as in weeping eczema
5.Genetic - inherited as an autosomal dominant trait. Family has a history of Hyperhidrosis
6.diseases of the nervous system
7.Tuberculosis-night sweats are a typical feature of tuberculosis
8.diabetes mellitus and pituitary disorders
9.Certain medicines such as aspirin, paracetamol may provoke excess sweating
10.alcohol, caffiene, and certain food(spices) may stimulate the sweat glands
What are the symptoms and signs of Hyperhidrosis?
-------------------------------------------------------
Persons who has Hyperhidrosis has the following:
Symptoms:
1.Genralised sweating
2.localised sweating of palms, soles, axilla and groins
3.Foul smell from the excess sweat is caused by the decomposition of skin cells by bacteria and yeast infection
Signs:
1.Skin may become thickened, fissured or scaly
2.Nail deformities may occur
3.Secondary bacterial and fungal infections may be present
How do you diagnose Hyperhidrosis?
-------------------------------------------
Diagnosis can usually be made by :
1.Sweaty palms or soles
2.thickened, fissured skin with nail deformities
What is the treatment of Hyperhidrosis?
------------------------------------------------
1.Treat the underlying cause such as hyperthyroidism, diabetes
2.Clean involved skin frequently with baths etc. Use talcum powder to dry skin.
3.Wear cotton socks and underwear and change daily.
4.Local application of aluminium chloride, hexahydrate, glutaradehyde and even tannic acid from tea.
Some side effects may be allergic dermatitis or staining of skin
5.Anticholinergic drugs can reduce the sweating but has side effects such as dryness of mouth and flushing
6.Surgery in severe cases may be required such as sympathectomy (for palms).
Sweat glands suction by removing some of the sweat glands has been shown to reduce sweating
7.Iontophoresis: may help but may be painful
8.Botox injection may disable the sympathetic nerves to the sweat glands amy lasts for 6-9 months
9.Hypnosis, relaxation and meditation has help to certain extent
10.Radiotherapy has been known to be effective but not used because of the danger of bone cancer.
What is the prognosis of Hyperhidrosis?
----------------------------------------
Prognosis is usually palliative as the sweat glands and nerve cells may grow back.
Recurrence is quite common.
---------------------------------
What is Hyperhidrosis?
----------------------
Hyperhidrosis is the condition when a person suffers from excessive perspiration due to overactivity of the sweat glands.
This may cause a social problem in people who need to shake hands or write with sweaty palms.
Excess perspiration with foul odor may also be offensive to people around the patient
What are the causes of Hyperhidrosis?
---------------------------------------
The cause of Hyperhidrosis is usually unknown.
It has been linked to :
1.excessive sweat glands
2.psychogenic excess production of sweats under stress and nervous conditions
3.Endocrine disorder such as hyperthyroidism
4.Skin diseases with increased hydration of skin such as in weeping eczema
5.Genetic - inherited as an autosomal dominant trait. Family has a history of Hyperhidrosis
6.diseases of the nervous system
7.Tuberculosis-night sweats are a typical feature of tuberculosis
8.diabetes mellitus and pituitary disorders
9.Certain medicines such as aspirin, paracetamol may provoke excess sweating
10.alcohol, caffiene, and certain food(spices) may stimulate the sweat glands
What are the symptoms and signs of Hyperhidrosis?
-------------------------------------------------------
Persons who has Hyperhidrosis has the following:
Symptoms:
1.Genralised sweating
2.localised sweating of palms, soles, axilla and groins
3.Foul smell from the excess sweat is caused by the decomposition of skin cells by bacteria and yeast infection
Signs:
1.Skin may become thickened, fissured or scaly
2.Nail deformities may occur
3.Secondary bacterial and fungal infections may be present
How do you diagnose Hyperhidrosis?
-------------------------------------------
Diagnosis can usually be made by :
1.Sweaty palms or soles
2.thickened, fissured skin with nail deformities
What is the treatment of Hyperhidrosis?
------------------------------------------------
1.Treat the underlying cause such as hyperthyroidism, diabetes
2.Clean involved skin frequently with baths etc. Use talcum powder to dry skin.
