Centre for advance orthopedics patient education by Center For Advanced Orthopedics

From Blog to Book.

centerforadvancedorthopedics.wordpress.com

Contents 1 2012 1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

1.9

5 April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

All That Tingles Is Not Carpal Tunnel! (2012-04-04 05:51) . . . . . . . . . . . . . . . . . .

Arthritis of the Elbow (2012-04-20 05:39) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

JOINT ARTHRITIS (2012-05-05 11:20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arthritis (2012-05-16 11:02) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

June . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Plantar Fasciitis (2012-06-08 07:02) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Does Your Shoulder keep you awake at Night? (2012-06-13 06:04) . . . . . . . . . . . . . .

July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Tennis Elbow (2012-07-02 10:11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Knee Arthritis Treatment (2012-07-07 08:10) . . . . . . . . . . . . . . . . . . . . . . . . . .

August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INJURIES OF THE CERVICAL SPINE (2012-08-16 08:53) . . . . . . . . . . . . . . . . . .

Osteomyelitis (Bone Infection Disease) (2012-08-27 08:26) . . . . . . . . . . . . . . . . . . .

September . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Treatment of Amputation (2012-09-07 11:22) . . . . . . . . . . . . . . . . . . . . . . . . . .

Injury To The Coccyx (Tailbone) (2012-09-29 08:56) . . . . . . . . . . . . . . . . . . . . . .

October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rickets (Deficiency of Vitamin D, Calcium and Phosphate) (2012-10-09 07:24) . . . . . . .

November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Meniscal (Cartilage) Tear (2012-11-03 12:07) . . . . . . . . . . . . . . . . . . . . . . . . . .

How to get relief from Pelvic Pain Injuries? (2012-11-20 12:14) . . . . . . . . . . . . . . . .

December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How to treat Arthritis Disease? (2012-12-18 06:01) . . . . . . . . . . . . . . . . . . . . . . .

What will causes of Ankle Pain Injury? (2012-12-28 07:34) . . . . . . . . . . . . . . . . . .

49 3

2 2013 2.1

55 January . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

To Know About Genu Valgum (Knock Knees) (2013-01-02 11:40) . . . . . . . . . . . . . . .

How can we prevent Medial Meniscus Injury? (2013-01-15 05:27) . . . . . . . . . . . . . . .

February . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How to treat Hip Dislocation? (2013-02-05 10:26) . . . . . . . . . . . . . . . . . . . . . . . .

How to diagnose Knee Joint Injury? (2013-02-21 09:48) . . . . . . . . . . . . . . . . . . . .

March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Obesity is emerging as a serious health threat among children (2013-03-06 07:05) . . . . . .

April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Carpal Tunnel Syndrome (2013-04-10 05:52) . . . . . . . . . . . . . . . . . . . . . . . . . . .

June . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How to Recover from Rheumatoid Arthritis? (2013-06-24 11:16) . . . . . . . . . . . . . . .

July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diving and Swimming Tips (2013-07-29 03:35) . . . . . . . . . . . . . . . . . . . . . . . . .

August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Safety Tips for Young Drivers (2013-08-21 06:39) . . . . . . . . . . . . . . . . . . . . . . . .

October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Experts’ Advice to Avoid Medical Errors (2013-10-22 08:22) . . . . . . . . . . . . . . . . . .

Steroid Injection Therapy May Increase Risk of Spinal Fracture (2013-10-29 07:33) . . . . .

November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Advantages of Computer Assisted Surgery (2013-11-20 10:14) . . . . . . . . . . . . . . . . .

2.10 December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Treatment for Achilles Tendon Injuries (2013-12-19 09:36) . . . . . . . . . . . . . . . . . . .

2.2

2.3

2.4

2.5

2.6

2.7

2.8

2.9

3 2014 3.1

3.2

3.3

3.4

3.5

85 January . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Post Knee Rehabilitation: Do’s and Don’ts (2014-01-15 12:14) . . . . . . . . . . . . . . . .

February . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Morton’s Neuroma (2014-02-14 05:38) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BONE & JOINT (2014-03-14 07:13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Greenstick Fracture (2014-04-26 12:30) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Legg- Calve Perthes Disease (2014-05-27 11:21) . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 1

2012 1.1

April

All That Tingles Is Not Carpal Tunnel! (2012-04-04 05:51) In Reality, All Tinglings are not Carpal Tunnel Syndromes Numbness of the hands and [1]carpal tunnel syndrome are synonymous for many patients. If hand or fingers experience weakness or tingling sensation, there is an automatic assumption of [2]carpal tunnel syndrome. The term has gained familiarity in the work places where upper extremities are exposed to repetitive motion. Keyboards are gaining notoriety for contributing to the condition. The syndrome has become a common household term in the nineties

[3] Carpal Tunnel Syndrome Treatment

An assortment of factors produces [4]pain, numbness, and weakness in the upper extremities and closely mimics the picture of carpal tunnel syndrome. Numbness is not necessarily a result of nerve pinching either this is a second common misconception. Conditions affecting as remote areas as the shoulders may produce a heavy and numb sensation in the [5]upper extremity. None of this has to do with any nerves whatsoever. Conversely, a [6]carpal tunnel syndrome pain may extend as high as the shoulder and can be confused with a shoulder condition. 5

Vascular conditions that compromise the circulation to the extremity are also accompanied by tingling and numbness. Conditions of the heart have been known to produce extremity symptoms these include[7] symptoms oftingling and numbness. Metabolic disorders are another culprit on the list mimicking carpal tunnel syndrome. On the top of the list are [8]Diabetes and thyroid disorders. These produce symptoms with or without nerve compression (nerve pinching). Conditions of the neck frequently produce numbness, pain, and weakness of the hands. Arthritic or disc conditions of the neck may produce nerve compression in the neck which produce [9]symptoms in the upper extremities. The term [10]carpal tunnel is derived from the tunnel shaped configuration of the tiny wrist bones. This tunnel harbors tendons that flex our fingers. A nerve called the median nerve is packed along the tendons. The median nerve carries sensations to the thumb and the majority of the fingers. The space has very little tolerance to any swelling and the resulting pressure. A wide variety of [11]causes may produce pressure in the carpal tunnel. One of the physiological causes is pregnancy. Pregnancy related symptoms usually disappear after childbirth. It is not uncommon to experience pain at night. Positions of wrist flexion such as driving and holding a newspaper [12]trigger pain andnumbness. Keyboards have a similar effect. Treatments: Examination usually requires a careful history and evaluation of the related symptoms. Blood tests and nerve conduction studies may be necessary to establish the diagnosis. Treatment usually consists of treating the underlying causes if they are identifiable. Splinting, protection, and anti-inflammatory medications produce considerable relief for most cases. [13]Carpal tunnel injections may be useful for more [14]chronic cases. C decompression is indicated for advanced or truely refractory cases. This out-patient procedure can be performed under a local or regional anesthesia. 1. http://centerforadvancedorthopedics.com/ 2. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 3. http://centerforadvancedorthopedics.files.wordpress.com/2012/04/carpal-tunnel-treatment.jpg 4. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 5. http://centerforadvancedorthopedics.com/ 6. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 7. http://centerforadvancedorthopedics.com/ 8. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 9. http://centerforadvancedorthopedics.com/ 10. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 11. http://centerforadvancedorthopedics.com/ 12. http://centerforadvancedorthopedics.com/ 13. http://centerforadvancedorthopedics.com/ 14. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx

Arthritis of the Elbow (2012-04-20 05:39) Arthritis of the Elbow: Causes, Types, Treatments, Procedure. How many times a day do you bend your elbow? A person usually bends their [1]elbow hundreds of times a day. Now imagine if every time you bent your elbow, you [2]felt the pain of arthritis. For many Americans, 6

this scenario is all too true. [3]Arthritis of the elbow can cause pain not only when they bend their elbow, but also when they straighten it. Causes of Arthritis of the Elbow: • [4]Rheumatoid Arthritis (RA). • [5]Osteoarthritis (OA or ”wear-and-tear” arthritis) • [6]Trauma [7]RA is a disease of the joint linings, or synovia. As the joint lining swells, the joint space narrows. The disease gradually destroys the bones and soft tissues. Usually, [8]RA affects both elbows, as well as other joint s such as the hand, wrist and shoulder. [9]OA affects the cushioning cartilage on the ends of the bones that enables them to move smoothly in the [10]joint. As the cartilage is destroyed, the bones begin to rub against each other. Loose fragments within the joint may accelerate degeneration. [11]Trauma or injury to the elbow can also damage the articular cartilage. This eventually leads to the development of post [12]traumatic arthritis. Usually, this form of arthritis is confined to the injured joint. In the early stages of RA, pain may be primarily on the outer side of the joint. Pain generally worse ns as you turn (rotate) your forearm. The pain of OA may intensify as you extend your arm. Pain that [13]continues during the night or when you are at rest indicates a more advanced stage of OA. In addition to pain, one may experience swelling, inability to perform daily activities because the elbow gives away, inability to straighten or [14]bend the elbow, [15]locking of the elbow, and [16]stiffness in the elbow. At times, both elbows are involved or pain can occur at the wrist, shoulders, and elbow; this is indicative of RA. Treatment: The initial treatment is non- surgical and depends on the [17]type of arthritis. Your physician will discuss the options with you and develop an individualized program of medical and physical activities. Among the therapies that can be used are: activity modification; since, OA may be linked to repetitive overuse of the joint, modifying job or sports activities can be helpful. Intermittent periods of rest can relieve[18] stress on the elbow. Painkillers, such as acetaminophen or ibuprofen can provide short-term pain relief. More potent agents can be prescribed to treat RA. These include anti malarial agents, gold salts, immunosuppressive drugs, and corticosteroids. An injection of a corticosteroid into the joint can often help. Physical therapy is another treatment option; heat or cold applications and gentle exercises may be prescribed. A splint worn at night, or one that permits movement as it protects the elbow from stresses, may also be helpful. Other assistive devices, such as handle extensions, can be used to maintain daily activities. Surgical Treatment: If your arthritis does not respond to the above [19]treatments, you and your physician may discuss surgical options. Because several nerves are near the elbow, a skilled orthopedic surgeon should be consulted. [20]Surgery usually results in improved pain control and increased range of motion. Procedure: The exact procedure will depend on the [21]type of arthritis you have, the stage of the disease, your age, expectations, and activity requirements. Arthroscopy, a procedure involving pencil-sized instruments and two or three small incisions, allows the surgeon to remove bone spurs, loose fragments, or a portion of the diseased synovium. This procedure can be used to treat both RA and OA. Another procedure is called a synovectomy; here, the [22]surgeon removes the diseased synovium. Sometimes, a port ion of bone is also removed to provide a greater range of motion. This procedure is often used in the early stages of RA. In 7

an osteotomy, part of the bone is removed to relieve pressure on the joint. This procedure is often used to treat OA. In an arthroplasty, the surgeon creates an artificial joint using either an internal prosthesis or an external fixation device. A total [23]joint replacement is usually reserved for patients over 60 years old or patients with RA in advanced stages. 1. http://centerforadvancedorthopedics.com/ 2. http://centerforadvancedorthopedics.com/ 3. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 4. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 5. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 6. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 7.

http:

//centerforadvancedorthopedics.com/Contact-Main-Office-And-Hollywood-Office-For%20Advanced-Orthopedics.aspx 8. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 9.

http:

//centerforadvancedorthopedics.com/Contact-Main-Office-And-Hollywood-Office-For%20Advanced-Orthopedics.aspx 10. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 11.

http:

//centerforadvancedorthopedics.com/Contact-Main-Office-And-Hollywood-Office-For%20Advanced-Orthopedics.aspx 12. http://centerforadvancedorthopedics.com/About-Your-Visit-in-Center-For-Advanced-Orthopedics.aspx 13. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 14. http://centerforadvancedorthopedics.com/ 15. http://centerforadvancedorthopedics.com/ 16. http://centerforadvancedorthopedics.com/ 17. http://centerforadvancedorthopedics.com/ 18. http://centerforadvancedorthopedics.com/ 19. http://centerforadvancedorthopedics.com/ 20. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 21. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 22. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 23. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx

1.2

May

JOINT ARTHRITIS (2012-05-05 11:20) Is [1]ARTHRITIS LIMITING YOU? [2]Arthritis is a painful joint condition that affects a reported 32.9 million American adults. Though it commonly occurs in adults however, children can also be affected. Arthritis can occur in an [3]injured or [4]diseased joint. A joint is where the ends of two or more bones meet. The bone ends of a joint are covered with cartilage, a smooth material that cushions the bone and allows the[5] joint to move smoothly without pain. Types: Though there are more than a hundred different types of[6] arthritis, the two most common types are called [7]Osteoarthritis and [8]Rheumatoid Arthritis. 8

[9]Osteoarthritis Arthritis: [10]Osteoarthritis is found in the joints of older people and in injured or overused joints of younger individual. It is commonly found in the knee, hips, and spine. In this type of [11]arthritis, the cartilage covering the joint begins to wear away. Occasionally, bone growths, called â&#x20AC;?spursâ&#x20AC;?, can develop in the joint. The resulting inflammation in the[12] joint causes pain and swelling. [13]Rheumatoid Arthritis: [14]Rheumatoid arthritis, another common form of [15]arthritis, is a long lasting disease in which the joint lining swells. This swelling invades surrounding tissues and causes chemical substances to attack and destroy the joint surface. Though [16]rheumatoid arthritis is commonly found in the hands and feet, it can also occur in the knees, hips, and elbows. [17]Swelling, pain, and stiffness are present even when the joint is not used. Though rheumatoid arthritis can affect anyone, more than seventy percent of those with this disease are above thirty. The main approach to treating arthritis centers on pain relief, increased motion, and increased strength. Many over-the-counter medications, including aspirin, ibuprofen, and naproxen can be used to control pain and inflammation associated with arthritis. Prescription medications are also available if over-the counter medications are not effective. People with [18]arthritic joints can use canes, crutches, and walkers to help relieve the stress placed on arthritic joints. [19]Treatment: Exercising and physical therapy can also be helpful in decreasing stiffness and in strengthening muscles around the joints. If these methods of [20]treatment are not successful, surgery is recommended. The type of surgery depends on the extent of [21]arthritis in the joints, its type, and the physical condition of the patient. [22]Surgical procedures include removal of the diseased or damaged joint lining, realignment of the joints, [23]total joint replacement, and fusion of the bone ends of a joint to prevent joint motion and relieve joint pam. Though there is no present cure for arthritis, researchers continue to make progress in finding the underlying causes for the major [24]types of arthritis. Still, people with arthritis can continue to perform normal activities. Various exercise programs, anti inflammatory drugs, and [25]weight reduction programs for obese people are ways to reduce pain, stiffness, and improve function. In persons with severe cases of arthritis, [26]orthopedic surgery can often provide dramatic pain relief and restore lost joint function. A total joint replacement, for example, can usually enable a person with severe arthritis in the hip or the knee to walk around without pain or stiffness. Consult your orthopedic doctor if you are having symptoms typical of arthritis. 1. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 2. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 3. http://centerforadvancedorthopedics.com/Default.aspx 4. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 5.

http:

//centerforadvancedorthopedics.com/Contact-Main-Office-And-Hollywood-Office-For%20Advanced-Orthopedics.aspx 6.

http:

//centerforadvancedorthopedics.com/Contact-Main-Office-And-Hollywood-Office-For%20Advanced-Orthopedics.aspx 7. http://centerforadvancedorthopedics.com/About-Your-Visit-in-Center-For-Advanced-Orthopedics.aspx 8. http://centerforadvancedorthopedics.com/About-Your-Visit-in-Center-For-Advanced-Orthopedics.aspx

9. http://centerforadvancedorthopedics.com/Location-Of-Advaced-Orthopedics.aspx 10. http://centerforadvancedorthopedics.com/About-Your-Visit-in-Center-For-Advanced-Orthopedics.aspx 11. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 12. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 13. http://centerforadvancedorthopedics.com/ 14. http://centerforadvancedorthopedics.com/ 15. http://centerforadvancedorthopedics.com/ 16. http://centerforadvancedorthopedics.com/ 17. http://centerforadvancedorthopedics.com/ 18. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 19. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD. 20. http://centerforadvancedorthopedics.com/ 21. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 22. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 23. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 24. http://centerforadvancedorthopedics.com/ 25. http://centerforadvancedorthopedics.com/ 26. http://centerforadvancedorthopedics.com/

Arthritis (2012-05-16 11:02) Managing Arthritis in Active Adults: All painful knees are not necessarily [1]arthritic. The knee is a complex joint with several moving parts which is frequently challenged during regular and recreational activities. It is not uncommon for one part or another to start showing signs of strain or regular wear and tear of the[2] joint surface, which is also known as articular cartilage. This surface has appearance of a resilient plastic that is well constructed to absorb the repetitive loads during walking and running. The joint surface may start to show signs of wear and tear with or without apparent injury. This wear and tear of the joint surface is also known as degenerative [3]arthritis. If the pain is produced by strains of parts other than the joint surface, the condition is not [4]arthritic. Smoking, overweight, trauma, repetitive loading and misalignments of the joint contribute to the development and continuation of the [5]knee arthritis. The knee has three main compartments or moving sections, which absorb the body loads during physical activities. The arthritic condition may involve one, two or all three compartments of the joint. It is important for the patients to have this knowledge, since the treatment may differ depending upon the involvement of a particular compartment. [6]Pain and stiffness are two of the most common [7]symptoms of arthritis. At times, this may be accompanied by swelling, popping, clicking and sensations of giving out. It is important to know that non-[8]arthritic conditions of the knee can also produce similar symptoms that closely mimic arthritis. A history of symptoms, clinical examination and standing Xrays are usually sufficient to make a correct diagnosis of degenerative arthritis. On rare occasions, additional testing such as CT scan or MRI scans may be necessary to arrive at a diagnosis. These additional tests are unnecessary and redundant in more than 90 % of patients. The X- rays might show joint space narrowing, small bone over growths such as bone spurs or deposits of calcium. At times the X- rays look completely normal and further investigations become necessary in face of continuing symptoms. 1. http://centerforadvancedorthopedics.com/ 2. http://centerforadvancedorthopedics.com/ 3. http://centerforadvancedorthopedics.com/ 4. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx

5. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 6. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 7. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 8. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx

1.3

June

Plantar Fasciitis (2012-06-08 07:02) Symptoms And Treatment Of Heel Spur Syndrome: [1]Plantar Fasciitis is commonly known as ”[2]heel spur syndrome”. It is common among people who are active in sports (i.e. running). This [3]pain generally begins as a dull pain in the heel that may come and go. At times the pain may be sharp and persistent. The pain is usually worse after times of rest such as sitting or sleeping; therefore, more pain is noticed in the mornings or at the start of physical activities. The [4]plantar fascia is a thick fibrous band on the bottom of the foot. This is attached from the heel bone to the toes and acts as a bowstring to produce the arch of the foot. Running and other activities may place tension on the [5]fascia. This prolonged tension causes the fascia to swell at the point where the fascia is attached to the [6]heel bone. Injury may also occur at the mid-sole or near the toes. It is difficult to rest the foot; therefore, it is important to seek treatment as soon as possible so that the problem does not progress. The [7]swelling reaction of the heel bone may produce new bone called [8]heel spurs. They are not initially painful and do not cause the problem; however, walking on spurs may cause sharp pain. Some contributing factors include flat feet, high arched feet, poor shoe support, toe running, soft terrain, increasing age, sudden increase in activity level, or family tendency. Keep in mind that plantar fasciitis may be aggravated by weight bearing sports. Treatment for Plantar Fasciitis Improvement may take longer if the condition has existed for a long time. It is important to wear good shoes and to lose excess weight. During the recovery period, it would be helpful to replace weight bearing [9]sports with non-weight bearing sports such as cycling or swimming. Weight training will help to maintain leg strength. A sport is considered weight-bearing if the foot is repeatedly landing on the ground such as running or jogging.