3.Wear cotton socks and underwear and change daily.
4.Local application of aluminium chloride, hexahydrate, glutaradehyde and even tannic acid from tea.
Some side effects may be allergic dermatitis or staining of skin
5.Anticholinergic drugs can reduce the sweating but has side effects such as dryness of mouth and flushing
6.Surgery in severe cases may be required such as sympathectomy (for palms).
Sweat glands suction by removing some of the sweat glands has been shown to reduce sweating
7.Iontophoresis: may help but may be painful
8.Botox injection may disable the sympathetic nerves to the sweat glands amy lasts for 6-9 months
9.Hypnosis, relaxation and meditation has help to certain extent
10.Radiotherapy has been known to be effective but not used because of the danger of bone cancer.
What is the prognosis of Hyperhidrosis?
----------------------------------------
Prognosis is usually palliative as the sweat glands and nerve cells may grow back.
Recurrence is quite common.
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, July 15, 2008
A Simple guide to Anal Fistula
A Simple guide to Anal Fistula
-------------------------------------
What is Anal Fistula?
----------------------------
Anal Fistula (or fistula-in-ano) is a chronic granulous track which communicate between the anorectal canal and the perianal skin.
There may be several external openings but only one internal opening
What is the cause of Anal Fistula?
------------------------------------------
Anal Fistula usually result from :
1.breakdown of anorectal abscesses
2.follows surgery for anal fissure
3.Less common causes are:
lymphogranuloma
carcinoma of rectum
ulcerative colitis,
regional ileitis
tuberculosis
What are the symptoms of Anal Fistula?
------------------------------------------------
1.pain especially on sitting down
2.purulent painless discharge(pus) near the anus
3.Recurrent perianal abscesses(pockets of pus around the anus)
4.pruritis ani(itch in anus)
How are Anal Fistula diagnosed?
-----------------------------------------
1.thorough examination of the perianal region
2.Rectal examination and palpation of the fistula track
3.Pass a probe through the perianal opening to determine the length of the track
4.Sigmoidoscopy and colonoscopy to detect internal opening and other lesions in the rectum and large intestine
5.Barium enema to exclude any ulcerative colitis and regional ileitis
What is the treatment of Anal Fistula?
------------------------------------------
There are 2 types of anal fistula:
1.High level fistulas penetrate the levator ani-muscle of the anal sphlinter
2.Low level fistulas are below the levator ani and are more common.
Treatment of lowlevel fistula:
1.lay open the track and curette(scrape the lining and debris in the track out)
Treatment of high level fistula:
1.open the track from within the ischiorectal fossa
2.colostomy may be necessary for multiple fistulas or very high internal opening
General treatment:
1.Treatment of associated diseases like diabetes, ulcerative colitis, regional ilitis, carcinoma
2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed
3.toilet and dressing of the wounds, with application of antibiotic creams
4.tub baths of the anal region several times a day in plain, warm water for about 10 minutes
What is the prognosis of Anal Fistula?
----------------------------------------
Good with surgery.
Rarely there may undesirable complication like rectal incontinence.
-------------------------------------
What is Anal Fistula?
----------------------------
Anal Fistula (or fistula-in-ano) is a chronic granulous track which communicate between the anorectal canal and the perianal skin.
There may be several external openings but only one internal opening
What is the cause of Anal Fistula?
------------------------------------------
Anal Fistula usually result from :
1.breakdown of anorectal abscesses
2.follows surgery for anal fissure
3.Less common causes are:
lymphogranuloma
carcinoma of rectum
ulcerative colitis,
regional ileitis
tuberculosis
What are the symptoms of Anal Fistula?
------------------------------------------------
1.pain especially on sitting down
2.purulent painless discharge(pus) near the anus
3.Recurrent perianal abscesses(pockets of pus around the anus)
4.pruritis ani(itch in anus)
How are Anal Fistula diagnosed?
-----------------------------------------
1.thorough examination of the perianal region
2.Rectal examination and palpation of the fistula track
3.Pass a probe through the perianal opening to determine the length of the track
4.Sigmoidoscopy and colonoscopy to detect internal opening and other lesions in the rectum and large intestine
5.Barium enema to exclude any ulcerative colitis and regional ileitis
What is the treatment of Anal Fistula?
------------------------------------------
There are 2 types of anal fistula:
1.High level fistulas penetrate the levator ani-muscle of the anal sphlinter
2.Low level fistulas are below the levator ani and are more common.
Treatment of lowlevel fistula:
1.lay open the track and curette(scrape the lining and debris in the track out)
Treatment of high level fistula:
1.open the track from within the ischiorectal fossa
2.colostomy may be necessary for multiple fistulas or very high internal opening
General treatment:
1.Treatment of associated diseases like diabetes, ulcerative colitis, regional ilitis, carcinoma
2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed
3.toilet and dressing of the wounds, with application of antibiotic creams
4.tub baths of the anal region several times a day in plain, warm water for about 10 minutes
What is the prognosis of Anal Fistula?
----------------------------------------
Good with surgery.
Rarely there may undesirable complication like rectal incontinence.
Monday, July 14, 2008
A Simple Guide to Sciatica
A Simple Guide to Sciatica
-----------------------------------------
What is Sciatica?
----------------------------------
Sciatica is the symptom of shooting pain down the leg occurring in the sciatic nerve due to inflammation or pressure on the nerve.
What are the causes of Sciatica?
------------------------------------------------
Sciatica occur as a result of pressure on the sciatic nerve as a result of:
1.slipped disc- a prolapsed intervertebral disc which slipped out of the ligaments holding it may press against the sciatic nerve especially in the lumbar vertebrae
2.disc degeneration - flattening of the disc due to degeneration allows the discs above and below it to compress the sciatic nerve
3.Spinal stenosis- narrowing of the spinal canal can cause compression on the sciatic and other nerves
4.sacroiliatis - inflammation of the sacroliac joint cause swelling of the bones involved in the joint and may compress the sciatic nerve
5.lumbar facet syndrome-the facet bone like any bone in the body can become inflammed, swells and press against the sciatic nerve.
6.Iliolumbar syndrome- the iliolumbar ligament extends from the spine to the iliac crest when inflammed or swollen due to injury can compress the sciatic nerve
7.piriformis syndrome-the piriformis muscle lies on top of the sciatic nerve at the buttock and if inflammed, swells and press on the sciatic nerve.
8.spinal tumour- any tumour in the spine which is near the sciatic nerve may compress it.
What are the symptoms and signs of Sciatica?
------------------------------------------------------------
Symptoms:
1.pain may be a continous dull ache in the leg or a shooting pain down the leg
2.pain is present in the buttocks, posterior thigh, and back of outer side of the leg to ankle
3.Pain is usually but not always relieved by rest(lying flat)
4.Pain is aggravated by
a.spinal movements like flexion
b.exercises
c.straining
d.coughing
e.sneezing
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Patient stands with spine rigid.
Sometimes there may sciatic scoliosis to protect the nerve roots on 1 side.
2.Straight leg raising test(SLR) which is normally up to 90 degrees is restricted
3. superficial paresthesia and sensory loss with or without tendon reflexes loss at knee or ankle and muscle weakness depending on severity and site of nerve root compression
What are the investigations required in Sciatica?
------------------------------------------------------------
1.Xrays of spine and pelvis for osteoarthritis, disc lesions, ankylosing spondylosis, or metastatic tumours
2.MRI of lumbar spine
3.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis
What is the treatment of Sciatica?
-----------------------------------------------------
Conservative treatment:
-----------------------
1.Bed rest with a hard board below the mattress- straighten the back
2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
3.Muscle relaxant to relax muscles
4.Physiotherapy such as traction, massage or expert manipulation of the vertebrae, shortwave diathermy
5.Wearing a corset to straigthen the back and help the traction of the spinal bones
6.After the initial phase of pain is over , gradual mobilisation and exercises to strenghten the spinal extensor muscles
Surgery:
----------
If conservative methods fail or the pain is too severe, surgical decompression is then considered:
1.microdiscectomy - insertion of a titanium disc to replace the damaged intervertebral disc
2.laminectomy - traditional surgical removal of the damaged intervertebral disc
Finally treatment of the underlying cause is important
What is the prognosis of Sciatica?