• [10]Treatment of plantar fasciitis includes rest. Pain will be the guide to let you know when you should rest your foot. • Ice can be applied for 30 to 60 minutes several times a day to [11]reduce swelling. The ice can be placed in a plastic bag covered with a towel. Apply ice for “approximately 15 minutes after activity. • Anti-inflammatory/analgesic medication may also be used to reduce swelling. If there is no help after 2-3 weeks, the [12]physician may decide to inject the tender area with cortisone or a local anesthetic. • A heel or felt sponge can help to spread, equalize, and absorb the shock as your heel lands. This would ease the pressure on the [13]plantar fascia. You may need to cut a hole in the sponge over the painful area to avoid irritation. 11

â&#x20AC;˘ [14]Surgery is rarely required for plantar fasciitis . It would only be considered if all other forms of conservative treatment fails. â&#x20AC;˘ When necessary, surgery requires the removal of the [15]bone spur and release of the plantar fascia. After recovery, return to sports activities slowly. Pain will indicate that you are doing too much. Your physician can give you the proper exercises to strengthen the small muscles of the foot and to support the damaged areas. This will help prevent [16]re-injury.

1. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 2. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedic 3. http://www.centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 4. http://www.centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 5. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 6. http://www.centerforadvancedorthopedics.com/Patient-Education-of-Orthopedics-Clinic.aspx 7. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 8. http://www.centerforadvancedorthopedics.com/About-Your-Visit-in-Center-For-Advanced-Orthopedics.aspx 9. http://www.centerforadvancedorthopedics.com/Patient-Education-of-Orthopedics-Clinic.aspx 10. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 11. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 12. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 13. http://http//www.centerforadvancedorthopedics.com/Staff-Information-Of-Advance-Orthopedic-.aspx 14. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 15.

http://http//www.centerforadvancedorthopedics.com/About-Your-Visit-in-Center-For-Advanced-Orthopedics.

aspx 16. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx

Does Your Shoulder keep you awake at Night? (2012-06-13 06:04) Shoulder Pain: Symptoms, Causes and Treatment. [1]Shoulder pain is a relatively common condition. Ordinary [2]strains and sprains produce shoulder discomfort. Most of the time the condition is self-limiting and resolves spontaneously. Some shoulder pains are recalcitrant and progressive. [3]Pain may or may not follow any specific injury; it may be spontaneous. Patients usually feel[4] stiffness and find themselves experiencing increasing difficulty in performing day to day routine functions. Pain eventually starts to invade periods of rest. Patients wake up several times during the night and find themselves rubbing their shoulders or popping [5]pain medications. Some patients develop weakness and cannot raise their arms to the side or forward. In most cases there is no visible [6]swelling or lump. It is not uncommon for some people to discount it as [7]arthritis. They think that since there is no lasting cure then they must suffer and learn to live with the problem. NOT TRUE! Most [8]chronic shoulder pains are not arthritic and are relatively easy to cure. The shoulder is a ball and socket kind of [9]joint. It is surrounded by an envelope of deep muscles 12

called [10]rotator muscles or commonly known as ”rotator cuff”. The cuff symbolizes an envelope like configuration. The [11]cuff is further covered by a [12]bony arch which provides shape and an outer configuration to the shoulder. The actual joint sits deeper, right below the bridge. Causes: Due to several reasons, the [13]muscles start to rub against the bony arch. This rubbing starts to produce irritation of the rotator cuff. If the rubbing continues for a period of time, the cuff starts to erode. The final outcome may be a good size tear in the cuff. The pressure and rubbing is the cause of pain. [14]Night pain indicates probable erosion of the cuff although this is not necessarily the case in each and every patient. This condition is also called ”[15]Impingement Syndrome”. A simple office examination usually reveals the problem. X-rays are usually performed to obtain further information. In some patients, special investigations are indicated to verify tears of the cuff. Local [16]anesthetic injection, at times, is applied to confirm the diagnosis of impingement. Another common cause of shoulder pain is degeneration of a tiny joint above the shoulder, the AC or acromioclavicular joint. Pain from this condition is usually on the top of the shoulder. One can usually feel a tender spot right over the shoulder. True arthritis of the [17]shoulder joint is rather an uncommon cause. One should always remember certain serious causes of shoulder pain. Fortunately these causes are rare. [18]Bone tumors, serious conditions in the chest or the abdomen can produce vague shoulder pain. Nerves pinching in the neck or TMJ conditions are also relatively common but non-serious causes of shoulder pain. Treatment: [19]Treatment of the problem is based upon the cause.

• Most cases are mild and relatively easily manageable. • Medications, simple exercises, and physical therapy are the usual treatments. • Most patients benefit from this plan. Some patients require injections, arthroscopy or [20]surgical correction to get rid of the problem. • For specific information on this condition, consult your[21] physician. 1. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 2. http://centerforadvancedorthopedics.com/ 3. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 4. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 5. http://centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 6. http://centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 7. http://centerforadvancedorthopedics.com/Patient-Education-of-Orthopedics-Clinic.aspx 8. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 9. http://centerforadvancedorthopedics.com/Current-Event-Center-For-Advanced-Orthopedics.aspx 10. http://centerforadvancedorthopedics.com/Staff-Information-Of-Advance-Orthopedic-.aspx 11. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 12.

http:

//centerforadvancedorthopedics.com/Contact-Main-Office-And-Hollywood-Office-For%20Advanced-Orthopedics.aspx 13. http://centerforadvancedorthopedics.com/Patient-Education-of-Orthopedics-Clinic.aspx 14. http://centerforadvancedorthopedics.com/Insurances-Accepted-Advaced-Orthopedics.aspx 15. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 16. http://centerforadvancedorthopedics.com/Testimonial-Center-For-Advanced-Orthopedics.aspx 17. http://centerforadvancedorthopedics.com/Patient-Education-of-Orthopedics-Clinic.aspx 18. http://centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 19. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 20.

http:

//centerforadvancedorthopedics.com/Contact-Main-Office-And-Hollywood-Office-For%20Advanced-Orthopedics.aspx 21. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx

1.4

July

Tennis Elbow (2012-07-02 10:11) Lateral Epicondylitis: Symptoms And Treatment [1]Tennis Elbow is an inflammation around the [2]bony knob of the outer side of the elbow. It occurs when the tissue that attaches [3]muscle to the bone becomes irritated. The bony knob is called the [4]lateral epicondyle; therefore, Tennis Elbow is also called lateral epicondylitis. The muscles that allow you to straighten your [5]fingers and rotate your [6]lower arm and wrist are called [7]extensor muscles. These muscles extend from the outer side of your elbow to your wrist and fingers. A cord like fiber called a [8]tendon attaches the extensor muscles to the elbow. Overuse or an accident can cause tissue in the tendon to become inflamed or [9]injured. Tennis elbow can be caused by playing a racket sport or doing anything that involves extending your [10]wrist or rotating your forearm such as twisting a screwdriver or lifting heavy objects with your palm down. It is common for the [11]tissue to become inflamed more easily as you get older. When the tendon is inflamed, the [12]nerves around the tendon become irritated. Then moving your elbow is painful. Turning your hand or grasping objects can also be painful. The most common symptom of tennis elbow is pain on the outer side of the elbow and down the [13]forearm. You may have pain all the time or only when you lift things. The elbow may also swell, get red, or feel warm to the touch. It may also hurt to grip, turn your hand or swing your [14]arm. Tennis elbow can be diagnosed from hearing symptoms and from the look and feel of your elbow. Treatment for Tennis Elbow [15]Treatment will depend how inflamed the tendon is. The goal of treatment will be to relieve the symptoms and regain full use of your elbow. Rest and Medication: The doctor may prescribe a tennis elbow splint to rest the [16]inflamed tendon and allow it to heal. You may wish to use the other hand or change grips to reduce the amount of stress on the tendon. Oral anti-inflammatory medications may be used to reduce [17]swelling. Heat or ice may also 14

be used to reduce swelling and relieve [18]pain. Exercise and therapy: Exercises and [19]therapy may be prescribed to gently stretch and strengthen the muscles around your [20]elbow. Anti-Inflammatory Injections: An injection may be given with an [21]anti-inflammatory such as cortisone to help reduce the swelling. You may have more pain at first; but, within a few days, your elbow should feel better. Surgery: [22]Surgery may be an option if no other treatments relieve the [23]pain or if the symptoms persist for a long period of time. Surgery would be used to repair the inflamed tendon. PREVENTION It is important to try to prevent a flare-up of [24]tennis elbow. You may wish to make a few changes in the way you do certain things. You should grip with the palm up and lift heavy objects with both hands. If you play racket [25]sports or golf, it is important to condition your [26]muscles, do warm-up and cool down exercises and use the correct strokes. 1. http://www.centerforadvancedorthopedics.com/ 2. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 3. http://www.centerforadvancedorthopedics.com/Patient-Education-of-Orthopedics-Clinic.aspx 4. http://www.centerforadvancedorthopedics.com/Staff-Information-Of-Advance-Orthopedic-.aspx 5. http://www.centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 6. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 7. http://www.centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 8. http://www.centerforadvancedorthopedics.com/Current-Event-Center-For-Advanced-Orthopedics.aspx 9. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 10. http://www.centerforadvancedorthopedics.com/Patient-Education-of-Orthopedics-Clinic.aspx 11. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 12. http://www.centerforadvancedorthopedics.com/About-Your-Visit-in-Center-For-Advanced-Orthopedics.aspx 13. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 14. http://www.centerforadvancedorthopedics.com/Staff-Information-Of-Advance-Orthopedic-.aspx 15. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 16.

http://www.centerforadvancedorthopedics.com/Contact-Main-Office-And-Hollywood-Office-For%

20Advanced-Orthopedics.aspx 17. http://www.centerforadvancedorthopedics.com/Location-Of-Advaced-Orthopedics.aspx 18. http://www.centerforadvancedorthopedics.com/Patient-Education-of-Orthopedics-Clinic.aspx 19. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 20. http://www.centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 21. http://www.centerforadvancedorthopedics.com/Patient-Education-of-Orthopedics-Clinic.aspx 22. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 23. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 24. http://www.centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 25. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 26.

http://www.centerforadvancedorthopedics.com/Contact-Main-Office-And-Hollywood-Office-For%

20Advanced-Orthopedics.aspx

Knee Arthritis Treatment (2012-07-07 08:10) Pain Relief Treatment for Knee Arthritis: In the [1]knee, [2]arthritis treatment can take several forms. Selection of [3]treatment takes several factors into consideration and these may include but are not limited to, severity of [4]pain and disability, response to previous treatments, number and extent of the compartments that are involved in the [5]disease process, general health of the patient and circulation of the extremity. Treatment:

• [6]Treatment could be as simple as modification of the physical activities and periodic utilization of ordinary pain medications. • Non-impact activities such as cycling and swimming can provide excellent [7]cardiovascular and aerobic advantage while the [8]joint is undergoing other medical treatments. • For mild misalignments, [9]heel wedges and balancing shoe inserts come in handy to alleviate [10]pain and improve function. • Non-steroidal anti-inflammatory medications do provide symptomatic relief without reversing the [11]arthritis. • Food supplements such as Glucosamine and Chondriotin sulfate also provides symptomatic relief and do not delay the progression of the arthritis. • These products are still under active research and their mode of action remains unknown. Myriad of [12]injections are also utilized to provide symptomatic [13]relief. Among these injectable steroids and lubricating type of injections are most popular. These injections if effective may provide relief for several months. Injectable steroids are safe and effective for nasty and painful flares; however, their utilization should be limited and never applied as a long-term [14]management strategy. Choice of Surgery:

• [15]Surgical alternatives may be explored for resilient arthritic knees. • [16]Surgery is an elective choice and never an absolute necessity. • For arthritis induced loose bodies and related mechanical problems a relatively simple outpatient procedure of [17]arthroscopy can alleviate the immediate problem without reversing the arthritis itself. • Removal of loose bodies can extend the life of the joint and postpone the need for major invasive procedures. In relatively younger adults, a portion of the joint can be replaced if the disease is localized to a single compartment. Such a procedure is known as uni-compartmental [18]knee replacement. If more than one compartment is involved, it may become necessary to replace the entire joint through a standard total knee replacement. Contrary to common misconception, a total knee replacement doesn’t entail removal of the entire knee; instead the procedure replaces the uneven arthritic surface with synthetic materials and preserves the bulk of the original [19]bones that produce the natural shape of the [20]knee joint. 16

Before any surgical procedures patients must familiarize themselves with the exact nature of [21]surgery, alternate approaches and risks that may accompany such procedures. No one should jump into surgical options without acquiring sufficient knowledge about the operation. 1. http://www.centerforadvancedorthopedics.com/ 2. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 3. http://www.centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 4. http://www.centerforadvancedorthopedics.com/About-Your-Visit-in-Center-For-Advanced-Orthopedics.aspx 5. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 6. http://www.centerforadvancedorthopedics.com/Download-Forms-of-Orthopedics-Therapy.aspx 7. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 8. http://www.centerforadvancedorthopedics.com/Patient-Education-of-Orthopedics-Clinic.aspx 9. http://www.centerforadvancedorthopedics.com/Current-Event-Center-For-Advanced-Orthopedics.aspx 10. http://www.centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 11. http://www.centerforadvancedorthopedics.com/Insurances-Accepted-Advaced-Orthopedics.aspx 12. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 13. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 14. http://www.centerforadvancedorthopedics.com/Current-Event-Center-For-Advanced-Orthopedics.aspx 15. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx 16.

http://www.centerforadvancedorthopedics.com/Contact-Main-Office-And-Hollywood-Office-For%

20Advanced-Orthopedics.aspx 17. http://www.centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 18. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 19. http://www.centerforadvancedorthopedics.com/Location-Of-Advaced-Orthopedics.aspx 20. http://www.centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx 21. http://www.centerforadvancedorthopedics.com/Location-Of-Advaced-Orthopedics.aspx

1.5

August

INJURIES OF THE CERVICAL SPINE (2012-08-16 08:53) Cervical Spine Injury : Causes, Symptoms and Treatment [1]Injuries of the [2]cervical spine are dangerous; and if associated with neurological damage, the results can be devastating. Though diagnostic and [3]treatment methods have vastly improved over years, [4]still injuries of the cervical spine pose the greatest challenge to the skill and acumen of [5]orthopedic and neurosurgeons. Jefferson pointed out two areas commonly involved in [6]cervical spine injuries, C1-2 and C5-7. According to Meyer, C2 and C5 are commonly involved. Neurological damage is seen in 40 percent of cases. In 10 percent of cases, radiographs are normal. Causes

â&#x20AC;˘ Fall from Height: It is the most common cause in developing countries. â&#x20AC;˘ Diving Injuries: Diving into water with insufficient depth or in an inebriated condition. 17

• Road Traffic Accidents (RTAs): Common cause in developed countries, e.g. [7]whiplash injury • Gunshot Injuries: These injury the [8]cervical spine and the cord directly. Mechanism of Injury

• Pure Flexion Force: For Example, compression [9]fracture of vertebral body, e.g. fall from height. • Flexion Rotation: For Example, fall on one side of the [10]shoulder, disruption of facet capsule is seen. • Axial Compression: For Example, fall of an object on the head results in load compression, e.g. explosive comminuted fracture of C5 body. • Extension Force: For Example, avulsion fracture of superior margin of [11]vertebral body, e.g. whiplash injury. • Lateral Flexion: For Example, fracture pedicle, fracture transverse process and [12]facet joints, etc. • Direct Injuries: For example, fracture spinous process and body. Due to assault, [13]gunshot injury, etc. WHIPLASH INJURY (SYN: Acceleration injury,[14] cervical sprain syndrome, soft tissue neck injury) Definition It is an unconventional and inconsequential ligamentous [15]injury of the cervical spine allegedly due to an extension injury following a rear-end collision in an RTA. Incidence

• It is seen in about 25 percent of rear-end collision of RTAs. • Seventy percent of those affected are women. • It is common in the 3rd or 4th decades. Clinical Features Symptoms

• [16]Upper neck pain that becomes worse with movement. • Occipital headache. • [17]Neck stiffness. • Rarely vertigo, auditory or visual disturbances, etc. Signs

• Decreased range of neck movements. 18

• Neck muscle spasm is seen. • [18]Symptoms appear within 48 hours of injury and 57 percent recover within three months. Final state is reached by one year. Investigations X-rays are usually normal. MRI helps to make a diagnosis. Treatment It is mainly conservative and consists of the following:

• Drugs: NSAIDs, [19]muscle relaxants, etc. are given. • Collars: These are recommended for the first three days. • Short [20]arc active movements are slowly begun. • Active ROM exercises are slowly commenced. • After the [21]pain subsides, isometric strengthening exercises are slowly commenced. • Other modalities take ultrasound, traction, manipulation, [22]massage, etc. also helps. 1. http://www.centerforadvancedorthopedics.com/ 2.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 3.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 4. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 5. http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.aspx 6. http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.aspx 7. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 8. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 9.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 10.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 11.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 12.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 13. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 14. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 15.

http:

//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx 16. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 17. http://www.centerforadvancedorthopedics.com/Current-Event-Center-For-Advanced-Orthopedics.aspx 18.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 19. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 20. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 21. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 22.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx

Osteomyelitis (Bone Infection Disease) (2012-08-27 08:26) Signs, Symptoms And Treatment of Bone Disease: [1]Osteomyelitis is one of the most difficult and challenging problems encountered in [2]orthopedics. From the life-threatening [3]acute osteomyelitis to the disabling [4]chronic osteomyelitis, it frustrates and thwarts the best efforts of orthopedic surgeons. The ravaging effects of osteomyelitis on a [5]bone and its neighboring joints are a tale of dismay and gloom. Definition Osteomyelitis is defined as a suppurative process of the bone caused by [6]pyogenic organisms or simply a pyogenic infection of the cancellous portion of the [7]bone. Classification Three types are described based on duration of [8]symptoms, route of spread of infection and host response. Hematogenous spread with primary infection being elsewhere like [9]tonsillitis, ASOM, pyoderma, etc. is the common mode of spread. Spread from neighboring infective sites like septic [10]arthritis and direct inoculation of infecting organisms by way of penetrating wounds, punctured wounds, [11]trauma, etc. come second. Clinical Features [12]Acute osteomyelitis is a clinical catastrophe. It presents in the following manner: Fever This is the most common presenting symptom. The child usually has very high [13]fever and is associated with profuse sweating, chills and rigors. Sometimes, the presentation is so acute that the child may be in shock and [14]unconscious. Swelling This usually follows the fever and may affect the ends of long [15]bones. acutely [16]painful and the [17]skin may appear red. Limitation of Movement 20

The swelling may be

The child may not move the [18]joint near the affected bone due to [19]pain and swelling. In fact, the child may lie still without moving the joint and this is sometimes called a state of pseudoparalysis. Clinical Signs This consists of general and local signs are :

1. General Features 2. Local Features General Features Symptoms:

• Fever • Sweating • Chills and Rigors • Patient is usually in shock Signs

• Increased Temperature • Increased Pulse Rate • Anemia • Signs of dehydration and shock General features of anemia, [20]dehydration, pyrexia, pulse rate, shock and toxicity may be present. Local Features Symptoms

• Local Swelling (80 %) • Limitation of movement (50 %) Signs

• Tenderness (80 %) • Local Erthema (50 %) 21

• Raised Temperature (50 %) • Fluctuation Present (20 %) • Effusion (10 %) • Decreased Movements (50 %) The local [21]swelling may show increased temperature may be tender to touch, and the [22]skin is stretched. Movements of the neighboring [23]joints are decreased and there may be effusion in them too. Investigations The investigations of [24]acute and chronic osteomyelitis is compared for easy remembrance and understanding. In general, in acute osteomyelitis, laboratory investigations and [25]bone scan are more useful while radiology is of much help in chronic osteomyelitis. Management Acute osteomyelitis is an [26]orthopedic emergency, which needs in patient admission. Treatment

• Rest in Bed: Protect affected part with splints to alleviate [27]pain and spasm. • Elevation of the part: Warm and moist packs to reduce the [28]swelling. • Systematic Treatment: Blood transfusions, intravenous fluids to correct shock and hypovolemia. • [29]Orthopedic Treatment • [30]Physical Therapy Treatment Principles of Antibiotics Therapy

• Appropriate drug: Usually the drug chosen is a broad spectrum bactericidal agent. • Appropriate Route: Intravenous for the first 2 weeks and oral for the next 4 weeks. • Appropriate Dose: The [31]drug depending on the body weight of the patient. • Appropriate time to stop: When the [32]disease is eradicated, controlled or resistance or side effects to the drugs develops. • Appropriate adjunctive measures: a combination of ampicillin and cloxacillin are found to be very effective though pencillin G still the drug of first choice in our country. Surgical Methods: Depending upon the situation anyone of the following [33]surgical methods could be employed: 22

• Aspiration: It helps in decompression and the material so obtained may be used to identify the organism and check for [34]antibiotic sensitivity. • Incision and Drainage: Helps to drain the subcutaneous abscess. • Multiple drill holes: If the abscess is subperiosteal, this technique helps to drain the [35]pus by making multiple holes in the cortex. • Small bone window: If the multiple drill holes do not drain the pus, a small window of [36]bone is removed from the cortex and the pus is evacuated. 1. http://www.centerforadvancedorthopedics.com/ 2. http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.aspx 3.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 4.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 5. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 6. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 7. http://www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md. aspx 8.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 9.

http:

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 12. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 13. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 14. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 15.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 16. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 17.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 18.

http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.

aspx 19. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 20. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 21.

http:

//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx 22. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 23. http://www.centerforadvancedorthopedics.com/Current-Event-Center-For-Advanced-Orthopedics.aspx 24.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 25. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 26.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 27. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx

28. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-a aspx

29. http://www.centerforadvancedorthopedics.com/About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medic aspx 30. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 31. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 32. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx

33. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-a aspx 34. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx

35. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-a aspx 36. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx

1.6

September

Treatment of Amputation (2012-09-07 11:22) Upper And Lower Limb Amputation Treatment: [1]Amputation is a procedure that removes a [2]limb, partly or totally, through the level of one or more [3]bones, whereas disarticulation is a procedure that removes a limb through the level of a [4]joint. Amputation is one of the oldest [5]surgical procedures. Refinements in amputation surgeries and advances in prosthetic designs occurred mainly during the two World Wars. This advancement is progressive and essential as the number of [6]amputations performed is increasing each year. This is due to an increasing aging population with greater incidences of [7]diabetes and [8]peripheral vascular diseases as well as due to an ever increasing incidence of accidents. Amputations are more common in men and more often in the lower limbs. Types of Amputation There are two types of amputation: (i) Open Amputation (ii) Closed Amputation Open Amputation In open amputation, also called [9]guillotine amputation, the skin is not closed over the amputation stump. Open amputation is indicated in cases where the wound is grossly contaminated or in cases of severe [10]infections. After amputation the stump is left open and dressed regularly till the infection subsides and the stump wound becomes healthy. The stump can then be covered by any of following methods: 24

• Skin grafting • Secondary closure • Revision of amputation: The amputation is done at a higher level, [11]skin flaps are designed and the stump wound is closed Closed Amputation In this type of amputation, the stump is closed primarily. All elective amputations are closed amputations. Surgical Principles Meticulous attention to details and gentle handling of [12]tissues are essentl.al for a good outcome following amputations. Important principles to be followed during amputation are: Levels of Amputation For an amputation in a [13]limb, ideal levels were suggested which gave the stump an optimum length to facilitate subsequent prosthetic fitting. For example, for an above-[14]knee amputation the optimum length of the stump was taken as 25-30 cm as measured from the tip of the greater trochanter. Similarly, for a below-knee stump the optimum length suggested was 15 cm as measured from the [15]tibial tubercle. However, with the recent developments in the fabrication and fitting of [16]prosthesis, it is not necessary to stick to these stump lengths. These days the prosthesis (artificial limb) can be custom-made to fit at different stump lengths. The viability of the tissue is the main criteria for determining the level of [17]amputation. The stump should, however, have a well-healed, non-tender, supple scar. The stump should be in proper shape and not bulky. Availability of total contact prosthesis has further increased the option in deciding the level of amputations. However, a joint must always be preserved, whenever possible. In Upper Limb an Amputation could be:

• Shortening of the [18]phalanges. • Ray Amputation of the Fingers: The whole digit is removed from the base of the corresponding metacarpal. • Below-Elbow Amputation: Amputation through [19]forearm bones. • Through-elbow disarticulation. • Above-Elbow Amputation: Amputation through the arm. • Through-[20]shoulder disarticulation. • Forequarter Amputation: It is carried out proximal to the [21]shoulder joint in which scapula and part of the clavicle are removed along with the shoulder girdle muscles. • Krukenberg Operation: This operation is usually performed in patients with bilateral below-elbow amputations, who have sufficiently long stumps. The forearm is split between the radius and [22]ulna to provide the pincer grip. The patient can hold a spoon or such lighter objects with this ”fork”. 25

Lower Limb: The amputation may involve a toe or it may be:

• Mid tarsal amputation. • Through -[23]ankle disarticulation. • Syme’s Amputation: The tibia and [24]fibula are divided just above the ankle joint. The intact skin over the [25]heel is attached back to the end of the stump with or without a part of the calcaneum. Because of the intact heel, it becomes an end-bearing stump and the patients generally manage very well walking even bare [26]foot after this type of amputation. • Below Knee Amputation: Amputation through the [27]leg bones. • Through knee disarticulation. • Above Knee Amputation: Amputation through the femur. • [28]Hip disarticulation. • Hind Quarter Amputation with excision of the hemi pelvis. Post-Operative Treatment The follow-up is as important in amputation surgery as the procedure itself. The aim of this [29]exercise is to provide a pliable, functional non-deformed stump, which can fit prosthesis as well. The Treatment Involves:

• Rigid Dressing: We use a plaster of Paris(PoP) stump cast at the conclusion of the [30]surgery with care taken to pad all the bony prominences, avoid proximal constrictions and prevent postoperative contractures. • Soft Dressing or conventional dressing with sterile snugly fitting pads and elastic bandages can also be used, alternatively. • Limb Positioning: The limb should be positioned properly to prevent contractures and [31]oedema. • Exercises: Stump [32]exercises are necessary and should be encouraged after the wound heals up. These exercises help in reducing the oedema, preventing joint contractures and developing muscle strength. • Crepe Bandage: The use of a crepe bandage over the stump is continued for 3-4 weeks. It helps in shaping the stump well which is conducive for the subsequent prosthetic fitting. • Prosthetic Fitting: The prosthetic fitting can be: • Immediate post-surgical. • Definitive • Immediate post-surgical fitting: A plaster of Paris mould is applied over the amputation stump immediately after surgery to which a temporary prosthesis-pilon is attached the next day. The patient is then allowed partial weight bearing as early as the [33]pain permits. 26

â&#x20AC;˘ Definitive Prosthesis: This is usually given 3 months after the [34]surgery, when the stump has matured. â&#x20AC;˘ Ambulation: This may be initiated: (i) Immediately after [35]surgery. (ii) Promptly when good stump healing is noticed. (iii) Early: after stump has healed. (iv) Late: after the stump has matured. 1. http://www.centerforadvancedorthopedics.com/ 2.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 3. http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.aspx 4.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 5.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 6.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 7. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 8. http://www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md. aspx 9. http://www.centerforadvancedorthopedics.com/Current-Event-Center-For-Advanced-Orthopedics.aspx 10. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 11. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 12. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 13. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 14.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 15. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 16.

http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.

aspx 17.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 18. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 19.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 20. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 21. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 22.

http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.

aspx 23.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 24. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 25.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx

26.

http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.

aspx 27.

http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.

aspx 28. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 29. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 30. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 31. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 32.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 33.

http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.

aspx 34. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 35. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx

Injury To The Coccyx (Tailbone) (2012-09-29 08:56) Causes And Treatment of Tailbone Pain: These are relatively rare [1]injuries, but could be quite troublesome to the patients. to the development of [2]coccydynia, which is described as a [3]chronic pain in the coccyx.

This can lead

Mechanism of Injury It is due to a direct fall on the [4]buttocks. It can also result from seat injuries while driving two wheelers or four wheelers. Of late constant pressure due to prolonged sitting as in the case of computer professionals can give rise to [5]coccydynia. Clinical Features The patient usually complains of pain in the buttocks and is unable to sit comfortably. Due to the development of coccydynia the pain may become [6]chronic. The patient also complains of difficulty in traveling and altered sitting postures due to the [7]pain. Investigations Plain X-ray of the [8]coccyx especially the lateral view helps to make the diagnosis. However, it is difficult to position the patient for the X-rays. MRI of the sacrococcygeal region is a better option. Treatment 1. Conservation Measures The [9]treatment is essentially conservative in nature with periods of bed rest and symptomatic treatment for [10]pain and inflammation. 28

2. Physiotherapy Management Consists of the following steps:

• To [11]relieve pain, thermotherapy likes ultrasound and TENS. • To relieve prolonged pressure on the buttocks, sitting on a ring cushion and sitting on alternate buttocks is adviced. • Isometric exercises to the glutei maximus [12]muscle in sitting lying and prone positions are advisable. • Sitz bath helps to relieve pain. 3. Injection Therapy If the pain is unrelieved by the usual conservative and [13]physiotherapy measures, injection therapy consisting of a mixture of local steroids(Depomedorol, Kenacort, etc.) and xylocaine gives excellent [14]relief of pain. 4. Surgical Excision of the Coccyx In extreme situations if all the above measures fail then [15]surgical removal of the coccyx may be considered. 1. http://www.centerforadvancedorthopedics.com/ 2.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 3.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 4. http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.aspx 5.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 6. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 7. http://www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md. aspx 8. http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.aspx 9.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 10. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 11. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 12.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 13.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 14.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 15. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx

1.7

October

Rickets (Deficiency of Vitamin D, Calcium and Phosphate) (2012-10-09 07:24) Symptoms, Types and Treatment of Rickets Disease: [1]Rickets is a metabolic disorder of childhood where the osteoid formation in the [2]bones is normal but its mineralization is defective. This results in softening of bones and deformities. Nutritional Rickets: [3]Nutritional rickets is the most common type of rickets seen in the developing countries. It is caused by deficiency of vitamin D in the diet and by inadequate exposure of the body to sunlight. Sunlight promotes the synthesis of vitamin D in the body. Nutritional rickets occur in children below 4 years of age. Path Physiology: The absorption of [4]calcium and phosphate from the intestine is reduced due to the deficiency of vitamin D. The subsequent fall in the serum calcium level stimulates hyper secretion of [5]parathyroid hormone. this, in turn, mobilizes calcium from the bone, making then soft and easily malleable to the pressure of weight bearing and other stresses. It also results in the formation of uncalcified bone matrix. The disorderly proliferation of the cartilage cells in the zone of proliferation, in the region of [6]metaphysis, results in ”cupping” of the metaphysis and widening of the epiphyseal plates. Signs and Symptoms: In the florid stage, the general health is affected; the child is irritable and stunted in growth. The following features may be seen:

1. Skull • Craniotabes: The [7]fontanelle remains open even after 2 years of age. • Frontal bossing: bossing (prominence) of the frontal and parietal bones. 1. Chest • Pigeon Chest: The [8]sternum is prominent and thrusted forwards. • Rickery Rosary: Prominence (beading) at the junction of [9]ribs with cartilages anteriorly gives an appearance of a “rosary.” • Harrison’s Sulcus: It is a transverse groove in the anterior part of the lower chest; due to the [10]muscular pull of the diaphragm. 1. Abdomen: The abdomen is protuberant and gives a ”pot-belly” appearance. This is largely due to muscular hypotonia. 30

2. Extremities: There is widening at the epiphyseal regions of the [11]wrist, knee and [12]ankle. Deformities like coxa vara, genu valgum or varum, deformity of the [13]tibia due to compressive forces of the body weight on the soft decalcified bones. Occasionally a peculiar deformity called wind- swept deformity may be seen. Types of Rickets:

• Vitamin D -Resistant Rickets (familial hypophasphataemia): There is inability of the renal tubules to reabsorb phosphate from the glomerular filtrate, leading to hypophasphataemia. • Fanconi Syndrome: This is due to the inability of the proximal tubules to reabsorb phosphates, glucose and amino acids. • Renal Rickets (renal osteodystrophy): The skeletal changes are associated with [14]chronic impairment and manifest between 5 and 10 years of age. • Coeliac Rickets: Diminished absorption of calcium from the intestines in steatorrhoea, sprue and [15]coeliac disease results in skeletal changes like those of nutritional rickets Investigations: [16]Serum calcium level may be normal or low but the serum phosphate is low. Serum alkaline phosphatase is markedly raised during the active stage of the [17]disease. Radiographs: In a suspected case of nutritional rickets, radiographs of both wrists and both [18]knees (AP view only) should be done. The width of the [19]epiphyseal plate is increased markedly with fluffy and irregular edges. There is ”cupping” of the metaphysis. There may be bending of the long bones. The bones show generalized rarefaction with thinning of the cortices. Treatment:

1. Drug Treatment: Administration of high doses of vitamin D with calcium supplements is the mainstay of the [20]treatment. Six lac units of vitamin D is given as a single dose initially; which may be repeated weekly for 3 weeks. After a favorable response, a maintenance dose of 400 units of vitamin D with calcium is given. 2. Orthopaedic Treatment: Mild deformities of the [21]limbs should be treated by the use of splints (mermaid Splint). Weight bearing should be avoided till there is evidence of calcification in the bones following vitamin D and calcium [22]therapy. Marked deformities need [23]surgical correction by corrective osteotomy. 1. http://www.centerforadvancedorthopedics.com/ 2.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 6. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 7. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 8. http://www.centerforadvancedorthopedics.com/Current-Event-Center-For-Advanced-Orthopedics.aspx 9. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 10. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 11.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 12. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 13. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 14. http://www.centerforadvancedorthopedics.com/Testimonial-Center-For-Advanced-Orthopedics.aspx 15. http://www.centerforadvancedorthopedics.com/Current-Event-Center-For-Advanced-Orthopedics.aspx 16. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 17. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 18. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 19.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 20.

http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.

aspx 21. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 22.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 23. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx

1.8

November

Meniscal (Cartilage) Tear (2012-11-03 12:07) Symptoms and Treatment of Meniscal Tear: What is a Meniscal (cartilage) Tear? The [1]meniscus is a piece of cartilage in the middle of your [2]knee. [3]Cartilage is tough, smooth, rubbery tissue that lines and cushion the surface of the joints. There is a meniscus on the inner side of your knee (the medial meniscus) and a meniscus on the outer side (the lateral meniscus). They attach to the top of the [4]shin bone ([5]tibia), make contact with the thigh bone (femur), and act as shock absorbers during weight-bearing activities. How does it occur? A meniscal tear can occur when the knee is forcefully twisted or occasionally with minimal or no [6]trauma, such as when you are squatting. 32

What are the symptoms? You may have [7]pain in your knee joint. You may have immediate swelling with fluid in the joint, called an effusion. You may be unable to fully bend or straighten your [8]leg. Your knee may lock or get stuck in one place. You may hear a snap or pop at the time of the [9]injury. A chronic (old) meniscal tear may give you pain on and off during activities, with or without swelling. Your knee may occasionally lock and you may have [10]stiffness in the knee. How is it diagnosed? Your [11]doctor will examine your knee and find that you have [12]tenderness along the joint line. Your doctor will move your knee in several ways that may cause pain along the injured meniscal surface. Your doctor may order X-rays to see if there are injuries to the bones in your knee but [13]meniscal tear will not show up on a x-ray. An MRI (magnetic resonance imaging) is sometimes useful in diagnosing a meniscal tear. How is it treated? Treatment may include:

• Applying ice to your knee for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days or until the pain and [14]swelling are gone. • Elevating your knee by placing a pillow underneath your leg. • Wrapping an elastic bandage around your knee to keep the swelling from getting worse. • Wearing a [15]knee immobilizer or other brace to prevent further injury. • Using crutches • Taking anti-inflammatory or [16]pain medication prescribed by your doctor. [17]Surgery is needed to repair or remove large torn pieces of cartilage.While you are recovering from your [18]injury, you will need to change your sport or activity to one that does not make your condition worse. For example, you may need to swim instead of run. When can I return to my sport or activity? The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent [19]damage. Everyone recovers from injury at a different rate. Return to your sport or activity will be determined by how soon your knee recovers, not by how many days or weeks it has been since your injury occured. In general, the longer you have [20]symptoms before you start [21]treatment, the longer it will take to get better. You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

• Your injured knee can be fully straightened and bent without pain. • Your knee and leg have regained normal strength compared to the uninjured [22]knee and leg. 33

• Your knee is not swollen. • You are able to jog straight ahead without [23]limping. • You are able to sprint straight ahead without limping. • You are able to do 45-degree cuts. • You are able to do 90-degree cuts. • You are able to do 20-yard figure-of-eight runs. • You are able to do 10-yard figure-of-eight runs. • You are able to jump on both legs without pain and jump on the injured leg without pain. If you feel that your knee is giving way or if you develop pain or have swelling in your knee, you should see your [24]doctor. How can a Meniscal Tear be prevented? Unfortunately, most injuries to knee [25]cartilage occur during accidents that are not preventable. However, you may be able to avoid these injuries by having strong thigh and hamstring [26]muscles, as well as by maintaining a good leg- stretching routine. When skiing, be sure that your ski bindings are set correctly by a trained professional so that your skin will release when you fall. 1. http://www.centerforadvancedorthopedics.com/ 2.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 3. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 4.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 5.

http:

http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons.

aspx 9. http://www.centerforadvancedorthopedics.com/ 10.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 11. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 12.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 13.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 14. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 15.

http:

//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx 16. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 17. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx

18. http://www.centerforadvancedorthopedics.com/ 19. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 20.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 21.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 22. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 23.

http:

//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx

24. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousa aspx 25. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 26. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx

How to get relief from Pelvic Pain Injuries? (2012-11-20 12:14) Classification, Symptoms and Treatment of Pelvic Fracture:

[1]

Stability of the Pelvis

Stability of the pelvis depends on both [2]bony and ligamentous structures. Anterior portion of the [3]pelvic ring neither participates in normal weight bearing nor is it essential for maintenance of pelvic stability. The posterior arch is formed by the sacrum, SI joints and ilia and is the weight-bearing portion of the pelvis. The posterosuperior SI ligaments provide most of the ligamentous stability of the SI [4]joints. Stable Pelvic Fracture These [5]fractures do not involve the pelvic ring and they are minimally displaced. Unstable Pelvic Fracture They involve the [6]pelvic ring and are widely displaced. Pelvic fractures pose a problem different from others. Here the emphasis is on recognition of potential complications associated with these fractures, the notable ones being [7]injuries to the major vessels and nerves of the pelvis and major viscera like intestines, bladder and the [8]urethra, severe intrapelvic hemorrhage from fracture of pelvic ring. Mortality from pelvic fracture varies from 10-50 percent. Proper fracture [9]management decreases the blood loss and controls the hemorrhage. A to F management as proposed by Mac Murthy in multiple 35

[10]trauma patients is important in management of the pelvic fractures. History Pelvic fractures usually occur due to high-velocity trauma following a road traffic accident (RTA) or due to fall from a height. The relative incidences are as follows;

• RTA-80.7 percent. • Fall-16.1 percent. • [11]Compression fracture-rest. Mechanism of injury There are four mechanisms by which pelvic ring fractures are produced:

• Lateral compression. • Anteroposterior compression. • Vertical shears forces. • Inferior forces (e.g. fall on [12]buttocks). The first two mechanisms are common in RTA and may cause stable or unstable fractures. Vertical shear forces are due to fall from a height and will cause grossly unstable fractures. Fortunately, most pelvic fractures are stable and respond to non operative [13]treatment. Unstable [14]fractures need manipulative reduction and stabilization by external fixators and sometimes by internal fixation. A proper evaluation of the fracture by radio-graph and CT scan helps to determine the best course of management. Classification Broadly speaking, the pelvic fractures can be placed under two categories. Fractures not Affecting the Integrity of the Pelvic Ring Direct blow fractures, which are commonly seen in iliac bone and avulsion fractures frequently encountered in the young, come under this group. Avulsion fractures are commonly seen in antero-superior and inferior iliac [15]spines and ischial tuberosity . Fractures Affecting the Integrity of the Pelvic Ring These are single or double break fractures in the pelvic ring and could be stable or unstable. A stable fracture is one, which resists displacing forces. Obviously, fractures, which cannot resist usual forces, are called unstable fractures and these pose a major [16]therapeutic challenge. 36

Many classifications have been proposed for pelvic fractures. Key and Conwell’s classification is by far the simplest and commonly used classification. It has prognostic importance too. Key and Conwell Classification Fracture of Individual Bones without a Break in the Pelvic Ring.

• Avulsion fracture of the: Anterosuperior iliac spine, Antero inferior iliac spine, Ischial tuberosity. • [17]Fracture of pubis or ischium. • Fracture wing of ilium (Duverney). • Fracture sacrum. • Fracture or dislocation of [18]coccyx. Single Break in the Pelvic Ring

• Fracture of both ipsilateral rami. • Fracture near or subluxation of symphysis pubis. • Fracture near or subluxation of [19]sacroiliac joints. Double Breaks in the Pelvic Ring

• Double vertical fracture or dislocation of pubis (Straddle fracture). • Double vertical fracture or dislocation of pelvis (Malgaigne’s fracture). Acetabuium Fractures

• Undisplaced. • Displaced. Tile’s Classification This is a mechanical classification based on the injury forces.

1. Type A Stable. 2. Type A1 Fracture Pelvis not involving ring. 3. Type A2 Stable, but minimally displaced. 4. Type B Rotationally unstable but vertically stable. 37

5. TypeB1 Open book [20]injury. 6. Type B2 Lateral compression Ipsilateral. 7. Type B3 Lateral compression-Contralateral.(Bucket handle). 8. Type C Rotationally and vertically unstable. 9. Type C1 Rotationally and vertically unstable. 10. Type C2 Bilateral. 11. Type C3 Associated with [21]ace tabular fractures. Clinical Features Symptoms The patient most often gives a history of high-velocity trauma and usually presents in a state of hypovolaemic shock. Features of intra-abdominal [22]injuries and genitourinary injuries are frequently present. Clinical Signs The patient may present with all signs of shock. Tenderness over the fracture site and one has to look for three important signs described by Milch. Quick facts Look for the signs of shock in pelvic fracture

• Pale look • Cold nose • Sweating • Tachycardia • Hypotension • Cold and clammy skin • [23]Unconsciousness. Clinical Tests

• Compression test: When a compressive force is applied through the two iliac bones, the patient complains of [24]pain in pelvic fracture. • Distraction test: When distraction force is applied to the two iliac bones at the anterosuperior iliac spine, the patient complains of pain. • Direct pressure test: Direct pressure over the [25]symphysis pubis elicits pain. 38

Following this, an examination for abdomen and [26]pelvis injuries is carried out and next urethral catheterization or urethrogram is done. Investigations Radiography Different radiographic views are recommended to study the fracture configuration, displacements, etc. in pelvic fractures:

• Plain AP view. • Oblique view-45 degree oblique projections. • Internal and external rotation view. • Inlet view- 40 degree caudad views. • Outlet view-40 degree cephalad view. CT scan Further radiographic studies include CT scans and 3-dimensional imaging. This is the gold standard in the evaluation of pelvic fractures. Management One should remember that pelvic fractures are usually due to high-velocity trauma and is associated with multiple fractures and multiple system injuries. Resuscitation and correction of [27]hypovolemic shock takes precedence over the management of fracture per se. nevertheless, once the general condition is stabilized attention should be given to treat the fracture, which will prevent further blood loss and damage to visceral organs. Different types of pelvic fractures, their clinical features and [28]treatment are listed. Treatment points Three main pitfalls in the treatment of pelvic fracture

• Treating only fracture overlooking visceral injuries. • Over treating a stable fracture. • Treating an unstable fracture. Treatment Methods Initial [29]treatment is carried out as follows: Resuscitation and other general measures, to improve the general condition of the patient. 39

Blood transfusion and other medical and [30]surgical emergency measures are carried out. Avulsion fractures: Conservative treatment like bed rest, traction, [31]physiotherapy, etc. gives good results. They rarely need surgery. Undisplaced fractures: Respond to bed rest, traction, pelvic slings, non steroidal anti-inflammatory drugs (NSAIDs), etc. Displaced fractures: Reduction by [32]lateral compression methods as described by Watson Jones is very helpful. Retention is by Spica cast, canvas sling or external fixators. Role of external and internal fixators: The above methods usually suffice, but the fractures associated with multiple system injuries need to be stabilized either by external fixators or by open reduction and internal fixation (ORIF). These two methods have the following advantages:

• Gives firm stability. • Helps [33]early mobilization. • Reduces period of bed rest. • Helps early control of osseous bleeding. Complications Pelvic fracture is a dreaded injury as it is associated with a [34]plethora of complications. The following are some of them. The [35]Center for Advanced Orthopedics represents two board certified orthopedic surgeons with combined experience in bone & joint problems of over 45 years.Our Services include are Total Joint Replacement Surgery – Hip and Knee,Hip Resurfacing & Partial Knee Resurfacing, Arthroscopic Surgery – Shoulders, Knees and Ankles, Sports Medicine, Musculoskeletal Conditions, Arthritis of the Hip, Knee and Shoulder, Osteoarthritis, Computer Assisted Surgery, Fracture Management, Sports Medicine. We severe two locations. For More Information Call Now at : [36](301) 645-5410 [37]http://www.centerforadvancedorthopedics.com/ 1. http://centerforadvancedorthopedics.files.wordpress.com/2012/11/pelvic-fracture-pain.jpg 2. http://www.centerforadvancedorthopedics.com/ 3.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 4. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 5.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 6. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 7.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 8. http://www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md. aspx

9. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 10. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 11.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 12.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 13. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 14. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 15. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 16. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 17. http://www.centerforadvancedorthopedics.com/Default.aspx 18.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 19. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 20. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 21.

http:

//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx 22.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 23.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 24. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 25.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 26. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx

31. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousa aspx 32. http://www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information. aspx

33. http://www.centerforadvancedorthopedics.com/About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports aspx 34. http://www.centerforadvancedorthopedics.com/Default.aspx 35. http://www.centerforadvancedorthopedics.com/ 36. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 37. http://www.centerforadvancedorthopedics.com/

1.9

December

How to treat Arthritis Disease? (2012-12-18 06:01)

Clinical Features And Treatment of Rheumatoid Arthritis:[1] [2]Rheumatoid arthritis is the most common inflammatory disease of the [3]joints. It is a systemic [4]disease of young and middle-aged adults characterized by proliferative and destructive changes in synovial membrane, periarticular structures, [5]skeletal muscles and perineural sheaths. Eventually, joints are destroyed, fibrosed or ankylosed. It is a widespread vasculitis of the small arterioles. Clinical Features in Rheumatoid Arthritis [6]Rheumatoid arthritis usually presents in three forms: 1. Classical Presentation In this group, the patient is usually a woman in her mid 30s, [7]Pain, swelling, stiffness of the small joints of[8] hands and feet are the common presenting complaints. The patient also gives history of weight loss, lethargy and depression. [9]Joint swelling could be symmetrical and the patient presents with deformities of [10]bones and joints in the late stages. The patient gives history of remissions and exacerbation of symptoms with seasonal variations. This is a very classical complaint in the absence of which diagnosis of [11]rheumatoid arthritis should be carefully made. Symptoms fluctuate from day-to-day. 2. Other Presentations This consists of palindromic presentation involving one or two [12]joints, systemic presentation-usually seen in middle-aged men presenting with pleurisy, pericarditis, etc. It mimics malignancy. It may present as polymyalgia particularly in elderly patients. It may present as [13]monoarthritic swelling, Sometimes the presentation may be very explosive unlike the usual [14]chronic presentation. 3. Extra-articular Features â&#x20AC;˘ Two or more features are present in 75 percent of the cases, [15]Rheumatoid factor is invariably present and indicates a bad prognosis. â&#x20AC;˘ Subcutaneous nodules are present in 25 percent of the cases. It is seen over the [16]elbow, sacrum and occiput. Nodules may also be present in lungs, eye, hearts, etc. When present over [17]flexor tendon, it may cause trigger finger. 42

• Widespread vasculitis. • Blood abnormalities commonly encountered in [18]rheumatoid arthritis are chronic anemia, iron deficiency anemia, vitamin B12 and folate deficiency, leukocytopenia, thrombocytosis and marrow hypoplasia. • [19]Osteoporosis could be generalized or localized in [20]bones around the joints. • Eye changes seen in rheumatoid arthritis are keratoconjunctivitis sicca or Sjogren’s syndrome, episcleritis (common), scleritis (serious problem), secondary glaucoma and scleromalacia perforans. • Lung affections in rheuma told [21]arthritis are pleurisy, pleural effusion, Kaplan’s syndrome (RA + pneumoconiosis involving the upper lobes) and fibrosing alveolitis in 2 percent. • Heart affections in rheumatoid arthritis are pericardial friction (10 %), pericardia } effusion (30 %), arrhythmias and heart block. • Neuromuscular system involvement includes [22]carpal tunnel syndrome, mononeuritis multiplex, muscle wasting, subluxation of CI and C2, etc. • Reticuloendothelial system affections include splenomegaly (5 %), Felty’s syndrome in 1 % (RA+ splenomegaly + Neutropenia), generalized lymphadenopathy and painless pitting edema of the [23]feet and ankles. ORTHOPEDIC DEFORMITIES IN RHEUMATOID ARTHRITIS Rheumatoid arthritis can affect any joint in the body. It involves the [24]peripheral joints more often and very rarely affects the larger joints. Of particular importance are the affection of the temporomandibular joint and [25]atlantoaxial joint, which can prove lethal due to the [26]cord compression. It has involvement of various joints in rheumatoid arthritis. Investigations Hb percentage is low and shows normochromic, [27]hypo chromic anemia. WBCs are decreased or normal, there are increased lymphocytes and the ESR is raised. 1. Serological Tests: Basis [28]Rheumatoid patient’s serum contains RA factor, which in the presence of g-globulin agglutinates certain strains of streptococci sensitized by sheep cells and latex particles. 2. Latex Fixation Test: Unknown serum + 7-globulin latex suspension 3. Inhibition Test: This test uses the characteristics of euglobulin from unknown serum; Euglobulin from normal serum neutralizes the rheumatoid factor thereby inhibiting agglutination. Euglobulin from [29]rheumatoid serum has no effect on the rheumatoid factor and agglutination occurs. This is the most sensitive test. Positive even when rheumatoid arthritis factor is present in minute amounts. Radiological Features of Rheumatoid Arthritis

• Soft tissue swelling. • Juxta-articular osteoporosis. 43

• Erosion of joint margins. • Joint spaces are decreased. • Deformities. • Atlantoaxial subluxation. • Subchondral erosions and cyst formation. • Fibrous and bony ankylosis develops in the stages. Other Common Abnormalities These include increased C-reactive protein (CRP), increased alkaline phosphatase, increased platelets, and decreased serum albumin. Citrulline antibody is present in most cases of early[30] rheumatoid arthritis. Antinuclear antibody (ANA) is also frequently raised in patients with rheumatoid arthritis. Synovial Fluid Analysis This is not performed routinely for diagnostic purposes but performed to exclude other causes of inflammation such as [31]infection. Synovial fluid in RA is typically yellow, watery and turbid due to high WBC and has low sugar content. MRI This gives valuable information about the various [32]soft tissue damages in rheumatoid with far more greater accuracy. Differential Diagnosis Differential diagnosis of rheumatoid arthritis with various other conditions. ential diagnosis of rheumatoid arthritis with the all-important [33]osteoarthritis.

However, for the differ-

Management Aims of Treatment To keep inflammatory process at a minimum, thereby, preserving joint motion, maintaining healthy muscles and preventing secondary [34]joint stiffness and deformity. To keep constitutional symptoms at a minimum. The possible deformities are anticipated and prevented by appropriate splinting. Finally, [35]surgical measures to correct the deformities, eliminate pain and provide stability are undertaken. General Measures It aims at improving the general condition of the patient and to keep the [36]joints properly splinted in functional position to guard against the ensuing [37]ankylosis.