----------------------------------------
Prognosis depends on the underlying cause.
Mild inflammation of the muscles, ligaments may recover with conservative methods
More severe inflammation of the nerve due to disc or spinal may become worse with time.
How do you prevent Sciatica?
---------------------------------
Avoidance of postural strain on the back- no high heels, avoid bending the back, keep the back straight
Sleep on a hard mattress
Wear a corset
Exercises to strenghten the back muscles.
-----------------------------------------
What is Sciatica?
----------------------------------
Sciatica is the symptom of shooting pain down the leg occurring in the sciatic nerve due to inflammation or pressure on the nerve.
What are the causes of Sciatica?
------------------------------------------------
Sciatica occur as a result of pressure on the sciatic nerve as a result of:
1.slipped disc- a prolapsed intervertebral disc which slipped out of the ligaments holding it may press against the sciatic nerve especially in the lumbar vertebrae
2.disc degeneration - flattening of the disc due to degeneration allows the discs above and below it to compress the sciatic nerve
3.Spinal stenosis- narrowing of the spinal canal can cause compression on the sciatic and other nerves
4.sacroiliatis - inflammation of the sacroliac joint cause swelling of the bones involved in the joint and may compress the sciatic nerve
5.lumbar facet syndrome-the facet bone like any bone in the body can become inflammed, swells and press against the sciatic nerve.
6.Iliolumbar syndrome- the iliolumbar ligament extends from the spine to the iliac crest when inflammed or swollen due to injury can compress the sciatic nerve
7.piriformis syndrome-the piriformis muscle lies on top of the sciatic nerve at the buttock and if inflammed, swells and press on the sciatic nerve.
8.spinal tumour- any tumour in the spine which is near the sciatic nerve may compress it.
What are the symptoms and signs of Sciatica?
------------------------------------------------------------
Symptoms:
1.pain may be a continous dull ache in the leg or a shooting pain down the leg
2.pain is present in the buttocks, posterior thigh, and back of outer side of the leg to ankle
3.Pain is usually but not always relieved by rest(lying flat)
4.Pain is aggravated by
a.spinal movements like flexion
b.exercises
c.straining
d.coughing
e.sneezing
5.pain is worse when sitting
6.weakness, numbness, difficulty in moving the leg
Signs:
1.Patient stands with spine rigid.
Sometimes there may sciatic scoliosis to protect the nerve roots on 1 side.
2.Straight leg raising test(SLR) which is normally up to 90 degrees is restricted
3. superficial paresthesia and sensory loss with or without tendon reflexes loss at knee or ankle and muscle weakness depending on severity and site of nerve root compression
What are the investigations required in Sciatica?
------------------------------------------------------------
1.Xrays of spine and pelvis for osteoarthritis, disc lesions, ankylosing spondylosis, or metastatic tumours
2.MRI of lumbar spine
3.Electromyogram and nerve conduction studies may give an an indication of the severity of damage to the nerve and the subsequent prognosis
What is the treatment of Sciatica?
-----------------------------------------------------
Conservative treatment:
-----------------------
1.Bed rest with a hard board below the mattress- straighten the back
2.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
3.Muscle relaxant to relax muscles
4.Physiotherapy such as traction, massage or expert manipulation of the vertebrae, shortwave diathermy
5.Wearing a corset to straigthen the back and help the traction of the spinal bones
6.After the initial phase of pain is over , gradual mobilisation and exercises to strenghten the spinal extensor muscles
Surgery:
----------
If conservative methods fail or the pain is too severe, surgical decompression is then considered:
1.microdiscectomy - insertion of a titanium disc to replace the damaged intervertebral disc
2.laminectomy - traditional surgical removal of the damaged intervertebral disc
Finally treatment of the underlying cause is important
What is the prognosis of Sciatica?