• Rest in bed. • Good diet, rich in proteins and minerals. 44

• Transfusion and hematinics to correct the anemia. • Hormones combination of estrogen and androgen to improve the [38]bone stock. • Removal of infective foci. • Splinting in the functional position helps in the event that ankylosis ensues. The splint is removed daily. Hot packs are given or the patient is placed. • Hubbard tank at (92.6-102degree F) and the joints are put into full range of motion. While the [39]joints are immobilized, muscle-setting exercises are advocated. After removal of the splints, resistance exercises are begun. Splints

• These are known to serve three main functions: • Rest and [40]relief of pain (rest splints). • Prevention and correction of deformity (corrective splints). • Fixation of damaged joint in a good functional position (fixation splints). Surgical Procedures in Rheumatology Aim of [41]surgery in rheumatoid arthritis is to:

• Relieve pain. • Correct the deformity of the joints. • Reduce joint instability. • Improve the range of movements of the joints. • [42]Surgical advice should be sought only when the disease is clearly progressive and conservative measures are failing, but before the patient starts to lose a significant amount of bone stock. If surgery is delayed, more bone is lost, the [43]soft tissue deteriorates and the deformity increases. Preoperative Considerations Before surgery for rheumatoid disease, a number of specific points should be checked. Related conditions such as diabetes, [44]hypertension and anemia should be adequately treated and:

• Steroid dosage should be reduced. • There should be no active infection. • A radiograph of the [45]cervical spine should be obtained to exclude instability. 45

Self-Management Techniques for Rheumatoid and Other Forms of Arthritis Self-management is the most important aspect of the [46]treatment of rheumatoid and other forms of arthritis. People practicing self-management techniques tend to experience less pain and are more active than those who do not practice self-management. In this management, the patient is made aware of the[47] disease and the rationale behind the treatment. They are made to realize that the success of the treatment is their ultimate responsibility. Ten Self-Help Techniques

1. Positive Mental Attitude: The patient is told to focus on things other than [48]pain and their own body. They are encouraged to think positively. 2. Regular Medications: The patient is told the value of regular and correct medication. 3. Regular Exercises: The patient should follow a regular and appropriate exercise program, most suited for them. 4. Use of Joints: The patient is told the value of correct posture and the methods of using the joints wisely to reduce stress on the [49]painful joints. 5. Energy Conservation: Patients are instructed to listen to the body’s ”inner signals” for rest. Slowing down and avoiding too many activities reduces the stress on the joints. 6. Assistive Devices: Devices linked splints, braces and walking sticks can help stabilize the joints, provide strength and [50]reduce pain and inflammation. 7. Adequate Sleep: A good adequate sleep provides rest to the ailing joints and reduces the pain and swelling. 8. Massage: A good moderate [51]massage brings warmth and relieves pain due to arthritis. 9. Relaxation Techniques: Relaxation techniques like yoga, medication, etc. help to relax the muscles, mind and controls respiration, heart rate, blood pressure. This helps in the [52]control of pain. Modification in the Daily Activities:

• Using Western toilets. • Bath aids and railings. • Long handle broomstick and mop to clean the floors. • Use of walking sticks while walking, climbing, etc. • High chairs. • Avoid squatting on the ground for food, etc. Use of dining table and chairs are recommended. • To avoid squeezing clothes after washing and just rinse they dry. • To avoid walking on hard and uneven and rough surfaces. 46

• To sleep on a hard surface. You are being affected by this illness then Our Center for Advanced Orthopedic Clinic is always beneficial for you. Come Instantly and Call Now at: [53](301)373-4303. For more detailed information – including detailed surgery information – the following websites might be useful: [54]http://www.centerforadvancedorthopedics.com/ 1.

http://centerforadvancedorthopedics.wordpress.com/2012/12/18/how-to-treat-arthritis-disease/

rheumatoid-arthritis/ 2. http://www.centerforadvancedorthopedics.com/ 3.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 4. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 5.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 6. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 7. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 8.

http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons.

aspx 9.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 10. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 11. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 12. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 13.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 14. http://www.centerforadvancedorthopedics.com/Default.aspx 15. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 16.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 17.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 18. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 19.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 20.

http:

//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx 21.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 22.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx

23. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousa aspx 24. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 25. http://www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md. aspx 26. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 27. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx

28. http://www.centerforadvancedorthopedics.com/About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports

aspx 29. http://www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information. aspx 30. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 31. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 32. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 33. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx

34. http://www.centerforadvancedorthopedics.com/About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medic aspx 35. http://www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information. aspx 36. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 37. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx

38. http://www.centerforadvancedorthopedics.com/About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medic aspx 39. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx

40. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-a aspx 41. http://www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information. aspx 42. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 43. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx

44. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-a aspx 45. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 46. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx

47. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-a aspx

48. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-a aspx 49. http://www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information. aspx 50. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 51. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 52. http://www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information. aspx 53. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 54. http://www.centerforadvancedorthopedics.com/

What will causes of Ankle Pain Injury? (2012-12-28 07:34)

Symptoms, Classification And Treatment of Ankle Pain Injuries:[1]

Definition of Ankles Injury: A complex [2]joint made up of distal ends of [3]tibia, fibula and the talus. The [4]tibiofibular joint functions as a uni planar hinge joint and in which about 25 degree of dorsiflexion and 35 degree of [5]plantar flexion takes place. The stability is provided by the configuration of the [6]ankle mortise and the ligaments, which are arranged in the following groups:

• Medial Collateral Ligament • Anterior and Posterior Talofibular Ligaments • Anterior Tibiofibular Ligament Signs of Ankles Injury: Post described [7]ankle injuries for the first time in 1768

• Interesting ’Incidence Facts’ about [8]ankle fractures • More commonly in Elderly Women. • About 2/3 are isolated Malleolar fracture. • About 1/4 are Bimalleolar fracture. • Trimalleolar fracture seen only in 7 percent. • Open fracture 2 percent. Mechanism of Ankles Injury: Ankles are usually injured due to low [9]injury rotational forces due to:

• Twisting injury while walking, running, sports, athletes, etc. are the most common mode of [10]ankle injuries. 49

• Fall from a height: Ankle injuries are indirect injuries here brought about by the displacing [11]talus. Classification of Ankles Injury: [12]Ankle injuries are classified after the mechanism causing them. Hence, it is of paramount importance to understand the movement of the [13]ankle to comprehend the classification. What complicates the issue is the practice of using more than one term to describe the same motion. There are six movements of the ankle and the hind foot.

• Plantar flexion and dorsiflexion are the up and down movements of the [14]foot. • Movement causing the[15] toes to point inwards is called internal rotation and movement causing the toes to point outwards is called external rotation. • Supination is the movement, which raises the medial aspect of the foot and the [16]heel off the ground. In pronation, the motion is to bring the lateral aspect of the foot and the heel from the ground. • In adduction, the hind [17]foot is moved towards the mid line and in abduction is moved laterally. • Pure vertical loading position as in landing, jumping, falling, etc. will cause Pylon [18]fracture by the driving of the talus into the tibia. 1. Lauge Hansen’s Classification Four major types are described. The [19]mechanism of injury could be adduction force, abduction force or external rotation force. The foot could be in supination or pronation. The first word refers to the position of the [20]foot at the time of injury and the second to the direction of injuring force. 2. Denis Weber Classification This is the other classification proposed for ankle injuries and it is based on the level of the [21]fibular fracture, while the Lange Hansen’s system is based on experimentally verified [22]injury mechanism like adduction, abduction, etc. AO Classification of Malleolar Fractures:

• Type A: Infrasyndesmotic ([23]Fracture of fibula below the syndesmosis) • Type A1: Isolated • Type A2: With medial malleolus fracture • Type A3: With posteromedial fracture. • Type B: Transsyndesmotic (Fracture of fibula at syndesmosis level). • Type B1: Isolated. • Type B2: With medial lesion (Mallelor or ligament injury). • Type B3: With medial lesion and posterolateral tibial fracture. 50

• Type C: Suprasyndesmotic (fracture of fibula above the sydesmosis). • Type CI: Simple diaphyseal fracture of fibula. • Type C2: Complex diaphyseal fracture of fibula. • Type C3: [24]Proximal fracture of fibula. Clinical Features: The patient usually gives history of inversion injury, following which there is[25] pain, swelling, deformity of the ankle. Movements are decreased, Drawer’s test, inversion and eversion [26]stress tests may be positive. Note the color and condition of the skin. Examine the entire [27]leg. Investigations: Anteroposterior, lateral and mortise non-weight bearing views of the ankle are recommended in the radiographs. CT scan, MRI and [28]arthroscopy evaluation is extremely helpful. Radiographic Parameters of the Normal Ankle:

• Talocrural angle-83 degree and 4 degree. • Medial clear space 4 mm. • Tibiofibular clear space < 6 mm. • Subchondral bone line between the distal tibia and medial surface of lateral malleolus should be continuous. Treatment of Ankles Injury: Goals

• Anatomical positioning of the talus beneath the tibia. • To obtain a [29]joint line that is parallel to the ground. • Smooth articular surface. If these three things are not achieved, post-traumatic [30]osteoarthritis results.

• Stable Injuries: No reduction is required, immobilization with only plaster splints till the swelling decreases and then a below [31]knee plaster cast is applied with foot in neutral position. • Unstable Injuries: Require reduction and [32]immobilization in plaster casts . The commonly encountered unstable injuries are: • Fracture Due to External Rotation: This is more common and can be managed both by conservative and operative methods. 51

• Conservative Method: This consists of reversal of the [33]injuring forces by closed reduction and a below knee plaster cast application. • A walking cast is applied after a period of one month. • Surgical Method: In this, the malleoli are fixed, first the lateral malleolus is fixed with pin or screws and later the medial [34]Malleolar fracture is fixed with a single screw perpendicular to the [35]fracture line. Below knee splint is given initially and later a cast is applied. Fracture primarily due to • Abduction: These are less common than the fractures due to external rotation. Nevertheless, the principles of the [36]treatment remain the same. Adduction force is required to bring about reduction and if closed reduction fails, open reduction is preferred. During the open reduction, both the malleoli are fixed. • Fracture Primarily Due to Adduction: Unlike external rotation and abduction, adduction violence is more frequently an isolated event. Wedging of small-comminuted fragments into the fracture line often prevents closed reduction, so that open reduction and internal fixation (ORIF) is required more frequently. Medial malleolus is approached first, since it is more unstable, and the fracture is fixed with two screws, one at right angle to the[37] tibial cortex and another at right angle to the fracture line. Lateral fibular is stabilized with plate and screws. • Fracture Resulting From Primary Vertical Compression: This may be isolated or associated with other forces described above. The [38]anterior and posterior tibial plafond margins are fractured. Two types are described: 1. Posterior Marginal Fracture for Undisplaced Fracture: Below [39]knee cast is sufficient. For more than 25 percent of articular surface involvement. ORIF with two screws is preferred. 2. Anterior Marginal Fracture (Tibial Plafond Injury): It may include a crush of the anterior lip or it may include a major fragment. If crushed, calcaneal traction is given and if there is a large [40]fragment, ORIF is required. Complications of Ankle Fracture: Complications of ankle fractures include post-traumatic [41]arthritis, reflex sympathetic dystrophy, [42]neurovascular injury (injury to posterior tibial vessels and nerve), nonunion (due to soft tissue interposition), Malunion, etc. The foot and ankle are two of the most versatile and complex areas of your body. If you are being affected of Ankle Pain Injury .Our Center for Advanced Orthopedic Clinic is always beneficial for you. Come Instantly and Call Now at: [43](301) 645-5410. For more detailed information – including detailed surgery information the following websites might be useful: [44]http://www.centerforadvancedorthopedics.com/ 1.

http://centerforadvancedorthopedics.wordpress.com/2012/12/28/what-will-causes-of-ankle-pain-injury/

injuries-of-the-ankle/ 2. http://www.centerforadvancedorthopedics.com/ 3.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 4. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 5.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 6.

http:

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 12. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 13. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 14. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 15.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 16.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 17.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 18.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 19.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 20. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 21. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 22. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 23. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 24. http://www.centerforadvancedorthopedics.com/Default.aspx 25.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 26. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx

27. http://www.centerforadvancedorthopedics.com/About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports aspx 28. http://www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information. aspx 29. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 30. http://www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md. aspx 31. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 32. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 33. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 34. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 35. http://www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information. aspx 36. http://www.centerforadvancedorthopedics.com/Default.aspx 37. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 38. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx

39. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousa aspx 40. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx

41. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 42. http://www.centerforadvancedorthopedics.com/Default.aspx 43. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 44. http://www.centerforadvancedorthopedics.com/

ipad covers (2013-04-25 15:50:15) Way cool! Some very valid points! I appreciate you penning this write-up and the rest of the site is also really good. Center For Advanced Orthopedics (2013-06-24 04:54:40) Thanks.

Chapter 2

2013 2.1

January

To Know About Genu Valgum (Knock Knees) (2013-01-02 11:40) Treatment For Knock Knees: Definition It is an outward deviation of the longitudinal axes of both [1]tibia and femur. Apex of the curve or angulations of the [2]knee are medial.

Incidence[3] Seventy-five percent children have [4]genu valgum upto 4 years of age. This is called physiological genu valgum, which usually disappears by 7 years. Types It is broadly classified into [5]physiological and pathological; the latter could be unilateral or bilateral. Clinical Features 55

Genu Valgum Complex: The primary deformity in a Genu Valgum is a medial angulation of the knee. In response to this, secondary deformities develop in the [6]femur, tibia and [7]foot. Primary and secondary deformities together form the Genu Valgum complex. Clinical Assessment

• Intermalleolar Gap: The severity of the deformity is measured by noting the [8]intermalleolar distance. • Method: In the spine position, the patella is brought to [9]vertical by rotating both the legs and made to touch lightly at the knee. Then holding both the [10]knees in position, the distance between the two malleoli is measured. The acceptable normal limit is 8-10 cm. In genu valgum deformity, it will be more than 10 cm. • Plumb Line Test: Normally, a line drawn from anterosuperior iliac [11]spine (ASIS) to middle of the [12]patella, if extended down strikes the [13]medial malleolus. In Genu valgum, the medial malleolus will be outside this line. • Knee Flexion Test: This is to detect the cause of Genu Valgum whether it lies in the femur or tibia. If the deformity disappears with [14]flexion of the knee, the cause lies in the lower end of femur and if it persists on flexion, the cause lies in the upper end of the tibia. Radiographs Clinical assessment of Genu Valgum is less accurate in adults and an assessment by radiology is preferred. X-ray of the entire [15]lower limb is taken with the patient weight bearing. The angle formed between the [16]femoral and tibial shafts is measured on the radiographs and allowing for a normal angle of 60, Genu Valgum is calculated. Treatment of Genu Valgum Mild Cases: Child is seen at intervals of 3 months and the progress is recorded. These cases usually require no [17]treatment, and raising the inner side of the heels by 4-5 mm may possibly relieve [18]strain on ankles. The knock-knee braces may be useful. If by the age of 4 years, intermalleolar distance is 10 cm or more, operation may become necessary and unless deformity is increasing rapidly, [19]operation is best postponed until the child is 10 years old. Severe Cases If lateral portion of [20]epiphyseal plate is intact as seen in the radiographs, it contributes to the longitudinal growth at a reduced rate. This situation is suitable for stapling of the medial epiphysis, which arrests the growth on the [21]medial side, allows the growth on the lateral side, and thus helps to correct the deformity. After skeletal maturity, an [22]osteotomy must be performed at the site of maximum deformity of tibia or femur. If limb is long, medial close wedge osteotomy is done. If limb is short, lateral open wedge osteotomy is done. [23]Knock-knee deformity more than 10 cm at the age of 10 years is an indication for [24]surgery. Our Center For Advanced Orthopedic is one of the best comprehensive orthopedic programs. Talk with a 56

physician about the Best Orthopedic Treatment for you. The Center for Advanced Orthopedics represents two board certified orthopedic surgeons with combined experience in bone & joint problems of over 45 years. This compassion and competence in problems related to arthritis, joint replacements, and sports related injuries is second to none in this field. For More Detailed Information Call Now at: [25](301)373-4303

[26]http://www.centerforadvancedorthopedics.com/ 1. http://www.centerforadvancedorthopedics.com/ 2.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 3.

http://centerforadvancedorthopedics.wordpress.com/2013/01/02/to-know-about-genu-valgum-knock-knees/

genu-valgum-knock-knee-2/ 4. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 5.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 6.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 7. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 8. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 9. http://www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md. aspx 10.

http:

//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx 11.

http:

//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx 12.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 13. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 14. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 15.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 16. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 17.

http:

//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx 18.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 19.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 20. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 21. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx

22. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousa aspx 23. http://www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information. aspx 24. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 25. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 26. http://www.centerforadvancedorthopedics.com/

How can we prevent Medial Meniscus Injury? (2013-01-15 05:27) Clinical

Features,

Investigations

And

Treatment

Knee

Pain:[1]

[2]Medial meniscus is more commonly injured than the lateral and is usually associated with other ligament injuries of the [3]knee. Smillie’s Classification Medial meniscus injury is seen in over 71 percent of the cases. In 5 percent of cases, [4]injury of medial meniscus is bilateral. Lateral meniscus is less commonly injured than the medial meniscus because it is smaller in diameter, thicker in periphery, wide, more mobile, attached to both [5]cruciate ligaments and stabilized posteriorly to the [6]femoral condyle by popliteus.

• Longitudinal tears (35 %)-in these [7]peripheral attachments tear 10 percent, complete tear 23 percent (bucket handle tear), and segmental tear 2 percent (ant/post). • Horizontal tears (48 %)-could be posterior, middle, or anterior. • Cystic degeneration (12 %). • Congenital abnormalities 5 percent. • Regenerative lesions. Mechanism of injury Mechanism of injury is a rotational force when a flexed [8]knee extends.

• In young, it can occur only when weight is being taken, knee is flexed and there is a twisting [9]strain. Young active athletes are more prone. • In middle life, fibrosis has decreased the mobility of meniscus and hence tear occurs with less force. • Predisposing Factors: These could be abnormal menisci shape, abnormal stress due to [10]chronic ligament laxity, etc. 58

Clinical Features The patient with medial meniscus injury presents with [11]pain on the inner aspect of the knee. History of locking is seen in 40 percent of the cases and [12]swelling if present is minimal. There is remarkable recovery after the initial acute attack and there could be periodic complaints pertaining to the knee. One or more clinical signs mentioned in the box can be elicited with careful examination of the knee. Investigations Radiograph is usually normal. The views recommended are anteroposterior, lateral, [13]Intercondylar notch and sunrise views of the patella.

• Arthroscopy helps to identify the torn [14]meniscus. • Arthrography may reveal the tear. Double contrast arthrography is 95 percent accurate. • MRI is expensive but useful. Differential Diagnosis Fracture of [15]tibial spine if present may give clue to the possible ACL tear. It also helps to exclude [16]osteochondritis dissecans, osteocartilaginous loose bodies, etc. Treatment Conservative: This is indicated in patients soon after [17]injury with no locking and with infrequent attacks of pain and in tears less than 10 mm, partial thickness tears. Measures

• Abstinence from weight bearing. • Rest, ice packs, compressive bandage. • Buck’s skin traction. • [18]Joint aspiration. • [19]Quadriceps exercises. • If symptom persists, a cylindrical cast may be considered. Manipulation under Anesthesia: If joint is locked due to the torn menisci, manipulation under [20]anesthesia is recommended. Surgery Indications: Surgery is indicated, if joint cannot be unlocked and if [21]symptoms are recurrent. Methods 59

â&#x20AC;˘ Arthroscopic Menisci Repair: This is the [22]treatment of choice of late. Repair is indicated if the tear is > 10 mm or is unstable on probing. Repair is successful in the outer third (red-red zone) edge of the [23]vascular rim (red-white zone) and even in a few vascular zones (white-white zone). â&#x20AC;˘ Closed Partial Meniscectomy Via: An arthroscopy is better than total removal of the menisci by open [24]surgery. â&#x20AC;˘ Meniscal Transplant: In cases with total menisectomies, cadaver menisci transplant may be considered. However, this is still in the evolving stage. Complete removal of the menisci incapacitates the [25]knee hence; the emphasis is on conservative surgery than the radical removal. Our Center For Advanced Orthopedic is one of the best comprehensive orthopedic programs. Talk with a physician about the Best Orthopedic Treatment for you. The Center for Advanced Orthopedics represents two board certified orthopedic surgeons with combined experience in bone & joint problems of over 45 years. This compassion and competence in problems related to arthritis, joint replacements, and sports related injuries is second to none in this field. For More Detailed Information Call Now at: [26](301) 645-5410 [27]http://www.centerforadvancedorthopedics.com/ 1. http://centerforadvancedorthopedics.files.wordpress.com/2013/01/medial-meniscus-injury1.jpg 2. http://www.centerforadvancedorthopedics.com/ 3.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 4. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 5.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 6.

http:

http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons.

aspx 10.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 11.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 12. http://www.centerforadvancedorthopedics.com/Default.aspx 13. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 14.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 15.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 16. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 17. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 18.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 19. http://www.centerforadvancedorthopedics.com/Default.aspx

20.

http:

//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx 21.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 22. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 23. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 24. http://www.centerforadvancedorthopedics.com/Default.aspx 25. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 26. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 27. http://www.centerforadvancedorthopedics.com/

2.2

February

How to treat Hip Dislocation? (2013-02-05 10:26)

Types and Treatment of Hip Dislocation: [1] [2]Dislocations of hip are grievous [3]injuries. Head of [4]femur slips out through the weak inferior aspect of capsule and displaces according to direction of the force. It is commonly seen in high-energy injuries among young adults. 50 % of cases are associated with [5]fracture of acetabular lip, which may prevent reduction. They are easily missed when associated with fracture shaft of femur. Dislocations of hip are of three types:

• [6]Posterior Dislocation (commonest) • Anterior Dislocation • Central Fracture Dislocation POSTERIOR DISLOCATION OF HIP JOINT Posterior dislocation of [7]hip joint is the most common dislocation of hip. This is also known as [8]Dashboard Injury. Clinical Features Usually the young adult is involved in a road traffic accident (RTA). Characteristically the limb is in 61

[9]flexion, adduction and internal rotation with appreciable shortening and painful restriction of movements. Head of [10]femur may be palpable in the gluteal region. Investigations Anteroposterior view of [11]pelvis shows the head lying outside the acetabulum. Shenton’s line shows a break in continuity. Occasionally the dislocation may be associated with [12]fracture of the posterior lip of acetabulum. Treatment Reduction of the hip dislocation is an [13]orthopaedic emergency. Dislocation is reduced by manipulation under general anaesthesia (GA). Reduction can be done by Following methods:

• Bigelow’s method • Stimson ’ s method • Classical Watson-Jones method After-treatment: The [14]limb is immobilized in a Thomas splint for 3 weeks in the position of abduction. Open reduction may be contemplated in cases of:

• Irreducible reductions • Cases with fracture of the acetabular lip • Instability/redislocation of [15]hip. ANTERIOR DISLOCATION [16]Anterior Dislocation is less common type of hip dislocation. It is seen in collision accidents when the motorist is hit on the medial aspect of the [17]thigh with the thigh in [18]flexion and abduction. Head of femur dislocates and may lie on the:

• Obturator foramen • Symphysis pubis Clinical Features The limb is in external rotation and extension with apparent lengthening. Radiologically the femoral head may be present below the [19]acetabulum. Treatment Reduction is achieved by manipulation under GA. Open reduction is attempted if closed manipulation fails. 62

Complications Complications are injury to the femoral [20]neurovascular bundle. CENTRAL FRACTURE DISLOCATION Central [21]fracture dislocation is a rare type. It is caused by a violent [22]injury on greater trochanter. Head of the femur is driven through the acetabulum. Depending upon the comminution and displacement of fracture fragments, Judet classified this as:

• Undisplaced fracture acetabulurn. • Fracture acetabulum with intact weight bearing part • Superior [23]rim fracture • Comminuted displaced fracture (bag of bones) Clinical Features Clinically the patient presents with severe [24]pain in the hip with restriction of [25]abduction and rotations. Per rectal examination is diagnostic with a bony mass palpable laterally. Treatment The aim of [26]treatment is attaining congruous [27]bone surface. This can be achieved by:

• Continuous skeletal traction to the [28]leg with additional trochanteric pin traction with the thigh in 30 degree abduction for 8-12 weeks. • Open reduction and internal fixation with reconstruction plates. Complications

• Thrombophlebitis of iliac and femoral veins. • Secondary [29]osteoarthritis. • Myositis ossificans • [30]Infection Hip Dislocation is caused by violence directed in the line of shaft of femur with the hip flexed and adducted. This dislocation commonly occurs in automobile accidents with the occupants thrown forward and knee striking the dashboard. Call today for best Orthopedics Surgeons: [31](301) 645-5410 [32]http://www.centerforadvancedorthopedics.com 63

1. http://centerforadvancedorthopedics.files.wordpress.com/2013/02/hip-dislocation.jpg 2. file://localhost/mnt/ext/blogbooker/tmp/yh2kr1x4/www.centerforadvancedorthopedics.com 3.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 4. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 5.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 6.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 7. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 8. http://www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md. aspx 9. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 10. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 11. http://www.centerforadvancedorthopedics.com/ 12.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 13. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 14.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 15.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 16.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 17. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 18.

http:

//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx 19. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 20. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 21. http://www.centerforadvancedorthopedics.com/ 22.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 23. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 24.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 25. http://www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information. aspx 26. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx 27. http://www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md. aspx 28. http://www.centerforadvancedorthopedics.com/ 29. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 30. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 31. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 32. http://www.centerforadvancedorthopedics.com/

How to diagnose Knee Joint Injury? (2013-02-21 09:48) Information about Knee Joint Disease:

[1] [2]Knee joint is one of the most common [3]joints affected by degenerative joint disease, tuberculosis, [4]pyogenic infection etc. The common complaints are:

• Pain: It may be present on walking squatting making the person unable to rise from sitting position. It is usually dull [5]aching and at times it may radiate down the leg. • Swelling: [6]Knee effusion is one of the common complaints which may present as [7]swelling of the knee. Other swellings seen around the knee are cysts from the [8]menisci and [9]bursitis from various bursae. • Stiffness: It is one of the aftermath of prolonged immobilization either due to disease or [10]treatment given. • Deformity: In [11]arthritis of the knee joint, the knee joint goes in for flexion deformity which may make the patient unable to do his daily activities. History of giving way or locking episodes must be asked for to rule out internal derangement of the knee. In [12]Intra-articular loose bodies, there may be episodes of locking. History of bleeding diatheses should be asked to rule out haemophilic arthritis due to repeated bleeding episodes. Examination

• Examination of the [13]knee joint includes examination of the entire lower limb from sacroiliac joint to the [14]foot because any disorder in the [15]limb can have an adverse effect on the knee which may be the presenting symptom. • The knee joint should be examined in various positions such as standing, sitting, squatting, supine and walking positions. Palpation The [16]knee should be palpated in anterior aspect, sides and in the popliteal fossa for any abnormalities.

• Superficial Palpation: The knee should palpate for increased warmth, [17]tenderness a crepitus. Tenderness should be elicited gently find whether it is due to [18]soft tissue inflammation or bony tenderness. 65

• Soft Tissues: The knee joint should be palpated for [19]synovial thickening and bursal enlargements in and around it. Synovial thickening is felt like feeling a bag of earthworms, especially over medial femoral condyle. The medial femoral condyle is covered by vastus medialis [20]muscle which gets atrophied earner than other muscles in knee joint disorders. This makes synovial thickening to be felt easier over the medial femoral condyle. • Bony Palpation: The bony structures are medial and lateral femoral and [21]tibial condyles, patella and head of fibula. These landmarks are palpated for their shape, smoothness, tenderness, irregularity and thickening. Joint line is palpated for any irregularity, tenderness and [22]osteophytes. Joint line is palpated by running the thumb over the medial surface of the tibial condyle upwards until a dip is felt which is the joint line. Lateral joint line is palpated similarly. Articular surface of [23]patella is palpated by sliding the patella laterally or medially and the undersurface of the patella is palpated for tenderness, irregularity and osteophytes. Presence of loose bodies can be felt easily on alternate [24]flexion and extension of knee. • Joint Effusion: Minimal effusion of the knee joint manifests as fullness of infrapatellar fossae. If the fluid is more, suprapatellar fossa bulges out. Presence of fluid is ascertained by demonstrating the presence [25]patellar tap. • Crepitus: Fine crepitus in a young person suggests [26]chondromalacia. Chondromalacia is a condition in which softening of patella occurs due degenerative changes. Coarse crepitations in elderly persons are seen in degenerative arthrosis and neuropathic joint. Movements A normal knee can be flexed until the back of leg touches the back of [27]thigh. If the [28]knee cannot be extended completely, both actively and passively, then the knee is said to be in fixed flexion deformity. If active extension of the knee is not possible, but passive extension is possible, then it is called extensor lag. This represents the weakness of [29]quadriceps mechanism. Extensor lag is measured by the degree of movement left behind to complete extension. Neurovascular examination

• Lateral popliteal [30]nerve is located behind the head of [31]fibula and it is rolled against it for any tenderness or thickening. • [32]Popliteal artery aneurysms are felt in the posterior aspect of the knee joint. Normally the popliteal artery pulsations are not easily felt or seen. • If it is easily seen or felt, a popliteal aneurysm should be ruled out. • Lymphatic system: The nodes to be examined are vertical group of inguinal lymph nodes and popliteal group of [33]lymph nodes. The [34]Center for Advanced Orthopedics represents two board certified orthopedic [35]surgeons with combined experience in bone & joint problems of over 45 years. Call now at: [36](301) 645-5410 [37]http://www.centerforadvancedorthopedics.com 1. http://centerforadvancedorthopedics.files.wordpress.com/2013/02/images.jpg 2. http://www.centerforadvancedorthopedics.com/

3. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 4.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 5. http://www.centerforadvancedorthopedics.com/Total-partial-knee-replacement-surgery.aspx 6.

http://www.centerforadvancedorthopedics.com/

Patient-Education-Orthopedic-Evaluation-Center-For-Advaced-Orthopedics.aspx 7. http://www.centerforadvancedorthopedics.com/Pain-and-swelling-in-foot-and-ankle.aspx 8. http://www.centerforadvancedorthopedics.com/Joint-pain-disorders-causes-and-orthopedic-treatment.aspx 9. http://www.centerforadvancedorthopedics.com/Shoulder-pain-orthopedic-treatment-in-md.aspx 10. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 11. http://www.centerforadvancedorthopedics.com/Rheumatoid-osteoarthritis-joints-diseases-treatment.aspx 12. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx#Hip 13.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 14.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 15. http://www.centerforadvancedorthopedics.com/ 16.

http:

//www.centerforadvancedorthopedics.com/Patient-Education-Joint-Disease-Center-For-Advanced-Orthopedics.aspx 17.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 18.

http:

//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx 19. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 20. http://www.centerforadvancedorthopedics.com/Hand-arm-elbow-pain-orthopedic-treatment.aspx 21.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 22. http://www.centerforadvancedorthopedics.com/Patient-Survey-Form-Center-For-advanced-orthopedics.aspx 23.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 24. http://www.centerforadvancedorthopedics.com/Lower-upper-severe-spine-back-pain-orthopedic-treatment.aspx 25. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 26. http://www.centerforadvancedorthopedics.com/ 27.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 28. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 29. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 30. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx

31. http://www.centerforadvancedorthopedics.com/About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports aspx 32. http://www.centerforadvancedorthopedics.com/Advantages-of-partial-knee-replacement-resurfacing.aspx

33. http://www.centerforadvancedorthopedics.com/About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports aspx 34. http://www.centerforadvancedorthopedics.com/Default.aspx

35. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousa aspx 36. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 37. http://www.centerforadvancedorthopedics.com/

Center For Advanced Orthopedics (2013-07-29 03:12:47) Thanks for the appreciation. Center For Advanced Orthopedics (2013-07-29 03:12:59) Thanks. blacharstwo samochodowe kraków (2013-07-18 11:05:01) My brother recommended I might like this website. He was totally right. This post truly made my day. You cann’t imagine just how much time I had spent for this information! Thanks! blacharstwo samochodowe kraków http://www.profesja-przewoznik.com.pl/tag,spedycja/ Carol (2013-07-24 11:55:07) I’m really glad I have found this information. Today bloggers publish only about gossips and net and this is actually irritating. A good website with interesting content, that is what I need. Thank you for keeping this web-site, I will be visiting it. Do you do newsletters? Cant find it. Carol http://www.ooizit.com/members/ztmdcjvey

2.3

March

Obesity is emerging as a serious health threat among children (2013-03-06 07:05) Definition and Prevention of Obesity:

[1] [2]Obesity has emerged as a major health threat in the United States. The challenge is now affecting our children who are following the path of the adults. Obesity is a direct precursor or contributor to several serious [3]ailments, such as [4]diabetes, hypertension, heart disease, stroke, cancer, degenerative [5]joint disease, [6]chronic back pain, higher risk of [7]injuries and a plethora of ailments. In the United States, obesity contributes to more than 360,000 deaths every year and is a major factor in escalating health care costs.

• Obesity limits mobility, reduces motivation, impacts self-image, promotes depression and other health related behavior [8]disorders. These conditions set in a negative vicious cycle that further perpetuates the obesity problem. 68

â&#x20AC;˘ Obese children run a higher risk of getting bullied than slimmer children. Weight status is a documented predictor for bullying that is independent of childâ&#x20AC;&#x2122;s intelligence, gender, social skills and academic or economical status. The risk peaks between the ages of 6 and 9. â&#x20AC;˘ [9]Obesity does not result from just overeating. Types of foods that we consume also impact our weight. Soda, liquor, fructose-laden fruit juices, fruit drinks, fast and fried foods, refined flour, pork and red meat are some of the common culprits. Plastics and growth [10]hormones in commercial foods have also been implicated in its causation. Passive entertainment such as television, excessive Internet usage, movies, video games and hours of fiction reading all contribute to the disorder. Prevention of Obesity: The very first step toward prevention is awareness of the problem and a diligent watch of the belt size. Waistline across the [11]umbilicus should measure 50 percent or less than the body height. Standard weight/height charts and BMI measurement methods are widely available and provide reliable measures to monitor progress. Lifestyle assessment and gradual [12]dietary and activity adjustments provide consistent and enduring results when compared to crash diets or other extreme programs. Cutting down 100 calories per day and burning an additional 100 calories per day can result in two pounds lost per month. Relapses are far less common in lifestyle adjustment methods. Home meals are far superior to restaurant meals. Normalizing weight ends up normalizing several other aspects of life with demonstrable enhancement of life, its quality, [13]health, energy, self-image, relations, productivity and overall improved sense of self. Visit our Website: [14]http://www.centerforadvancedorthopedics.com 1. http://centerforadvancedorthopedics.files.wordpress.com/2013/03/index.jpg 2. http://www.centerforadvancedorthopedics.com/ 3. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 4.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 5.

http:

//www.centerforadvancedorthopedics.com/Patient-Education-Joint-Disease-Center-For-Advanced-Orthopedics.aspx 6.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 7.

http:

//www.centerforadvancedorthopedics.com/Patient-Education-Sports-Medicine-Center-For-Advaced-Orthopedics.aspx 8. http://www.centerforadvancedorthopedics.com/Hand-arm-elbow-pain-orthopedic-treatment.aspx 9.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 10. http://www.centerforadvancedorthopedics.com/Joint-pain-disorders-causes-and-orthopedic-treatment.aspx 11. http://www.centerforadvancedorthopedics.com/Lower-upper-severe-spine-back-pain-orthopedic-treatment.aspx 12.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 13. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 14. http://www.centerforadvancedorthopedics.com/

2.4

April

Carpal Tunnel Syndrome (2013-04-10 05:52) Symptoms and Treatment of Carpal Tunnel Syndrome:

[1] For vast majority, [2]Carpal Tunnel Syndrome has no known cause. This condition presents in all age groups and children are no exception. Most common age group involves middle aged women of 50-55 yrs. Conditions such as diabetes, [3]thyroid dysfunction, vitamin D deficiency, [4]rheumatoid arthritis also influence the development of Carpal Tunnel Syndrome and [5]treatment of primary condition can alleviate or resolve [6]symptoms of CTS. 20-25 % of pregnant women develop symptoms of CTS during the last trimester and symptoms usually resolve after childbirth. Use of pneumatic tools and work in very cold environments may be associated with relatively higher frequency of CTS. Key board operations or other [7]repetitive motions of the upper extremities have no proven association with CTS Younger people with recent onset respond to conservative treatment such as night [8]splinting or corticosteroid injection into the [9]carpal tunnel. Pregnant patients also respond well to splining. Older patients who have chronic symptoms for more than 12 months may present with numbness, weakness and [10]muscle wasting. This population may temporarily respond to splinting or injections and do better with surgical release. Patients with concomitant conditions, such as; diabetes also respond well to surgical release. Surgery can be performed trough standard open method, mini-incision method or through endoscope. Local, regional or general [11]anesthesia may be used based upon patientâ&#x20AC;&#x2122;s preference. 85-88 percent patients report excellent results after surgery with complete resolution of [12]symptoms. Recurrence rate is about 1.8-3 %. Visit here for more Information: [13]http://www.centerforadvancedorthopedics.com 1. http://centerforadvancedorthopedics.files.wordpress.com/2013/04/index.jpg 2. http://www.centerforadvancedorthopedics.com/ 3. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 4. http://www.centerforadvancedorthopedics.com/Rheumatoid-Arthritis-symptoms-and-treatment.aspx

5. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 6.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 7. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 8. http://www.centerforadvancedorthopedics.com/Hand-arm-elbow-pain-orthopedic-treatment.aspx 9.

http:

//www.centerforadvancedorthopedics.com/Patient-Education-Joint-Disease-Center-For-Advanced-Orthopedics.aspx 10. http://www.centerforadvancedorthopedics.com/Hand-arm-elbow-pain-orthopedic-treatment.aspx 11.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 12. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 13. http://www.centerforadvancedorthopedics.com/

skythia (2013-08-08 16:00:48) Carpal tunnel syndrome is a compression on the the median nerve due to prolong typing, computer gaming and writing. You can check more information on this site and read more articles on our experts advice. http://carpaltunnelhq.com

2.5

June

How to Recover from Rheumatoid Arthritis? (2013-06-24 11:16) Investigations and Treatment of Rheumatoid Arthritis:

[1] [2]Rheumatoid arthritis is a systemic [3]disease. It involves systems/organs other than the [4]joints. However, only the [5]orthopaedic aspects of this disease will be discussed here. Seropositive Rheumatoid Arthritis Seropositive rheumatoid arthritis is a systemic inflammatory disease. It is an autoimmune disease mainly affecting the connective tissue. Hence the greatest effect is seen in the parts with more of connective interstitium. Clinical Features