----------------------------------------
Prognosis depends on the underlying cause.
Mild inflammation of the muscles, ligaments may recover with conservative methods
More severe inflammation of the nerve due to disc or spinal may become worse with time.
How do you prevent Sciatica?
---------------------------------
Avoidance of postural strain on the back- no high heels, avoid bending the back, keep the back straight
Sleep on a hard mattress
Wear a corset
Exercises to strenghten the back muscles.
Friday, July 11, 2008
A Simple Guide to Trigeminal Neuralgia
A Simple Guide to Trigeminal Neuralgia
-----------------------------------------------
What is Trigeminal Neuralgia?
--------------------------------------
Trigeminal Neuralgia is the sudden ,lightning-like paroxysms of pain which occurs in the distribution of one or more branches of the trigeminal nerve usually on one side of the face.
It is a rare codition affecting more women than men.
It is more common at the age of 60 years and above.
What are the causes of Trigeminal Neuralgia?
----------------------------------------------------
Trigeminal Neuralgia has no known cause,
but may be due to :
1.compression of the trigeminal nerve by tumors or vascular anomalies(eg aneurysm)
2.Trauma- injury to the trigeminal nerve
3.Tumours- compressing the trigeminal nerve
4.Infections-meningeal inflammation of the trigeminal nerve
5.Temporomandibular Joint Syndrome - inflammation in the temporomandibular joint may compress or cause inflammation in the trigeminal nerve.
6.Multiple sclerosis-an area of demyelination from multiple sclerosis may be the cause- more common in younger patient.
What are the symptoms and signs of Trigeminal Neuralgia?
---------------------------------------------------------------
Symptoms:
-----------
1.Pain is brief, lightning-like, paroxysmal with usually severe.
There may be recurrent stabs of pain or spontaneous exacerbations of pain.
It can last from a few seconds to 1-2 minutes and is followed by a refractory period(no pain).
Sometimes the pain occurs in clusters to the extent that the patient complains that it lasts for hours.
Usually the maxillary branch is most commonly involved ,followed by the mandibular, and then the ophthalamic.
Pain is unilateral (rarely bilateral).
Pain may occur several times a day.
It rarely occurs at night.
There are certain triggers which can spark off an attack:
-----------------------------------------------------------
Light touch at the trigger zone such as the lips is the most provocative.
Other triggers are
1.shaving,
2.face washing,
3.chewing
4.talking
5.brushing teeth
6.sneezing
Pain causes brief muscle spasm of the facial muscles, inducing the tic.
Signs:
---------
Physical examination findings are normal.
A normal neurologic examination is part of the diagnosis of idiopathic Trigeminal Neuralgia.
A careful examination of the cranial nerves must be done, including the corneal reflex.
Any abnormality in the neurological examination suggests that the trigeminal neuralguia is secondary to other illnesses.
What are the investigations required in Trigeminal Neuralgia?
----------------------------------------------------------------
1.Blood for infections such as meningitis,
2.MRI of brain to exclude an uncommon mass lesion or aberrant vessel compressing the nerve roots.
What is the treatment of Trigeminal Neuralgia?
-----------------------------------------------------
Medications:
----------------
1.Carbamazepine is the most effective medical treatment.
2.Baclofen (Lioresal)
Most often used after therapy with carbamazepine has been initiated.
A combination of carbamazepine and Baclofen often relieve pain in many patient.
3.Other anticonvulsant such as phenytoin, oxcarbazepine, clonazepam, lamotrigine, valproic acid, and gabapentin.
4.Muscle relaxants
These agents are also useful in the treatment of Trigeminal Neuralgia.
They can depress the sensitivity of the nerve and relax the muscle.
Mental and physical sluggishness and dizziness occur with use of most anticonvulsant and muscle relaxants.
Surgery
-------------
1.Percutaneous radiofrequency ablation of a portion of the trigeminal ganglion
is the method of choice.
2.anesthetic blocks of the trigeminal ganglion.
3.decompression of trigeminal root entry of impinging vascular structures.
4.Surgical division of the affected branch of the nerve.
What is the prognosis of Trigeminal Neuralgia?
------------------------------------------------------
80% of patients respond well to carbamazepine but recurrences and exacerbations are common.
Surgery is usually effective but may leave permanent neurological deficit.
Trigeminal Neuralgia is not life threatening.
-----------------------------------------------
What is Trigeminal Neuralgia?
--------------------------------------
Trigeminal Neuralgia is the sudden ,lightning-like paroxysms of pain which occurs in the distribution of one or more branches of the trigeminal nerve usually on one side of the face.
It is a rare codition affecting more women than men.
It is more common at the age of 60 years and above.
What are the causes of Trigeminal Neuralgia?
----------------------------------------------------
Trigeminal Neuralgia has no known cause,
but may be due to :
1.compression of the trigeminal nerve by tumors or vascular anomalies(eg aneurysm)
2.Trauma- injury to the trigeminal nerve
3.Tumours- compressing the trigeminal nerve
4.Infections-meningeal inflammation of the trigeminal nerve
5.Temporomandibular Joint Syndrome - inflammation in the temporomandibular joint may compress or cause inflammation in the trigeminal nerve.
6.Multiple sclerosis-an area of demyelination from multiple sclerosis may be the cause- more common in younger patient.
What are the symptoms and signs of Trigeminal Neuralgia?
---------------------------------------------------------------
Symptoms:
-----------
1.Pain is brief, lightning-like, paroxysmal with usually severe.
There may be recurrent stabs of pain or spontaneous exacerbations of pain.
It can last from a few seconds to 1-2 minutes and is followed by a refractory period(no pain).
Sometimes the pain occurs in clusters to the extent that the patient complains that it lasts for hours.
Usually the maxillary branch is most commonly involved ,followed by the mandibular, and then the ophthalamic.
Pain is unilateral (rarely bilateral).
Pain may occur several times a day.
It rarely occurs at night.
There are certain triggers which can spark off an attack:
-----------------------------------------------------------
Light touch at the trigger zone such as the lips is the most provocative.
Other triggers are
1.shaving,
2.face washing,
3.chewing
4.talking
5.brushing teeth
6.sneezing
Pain causes brief muscle spasm of the facial muscles, inducing the tic.
Signs:
---------
Physical examination findings are normal.
A normal neurologic examination is part of the diagnosis of idiopathic Trigeminal Neuralgia.
A careful examination of the cranial nerves must be done, including the corneal reflex.
Any abnormality in the neurological examination suggests that the trigeminal neuralguia is secondary to other illnesses.
What are the investigations required in Trigeminal Neuralgia?
----------------------------------------------------------------
1.Blood for infections such as meningitis,
2.MRI of brain to exclude an uncommon mass lesion or aberrant vessel compressing the nerve roots.
What is the treatment of Trigeminal Neuralgia?
-----------------------------------------------------
Medications:
----------------
1.Carbamazepine is the most effective medical treatment.
2.Baclofen (Lioresal)
Most often used after therapy with carbamazepine has been initiated.
A combination of carbamazepine and Baclofen often relieve pain in many patient.
3.Other anticonvulsant such as phenytoin, oxcarbazepine, clonazepam, lamotrigine, valproic acid, and gabapentin.
4.Muscle relaxants
These agents are also useful in the treatment of Trigeminal Neuralgia.
They can depress the sensitivity of the nerve and relax the muscle.
Mental and physical sluggishness and dizziness occur with use of most anticonvulsant and muscle relaxants.
Surgery
-------------
1.Percutaneous radiofrequency ablation of a portion of the trigeminal ganglion
is the method of choice.
2.anesthetic blocks of the trigeminal ganglion.
3.decompression of trigeminal root entry of impinging vascular structures.
4.Surgical division of the affected branch of the nerve.
What is the prognosis of Trigeminal Neuralgia?
------------------------------------------------------
80% of patients respond well to carbamazepine but recurrences and exacerbations are common.
Surgery is usually effective but may leave permanent neurological deficit.
Trigeminal Neuralgia is not life threatening.
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