â&#x20AC;˘ The onset of the disease is insidious and is common between the age group of 20 and 40 years. â&#x20AC;˘ Women are affected more than men in the ratio of 3:1. 71

• The initial symptoms are [6]pain, [7]swellings and morning stiffness of small joints of the hands and [8]feet. • Involvement of the synovial lining of tendon sheaths, bursae and ligaments gives rise to pain, swelling, increased warmth and [9]stiffness. • The disease usually involves metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints of the hand. It can also involve the wrist and [10]elbow joints. These joints are swollen and tender. Involvement of hand manifests as ulnar drift, boutonniere (buttonhole) deformity and swan neck deformity. Involvement of foot is seen as hallux valgus, hammer-toe, claw toe or callosities. Rarely this disease may present as a monoarticular lesion affecting the larger joints of lower limb. The joint is swollen and painful on movements. With progressive destruction of the articular cartilage the joints go in for fixed deformities. Investigations

• Laboratory findings: Haematological investigation may show anaemia and an elevated ESR. The C-reactive protein is also raised and the rheumatoid factor (Rh factor), i.e. immunoglobulin M (IgM) is positive in about 80 % of the patients. About 20-30 % of patients may have clinical features of rheumatoid arthritis but negative serological tests; called seronegative [11]rheumatoid arthritis. • Radiological features: Radiographs show juxta-articular [12]osteoporosis with joint space narrowing and subchondral cysts. There is erosion of the articular margins. In later stages, there is generalised osteoporosis with deformity of the hand and feet. • Synovial biopsy can be obtained by open or arthroscopic methods. Treatment Rheumatoid arthritis is one of the most common chronic ailments in the world. It causes the greatest disability among young adults affecting their commercial capability. Its treatment therefore needs interdisciplinary approach involving a rheumatologist, [13]orthopaedician, physiatrist, psychologist and occupational therapist. The goal of [14]treatment in rheumatoid arthritis is:

• Control of synovitis and pain • Maintaining joint function • Prevention of deformity The ideal regime should be: physical rest and drug therapy in the acute phase and physical therapy and maintenance drug therapy during the remission stage. [15]The Center for Advanced Orthopedics represents two board [16]certified orthopedic surgeons with combined experience in bone & joint problems of over 45 years. This compassion and competence in problems related to arthritis, [17]joint replacements, and [18]sports related injuries is second to none in this field. [19]http://www.centerforadvancedorthopedics.com/ 72

1. http://centerforadvancedorthopedics.files.wordpress.com/2013/06/images.jpg 2. http://www.centerforadvancedorthopedics.com/ 3. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 4. http://www.centerforadvancedorthopedics.com/Hand-arm-elbow-pain-orthopedic-treatment.aspx 5.

http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons.

aspx 6.

http:

//www.centerforadvancedorthopedics.com/Patient-Education-Joint-Disease-Center-For-Advanced-Orthopedics.aspx 7. http://www.centerforadvancedorthopedics.com/Hand-arm-elbow-pain-orthopedic-treatment.aspx 8.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 9. http://www.centerforadvancedorthopedics.com/Default.aspx 10.

http:

//www.centerforadvancedorthopedics.com/Patient-Education-Joint-Disease-Center-For-Advanced-Orthopedics.aspx 11. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 12.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 13.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 14.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 15. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 16.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 17. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx#JointDiseases 18.

http:

//www.centerforadvancedorthopedics.com/Patient-Education-Sports-Medicine-Center-For-Advaced-Orthopedics.aspx 19. http://www.centerforadvancedorthopedics.com/

2.6

July

Diving and Swimming Tips (2013-07-29 03:35) Expert advice from your Orthopedist: [1]Swimming is one of the top summer activities. Swimming provides both relaxation and exercise. Without safety cautions swimming can be hazardous. Children 17 and younger are more susceptible to [2]injuries if they fail to exercise caution. U.S Consumer Product Safety Commission reported more than 237,500 swimming and 25,522 diving injuries in 2012. Most of these [3]back and [4]neck injuries are preventable by adherence to safety tips. American Academy of [5]Orthopedic Surgeons and American Spinal Injury Association provide the following safety tips for swimmers: Diving Tips:

â&#x20AC;˘ Donâ&#x20AC;&#x2122;t ever dive into shallow water. Before diving, inspect the depth of the water to make sure it is deep enough for diving. If diving from a high point, make sure the bottom of the [6]body of water is 73

double the distance from which you’re diving. For example, if you plan to dive from eight feet above the water, make sure the bottom of the body of water, or any rocks, boulders or other impediments are at least 16 feet under water. • Never dive into above-ground pools • Never dive into water that is not clear, such as a lake or ocean, where sand bars or objects below the surface may not be seen. • Only one person at a time should stand on a diving board. Dive only off the end of the board and do not run on the board. Do not try to dive far out or bounce more than once. Swim away from the board immediately afterward to make room for the next diver. • Refrain from body surfing near the shore since this activity can result in [7]cervical spine injuries, some with quadriplegia, as well as [8]shoulder dislocations and [9]shoulder fractures. Swimming Tips:

• Do not [10]swim alone or allow others to swim alone. • Make sure children are supervised at all times. Back yard pools should have a 5-foot minimum high fence that completely surrounds it. 1. http://www.centerforadvancedorthopedics.com/ 2. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 3. http://www.centerforadvancedorthopedics.com/Lower-upper-severe-spine-back-pain-orthopedic-treatment.aspx 4. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 5.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 6.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 7. http://www.centerforadvancedorthopedics.com/Lower-upper-severe-spine-back-pain-orthopedic-treatment.aspx 8. http://www.centerforadvancedorthopedics.com/Orthopedic-center-for-shoulder-joint-replacement.aspx 9. http://www.centerforadvancedorthopedics.com/Shoulder-structure-function-pain-orthopedic-treatment.aspx 10. http://www.centerforadvancedorthopedics.com/Default.aspx

2.7

August

Safety Tips for Young Drivers (2013-08-21 06:39) Expert advice from your Orthopedic Surgeon:

• [1] Summer months brings more time for fun and activities for the young people. The activities include travelling and driving. While driving is fun, distracted driving can result in tragic crashes, serious [2]injuries and fatalities. Fortunately these tragic events are [3]preventable. 74

• According to The National Highway Traffic Safety Administration (NHTSA), approximately 387,000 Americans were injured in distracted driving-related crashes in 2011, and there were an estimated 3,331 fatalities. • Ten percent of [4]injury crashes in 2011 were reported as “distraction-affected,” and 11 percent of all drivers under the age of 20 involved in a fatal crash were reportedly distracted at the time of the crash. • According to AAA, summer is the most dangerous time of year for teen drivers with seven of the top 10 deadliest days occurring between Memorial Day and Labor Day holidays. • [5]Young drivers should keep their hands on the steering wheel and eyes on the road to ensure that they, their friends, family and fellow travelers, stay safe. • Sending or receiving a text takes a driver’s eyes off the road for an average of 4.6 seconds, according to the U.S. Department of Transportation. At 44 mph, that’s like driving the entire length of a football field, blind. New NHTSA research found that drivers are more than three times more likely to get in a car crash while reaching for an object in the car; 23 times more likely while texting. • A CDC study showed that 45 % of driving teens admitted to texting while driving and 25 % of these practiced that as a regular habit. • These teens also are more prone to other risky behaviors, such as; drinking alcohol. Students who texted while driving were also more likely to be irregular seat belt wearers and to ride in a car with a driver who had been drinking alcohol. • The first priority for all drivers is the safe operation of their car or truck which means keeping eyes on the road and [6]hands on the wheel. 1. http://centerforadvancedorthopedics.files.wordpress.com/2013/08/picture1.png 2. http://www.centerforadvancedorthopedics.com/Default.aspx 3.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 4. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 5.

http:

//www.centerforadvancedorthopedics.com/Patient-Education-Sports-Medicine-Center-For-Advaced-Orthopedics.aspx 6. http://www.centerforadvancedorthopedics.com/Hand-arm-elbow-pain-orthopedic-treatment.aspx

2.8

October

Experts’ Advice to Avoid Medical Errors (2013-10-22 08:22) Expert advice from your [1]orthopedic surgeon: In 1999, the Institute of Medicine (IOM) issued a report. According to this report, 44,000 to 98,000 people die in hospitals each year as the result of medical errors that could be prevented. These figures would make medical errors the eighth leading cause of death in the U.S., ahead of deaths from motor vehicle accidents, breast cancer or AIDS. Medication errors alone may be responsible for about 7,000 deaths per year. What is Patient Safety? The [2]patient safety is defined as freedom from accidental injury and medical error. Medical error is 75

”the failure to complete a planned action as intended or the use of a wrong plan to achieve an aim.

[3] SURGEON

EXPERT ADVICE FROM YOUR ORTHOPEDIC

Where Errors Occur? Errors occur in [4]hospitals as well as in other health care settings, such as physicians’offices, nursing homes, pharmacies, urgent care centers, and homes. Unfortunately, very little data exist on the extent of the problem outside of hospitals. Many errors probably occur outside the hospital. The Costs of Errors Medical errors are costly. The IOM report estimates that medical errors cost the nation about $37.6 billion each year. About $17 billion of those costs are associated with preventable errors. About half of the expenditures for preventable medical errors are for direct [5]health care cost. Public Fears Awareness of the problems of medical errors and [6]patient safety has been growing. Americans have a very real fear of medical errors. According to a national poll conducted by the National Patient Safety Foundation:

1. Four out of 10 people who responded (42 percent) had been affected by a medical error, either personally or through a friend or relative. 2. Nearly one third of people who responded (32 percent) indicated that the error had a permanent negative effect on the patient’s health. Overall, the people who responded thought the [7]health care system was ”moderately safe.” But another survey, conducted by the American Society of Health-System Pharmacists, found that Americans are ”very concerned” about:

1. Being given the wrong medicine (61 percent). 2. Being given two or more medicines that interact in a negative way (58 percent). 3. Complications from a[8] medical procedure (56 percent). 76

Where’s the problem? Most people believe that medical errors are the fault of a healthcare provider. When asked about possible solutions to medical errors:

1. Three out of four people who responded thought it would be most effective to ”keep health professionals with bad track records from providing care.” 2. Nearly 70 percent thought the problem could be solved through ”better training of health professionals.” But the IOM report said that most medical errors are not due to a person. Instead, they are related to the way things happen. The key to reducing medical errors is to improve the way care is delivered and not to blame a person. [9]Health care professionals are human. Like everyone else, they make mistakes. Improving the system can reduce error rates and improve the [10]quality of health care:

1. A 1999 study showed that if a pharmacist went along with [11]doctors on medical rounds, errors related to medication ordering could drop by as much as 66 percent. 2. Using standard guidelines, establishing protocols, and standardizing equipment has reduced errors related to anesthesia by nearly seven fold. 3. One veteran’s hospital uses hand-held computers and bar codes for ordering medicines. The hospital’s medication error rate dropped by 70 percent. Soon, all VA hospitals will use this system. Types of Errors: Most people believe that medical errors usually involve drugs or surgeries where something goes wrong. A patient may get the wrong prescription or dosage, or a sponge used to soak up blood during a surgery may be left in the patient. However, there are many other types of medical errors, including: Diagnostic errors. The wrong diagnosis may mean that the[12] patient doesn’t get the right kind of therapy or treatment. Test results could be misinterpreted. The patient may fail to receive an indicated diagnostic test.

1. Equipment failure. Perhaps a battery is dead, or a valve pump doesn’t work properly. 2. Infections. The patient may get an infection unrelated to the illness while in the hospital, or a surgical site may become infected. 3. Blood transfusion-related injuries. A patient may receive blood that doesn’t match his or her own blood type. 4. Misinterpreted medical orders. A [13]doctor prescribes a ”no salt” diet, but the hospitalized patient gets a meal seasoned with salt. 77

Preventing Errors: Research indicates that more than half, and maybe as many as 75 percent, of medical errors can be prevented. For example:

1. Using computers to order medications and treatments could eliminate problems with not understanding a doctor’s handwriting. 2. Medicine packages and names should look and sound different to prevent mix-ups and confusion. 3. Standard treatment policies and protocols help avoid confusion about what to do and what works best in most cases. The American Academy of [14]Orthopedic Surgeons (AAOS) believes that patient safety is a major concern. It is working to reduce medical errors through its Patient Safety Committee. The AAOS and other organizations of [15]healthcare professionals, hospitals and consumers are developing a national plan to measure healthcare quality and ensure accurate reporting of errors. It also has a public education campaign called ”Take Care: Patient Safety Is No Accident.” Talk to your [16]orthopedic surgeon about preventing medical errors. [17]Shaheer Yousaf MD [18]Center For Advanced Orthopedics 1.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 2. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 3. http://centerforadvancedorthopedics.files.wordpress.com/2013/10/medical-errors.jpg 4. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx 5.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 6. http://www.centerforadvancedorthopedics.com/ 7. http://www.centerforadvancedorthopedics.com/Center-For-Advanced-Orthopedics-Articles-of-Interest.aspx 8.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 9.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 10.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 11.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 12.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 13.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 14.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 15.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 16. http://www.centerforadvancedorthopedics.com/Default.aspx

17. http://www.centerforadvancedorthopedics.com/Dr-Shaheer-Yousaf-Board-Certified-Md-Top-Best-Surgeon.aspx 18. http://www.centerforadvancedorthopedics.com/

Steroid Injection Therapy May Increase Risk of Spinal Fracture (2013-10-29 07:33)

[1] Fracture

Steroid Injection Therapy May Increase Risk of Spinal

Most aging adults will experience [2]back pain or a spinal disorder at some time in their life. In fact, about 25.8 million visits were made to physicians’ offices due to primary back problems.[3]Treatment focuses on pain relief and is available in both non-surgical (medication or physical therapy) and [4]surgical forms. A retrospective study in the June 5th issue of the Journal of [5]Bone and Joint Surgery (JBJS)looked at one type of back treatment– a lumbar epidural steroid injection (LESI) – and whether or not that treatment had an impact on bone fragility and vertebral fractures (spinal fractures). A higher number of injections was associated with increased risk. Authors concluded that LESIs may lead to increased bone fragility over time, and while injection therapy is useful in some cases, it should be approached cautiously for patients at risk for fractures associated with [6]osteoporosis. [7]Patients at a high risk for vertebral fractures after an epidural injection include older women, those who have had an earlier fracture, those who smoke and those who are underweight. Young and active male patients have a lower risk of vertebral fracture. “In the appropriate setting, and for the right patient, LESI provides effective symptomatic relief and improved level of function, said Shlomo Mandel, MD, MPH, lead author of the JBJS study and orthopedic surgeon at Henry Ford Health System. “Through careful screening and monitoring steroid exposure, the risk of a fracture can be minimized. As [8]orthopedic surgeonswho specialize in spine, we know there is a role for injection therapy, but the challenge is to make sure it is administered safely and still provide long-term benefits.” “It’s important to remember that when contemplating an epidural steroid injection a [9]physician should have a symptomatic history, physical findings and corresponding imaging of direct pressure on a single nerve, ” added Dr. Mandel. “Together with our patient, we review the benefits and risks of alternative treatments before selecting an epidural steroid injection.”

[contact-form][contact-field label=’Name’ type=’name’ required=’1’/][contact-field label=’Email’ type=’email’ required=’1’/][contact-field label=’Conatct Number’ type=’text’ required=’1’/][contact-field label=’Comment’ type=’textarea’ required=’1’/][/contact-form] 79

1. http://www.centerforadvancedorthopedics.com/ 2. http://www.centerforadvancedorthopedics.com/steroid-injection-therapy-risk.aspx 3. http://www.centerforadvancedorthopedics.com/specialities-center-for-advanced-orthopedics.aspx 4. http://www.centerforadvancedorthopedics.com/specialities-center-for-advanced-orthopedics.aspx 5. http://www.centerforadvancedorthopedics.com/surgery-and-total-joint-replacement.aspx 6.

http:

//www.centerforadvancedorthopedics.com/Patient-Education-Joint-Disease-Center-For-Advanced-Orthopedics.aspx 7.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 8.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 9.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx

2.9

November

Advantages of Computer Assisted Surgery (2013-11-20 10:14) CAS([1]Computer Assisted Surgery) is a contemporary technology employed by[2] orthopedic surgeons for the progressive verification of the [3]surgical procedure and accurate alignment and positioning of [4]joint implant. This is a perfect option for the patients who can not afford repeated surgical procedures due to their age and medical deterioration. Furthermore, the joint geometry of each and every individual is specific and different as well and this technique forwards a patient specific and computer guided accuracy to surgical procedure accordingly. CAS forwards following unprecedented advantages when used for [5]surgical procedures : " Eliminates trauma to underlying muscles and soft tissues as a small incision is made during the surgical procedure. " Lessens pain, speeds up recovery and furthermore results in better range of motion. " Facilitates preoperative planning and assessment of surgical difficulties, which further helps the [6]surgeons to optimize their surgical approach and to obtain better and accurate results as far as possible. " Heightens the life span and strength of [7]joint implant. " Minimizes the risk of [8]dislocation and repeated surgery as it provides the [9]surgeons with comprehensive data about a patientâ&#x20AC;&#x2122;s anatomy. Hence resulting in proper and precise placement of[10] joint implant. " Improves overall functioning of [11]replaced joint. " Needs less hospitalization and shortens post-operative rehabilitation. " Provides surgeons with feedback information during the surgical procedure thus enabling them to operate as planned. " Enhances the balancing of soft tissues. [12]joint implant " Very beneficial in the case of over weighted patients, in whom even the slightest of the misalignment can shorten the life span of . " Minimizes the errors in the positioning component and limb alignment, that normally occurs during conventional[13] joint surgery. " Less scaring leads to reduced blood loss which further lessens the need of blood transfusion. " By replacing conventional instrumentation, eliminates the risk of getting fat particles into your blood stream which can cause pulmonary and cognitive complications. 80

" Provides additional control to restore operated leg to appropriate length, which is crucial after [14]total hip replacement. [15]Contact Center For Advanced Orthopedics for Computer Assisted Surgery and various other contemporary techniques prevalent in medicine today. It is our top most priority to present our patients with utmost care and treatment as per their specific needs and requirements. 1. http://www.centerforadvancedorthopedics.com/ 2.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 3. http://www.centerforadvancedorthopedics.com/Center-For-Advanced-Orthopedics-Articles-of-Interest.aspx 4. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 5. http://www.centerforadvancedorthopedics.com/Center-For-Advanced-Orthopedics-Articles-of-Interest.aspx 6.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 7. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 8. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 9.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 10.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 11.

http:

//www.centerforadvancedorthopedics.com/Patient-Education-Joint-Disease-Center-For-Advanced-Orthopedics.aspx 12.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 13. http://www.centerforadvancedorthopedics.com/Advantages-of-Hip-Resurfacing-or-total-hip-replacement.aspx 14.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 15. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx

2.10

December

Treatment for Achilles Tendon Injuries (2013-12-19 09:36) What do you mean by Achilles Tendon Injury? [1]Achilles tendon is a longer tendon which stretches from your heel to your calf muscles and more over, it is one of the most commonly injured tendons of your body. This injury occurs, when the [2]Achilles tendon ruptures or tears away due to over-stretching. This type of rupture can be complete or partial as well. It usually affects your walking ability. Achilles tendon is responsible for the every movement made by your [3]feet i.e. it enables your [4]foot to point downwards, rise on your toes and push off your foot as well. What causes injury to Achilles Tendon? Regular stress to [5]Achilles tendon from the various causes is responsible for its rupture or tear. This 81

stress may occur due to:

• Over exertion • Quickly raising the intensity or level of exercises. • Flat feet • Poorly fitted foot wears • Insufficient warm up before exercises • Wearing high heels • Over tight leg or [6]tendon muscles • Running or jogging on hard surfaces • Oft repeated steroid injections • Damage or trauma to ankles • Weak and tensed calf muscles Apart from these, people participating in the following sports’ activities are more vulnerable to this injury:

• Gymnastics • Dance • Foot ball and Basket ball • Base ball and Volley ball • Tennis What are signs and symbols of[7] Achilles Tendon Injury? Pain in Achilles tendon injury is often intense and patients complain of sudden snap at the back of the leg. Following facts can be enlisted as the potential symptoms of Achilles tendon injury:

• Throbbing pain above your heels, especially while stretching or standing on your toes. • Tenderness and Stiffness of muscles • Swelling around the calf muscles or near your heel • Inability to stand, run, climbing stairs, bending your foot downwards or pointing your toes, • Snapping or popping noise during the injury. 82

What are the treatments available to cure Achilles Tendon Injury? The[8] treatment for Achilles Tendon Injury depends upon your age, level of activity and above all the severity of injury. In most of the cases, surgery is advised to treat completely ruptured tendon. Studies have shown that both surgical and non surgical treatments are equally affective to treat[9] Achilles Tendon Injury. But the sports personsâ&#x20AC;&#x2122; especially those participating in recreational sports or the people of younger age, opt for surgery as their treatment option. [10]Surgical treatment eliminates the chances of recurrence. Both open and closed surgical techniques are opted to repair tear off tendon. Majority of the people under going [11]surgical treatment , within a short time period return to their routine activities and as well regain their strength and endurance. [12] Contact Center for Advanced Orthopedics and Sports Medicine [13]Contact us at Center of Advanced Orthopedics and Sports Medicine for the compassionate and competent treatment of any of your musculoskeletal problems or injuries. Our [14]two board certified orthopedic surgeons with over 45 years of combined experience in bone and joint problems use the most advanced and least invasive surgical technologies to provide quality care and treatment to their patients. 1. http://www.centerforadvancedorthopedics.com/Pain-and-swelling-in-foot-and-ankle.aspx 2. http://www.centerforadvancedorthopedics.com/Pain-and-swelling-in-foot-and-ankle.aspx 3. http://www.centerforadvancedorthopedics.com/Pain-and-swelling-in-foot-and-ankle.aspx 4. http://www.centerforadvancedorthopedics.com/Pain-and-swelling-in-foot-and-ankle.aspx 5. http://www.centerforadvancedorthopedics.com/Knee-Video-Treatment-Options.aspx 6. http://www.centerforadvancedorthopedics.com/Foot-and-ankle-pain-orthopedic-treatment.aspx 7. http://www.centerforadvancedorthopedics.com/Pain-and-swelling-in-foot-and-ankle.aspx 8.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 9. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 10.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 11.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 12. http://www.centerforadvancedorthopedics.com/ 13. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 14.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx

Chapter 3

2014 3.1

January

Post Knee Rehabilitation: Do’s and Don’ts (2014-01-15 12:14) Knee Replacements

[1]

Post Knee Rehabilitation

[2]Knee Replacements normally help to relieve pain, improve knee functions and overall quality of life of an individual who is otherwise leading the life of a dependent. But the [3]recovery of the patients after [4]knee replacement largely depends upon the activities that he adopts. In other words, we can say that post replacement phase and your involvement in this [5]recovery phase is crucially important for you to resume your previous routine and to once again become able to perform your daily activities hassle free. There are certain do’s and don’ts that you should observe for your speedy and overall recovery after your [6]replacement surgery:

• Try to follow a scheduled regime i.e. practice all the exercises prescribed by your physical therapists and as well attend your[7] physical therapy sessions regularly. • Take your prescribed pain relieving and other medications regularly and do not discontinue their use without checking with your [8]doctor. 85

• Rest your [9]operated knee sufficiently. • Take a short walk regularly for several times a day. Staying on your walking regime can speed up your recovery. • Apply hot and cold packs accordingly, in order to reduce soreness, stiffness and to relax muscles as well. • While lying down, elevate your knee above your heart level. You can do it with help of pillows. • Practice activities like; turning, twisting, bending, kneeling and sitting initially with your physical therapists as you can learn to perform them safely and efficiently. • Straighten and bend your legs as much as possible. To enhance extension, lie down with a rolled towel under your [10]knees. • To improve flexion, practice bending your knee back while sitting on a chair. It is advisable to practice this posture under the observation of your [11]physical therapist. • Take your vitamins and supplements regularly. Vitamin D and Iron helps to recover speedily and as well to restore blood count after surgery. • To minimize the risk of blood clotting, put on compression stockings; if recommended and advised by your doctor. • Observe a strict exercising regime, as regular exercising will build up your strength and endurance. • Engage yourself in low-impact or low-stress activities viz. hiking, golfing, walking, stationery biking or biking on leveled surfaces, stationery skiing, swimming and yoga. • Avoid or minimize the use of alcohol, if you are on a blood thinning medication. • Avoid smoking, as it may constrict your blood vessels thus leading to slow healing. • Don’t get obese, as over weight can put unnecessary stress on your operated knee thus slowing down your healing process. • Keep away from high-impact activities like; high impact aerobics, jogging or running, downward skiing, rope jumping etc. • Do not twist or kneel down on your operated knee. • Do not cross your legs, knees or ankles. • Avoid heavy lifting as it can put unnecessary pressure on your operated knee or can possibly damage it. [12]Contact Center for Advanced Orthopedics and Sports Medicine [13]Contact Center for Advanced Orthopedics and Sports Medicine for any of your arthritis and joint related problems. Our experienced and [14]board certified surgeons go over an extra mile to provide you with quality care by making use of state of the art techniques and technologies. 1. http://centerforadvancedorthopedics.files.wordpress.com/2014/01/knee-replacement.jpg 2. http://www.centerforadvancedorthopedics.com/Orthopedic-clinic-for-knee-joint-replacement-md.aspx 3. http://www.centerforadvancedorthopedics.com/Working-of-knee-causes-treatment-of-knee-pain.aspx 4. http://www.centerforadvancedorthopedics.com/Orthopedic-clinic-for-knee-joint-replacement-md.aspx

5. http://www.centerforadvancedorthopedics.com/Home-Exercise-for-knee-pain-treatment.aspx 6. http://www.centerforadvancedorthopedics.com/ 7. http://www.centerforadvancedorthopedics.com/Home-Exercise-for-knee-pain-treatment.aspx 8.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 9. http://www.centerforadvancedorthopedics.com/Orthopedic-clinic-for-knee-joint-replacement-md.aspx 10. http://www.centerforadvancedorthopedics.com/Working-of-knee-causes-treatment-of-knee-pain.aspx 11.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx

3.2

February

Morton’s Neuroma (2014-02-14 05:38)

Morton’s Neuroma: Causes, Symptoms and Treatment If at times, you feel as if you are walking on a marble or pebble or you feel continuous pain in the ball of [1]foot, you may have [2]Morton’s Neuroma. It is a condition affecting on e of the nerves between the toes. This condition is more common among women than men as they tend to wear uncomfortable footwear like high-heeled or narrow shoes. What do we mean by Morton’s Neuroma? [3]Morton’s Neuroma also referred to as Morton’s Metatarsalgia or Interdigital Neuroma, is a non-cancerous growth of nerve tissue that commonly develops at the ball of foot between the third and fourth toe. In other words, [4]Morton’s Neuroma is a pinched or inflamed nerve between the bones at the ball of foot. What are the factors leading to Morton’s Neuroma? The exact [5]cause of Morton’s Neuroma is not known. Various factors including the following are considered as the major reasons to develop this painful condition: 87

[6]

Morton’s neuroma - Treatment

• Regular or chronic stress and irritation of [7]plantar digital nerve • Narrower space between the long bones (metatarsals) of the foot • Wearing narrow or high heeled shoes • Growth of a fatty lump (lipoma) around the joint • Formation of fluid filled sac around the joint • Wearing constrictive (tight) foot wear • Inflammation in the joints • [8]Foot problems including; flat feet, high foot arches, bunions and hammer toes • Abnormally positioned toes • Sports including running and jumping What are the signs and symptoms of Morton’s Neuroma? The signs and symptoms of [9]Morton’s Neuroma usually occur unexpectedly and more likely to worsen over time. Its symptoms mainly include:

• Pain starts from the ball of the foot and extends up to the affected toes • Burning or sharp pain while walking, performing weight bearing activities, when the ball of the foot is squeezed or foot itself is pressurized • Numbness at the bottom of the foot • Parasthesia or pins-and-needles feeling • Toe-pain 88

• Affected toes may spread apart which doctors refer to as V’ sign • Swelling between the toes • Feeling as if there’s something in the shoe or a sock has bunched up What are the [10]treatment options available to relieve the condition? The [11]orthopedic surgeons will develop a treatment plan evaluating the stage and severity of your condition or problem. Following non-invasive treatment techniques are adopted to [12]treat Morton’s Neuroma:

• Padding options are recommended to lessen the pressure on nerve and to decrease the compression as well • Placing the ice-pack on the affected area may be suggested to reduce swelling • [13]Surgeons may also provide custom [14]orthotic devices to support your metatarsal arch • Activities placing pressure on the nerves are suggested to avoid till the condition improvises • Shoe-modifications are advised i.e. wear shoes with wide toe-box and avoid narrow-toed or high-heeled shoes • Calf-stretching exercises may be advised to lessen the pressure on your foot • Injection therapy may be employed including; cortisone and local anaesthetics If non-surgical treatment options do not improve your condition then your [15]orthopedic surgeon may discuss surgical options with you, where either a small portion of the nerve is resected or tissues around the nerve is released. [16]Contact Center for Advanced Orthopedics and Sports Medicine Contact[17] Center of Advanced Orthopedics and Sports Medicine for the state-of-art treatment of any of your musculoskeletal problems and injuries. Our [18]board certified and experienced surgeons make use of latest techniques and technologies to provide you quality care and to make you as staunch and sturdy as before. 1. http://www.centerforadvancedorthopedics.com/ 2. http://www.centerforadvancedorthopedics.com/ 3. http://www.centerforadvancedorthopedics.com/ 4.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 5. http://www.centerforadvancedorthopedics.com/Pain-and-swelling-in-foot-and-ankle.aspx 6. http://centerforadvancedorthopedics.files.wordpress.com/2014/02/mortons-neuroma-treatment.jpg 7. http://www.centerforadvancedorthopedics.com/Pain-and-swelling-in-foot-and-ankle.aspx 8. http://www.centerforadvancedorthopedics.com/Pain-and-swelling-in-foot-and-ankle.aspx 9. http://www.centerforadvancedorthopedics.com/Foot-and-ankle-pain-orthopedic-treatment.aspx 10. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 11.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 12.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 13.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 14. http://www.centerforadvancedorthopedics.com/Default.aspx 15.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx 16. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons. aspx 17. http://www.centerforadvancedorthopedics.com/ 18.

http://www.centerforadvancedorthopedics.com/

Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx

3.3

March

BONE & JOINT (2014-03-14 07:13) Smoking Impact on Spine, Discs and Bones

[1]

Impact of Smoking on the Bones

In the United States [2]smoking claims more than 440,000 lives each year. In general, it reduces life expectancy by 7-10 years. Besides heart and lungs diseases,[3] smoking seriously affects spine, discs, bones and joints Every tissue in the human body is affected by smoking, but several effects are reversible. By avoiding or quitting smoking, you can reduce your risk for incurring many conditions. Quitting [4]smoking can also help your body regain some of its normal healthy functioning. Following are the scientific findings about that explain relationship between smoking and [5]musculoskeletal health.

• [6]Smoking increases your risk of developing [7]osteoporosis a weakness of bone that causes fractures. Elderly smokers are 30 % to 40 % more likely to break their hips than their non-smoking counterparts. Smoking weakens [8]bones in several ways, including: • [9]Studies have shown that smoking reduces the blood supply to bones, just as it does to many other body tissues. • The nicotine in cigarettes slows the production of bone-forming cells (osteoblasts) so that they make less [10]bone. • Smoking decreases the absorption of calcium from the diet. Calcium is necessary for bone mineralization, and with less bone mineral, smokers [11]develop fragile bones (osteoporosis). • [12]Smoking seems to break down estrogen in the body more quickly. Estrogen is important to build and maintain a strong skeleton in women and men. 90

• Smoking also effects the other tissues that make up the [13]musculoskeletal system, increasing the risk of injury and disease: • [14]Rotator cuff (shoulder) tears in smokers are nearly twice as large as those in nonsmokers, which is probably related to the quality of these tendons in smokers. • Smokers are 1.5 times more likely to suffer overuse [15]injuries, such as bursitis or tendonitis, than nonsmokers. • Smokers are also more likely to suffer [16]traumatic injuries, such as [17]sprains or fractures. • Smoking is also associated with a higher risk of [18]low back pain and [19]rheumatoid arthritis. • Smoking is associated with degradation of the intervertebral [20]discs and accelerates disc related back conditions. • Smoking has a detrimental effect on fracture and wound healing. • [21]Fractures take longer to heal in smokers because of the harmful effects of nicotine on the production of bone forming cells. • Smokers also have a higher rate of complications after [22]surgery than nonsmokers such as poor wound healing and infection and outcomes are less satisfactory. This is related to the decrease in blood supply to the tissues. • Smoking has a detrimental effect on athletic performance. Because smoking slows lung growth and impairs lung function, there is less oxygen available for muscles used in sports. Smokers suffer from shortness of breath almost three times more often than nonsmokers. Smokers cannot run or walk as fast or as far as nonsmokers.

• Smoking can make you too thin and put you at greater risk for [23]fractures. Nicotine signals the brain to eat less and can prevent the body from getting adequate nutrition. Having a good body weight is important for general health. [24]Shaheer Yousaf MD Center For Advanced Orthopedics Source: AAOS 1. http://centerforadvancedorthopedics.files.wordpress.com/2014/03/smokingbanner.jpg 2. http://www.centerforadvancedorthopedics.com/smoking-impact-on-spine-discs-and-bones.aspx 3. http://www.centerforadvancedorthopedics.com/smoking-impact-on-spine-discs-and-bones.aspx 4. http://www.centerforadvancedorthopedics.com/smoking-impact-on-spine-discs-and-bones.aspx 5. http://www.centerforadvancedorthopedics.com/specialities-center-for-advanced-orthopedics.aspx 6. http://www.centerforadvancedorthopedics.com/smoking-impact-on-spine-discs-and-bones.aspx 7.

http:

//www.centerforadvancedorthopedics.com/patient-education-joint-disease-center-for-advanced-orthopedics.aspx 8. http://www.centerforadvancedorthopedics.com/lower-upper-severe-spine-back-pain-orthopedic-treatment.aspx 9. http://www.centerforadvancedorthopedics.com/orthopedic-patients-education-related-topics.aspx 10. http://www.centerforadvancedorthopedics.com/lower-upper-severe-spine-back-pain-orthopedic-treatment.aspx 11.

http://www.centerforadvancedorthopedics.com/osteoarthritis-arthritis-orthopedic-symptoms-and-treatment.

aspx

12. http://www.centerforadvancedorthopedics.com/smoking-impact-on-spine-discs-and-bones.aspx 13.

http://www.centerforadvancedorthopedics.com/

videos-and-animations-patient-education-center-for-advanced-orthopedics.aspx 14. http://www.centerforadvancedorthopedics.com/shoulder-pain-orthopedic-treatment-in-md.aspx 15.

http://www.centerforadvancedorthopedics.com/patient-education-general-center-for-advanced-orthopedics.

aspx 16. http://www.centerforadvancedorthopedics.com/patient-education-trauma-center-for-advanced-orthopedics.aspx 17. http://www.centerforadvancedorthopedics.com/pain-and-swelling-in-foot-and-ankle.aspx 18. http://www.centerforadvancedorthopedics.com/lower-upper-severe-spine-back-pain-orthopedic-treatment.aspx 19. http://orthoinfo.aaos.org/topic.cfm?topic=A00208 20. http://www.centerforadvancedorthopedics.com/rheumatoid-osteoarthritis-joints-diseases-treatment.aspx 21. http://www.centerforadvancedorthopedics.com/specialities-center-for-advanced-orthopedics.aspx 22. http://www.centerforadvancedorthopedics.com/surgery-and-total-joint-replacement.aspx 23. http://www.centerforadvancedorthopedics.com/orthopedic-patients-education-related-topics.aspx 24. http://www.centerforadvancedorthopedics.com/dr-shaheer-yousaf-board-certified-md-top-best-surgeon.aspx

3.4

April

Greenstick Fracture (2014-04-26 12:30) Greenstick Fracture: Symptoms, Causes and Treatment: [1]Greenstick Fractures are more common among children than adults, as their bones are softer and flexible than the adults. At times, these[2] fractures are difficult to be diagnosed and are taken as sprains, as they do not cause much pain and swelling. What is a Greenstick Fracture? When a young and soft bone instead of breaking up into different pieces; bends and cracks or breaks away partially, it is called [3]Greenstick Fracture. These fractures usually occur during the infancy and childhood because the bones are soft and flexible during this period. In a Greenstick Fracture, only one side of the [4]bone gets broken while the other one only bends. The term Greenstick Fracture is derived from the analogy of breaking up of a young, fresh and green tree branch. What are the potential signs and symbols of Greenstick Fracture?

[5] 92

Following can be considered as the potential signs of

Greenstick Fracture:

• Abnormally twisted limb • Pain • Swelling • Decreased range of motion • Inability to put weight on the affected limb Moreover, [6]arm fractures are more common than[7] leg fractures because children usually throw open their arms when they start falling. What are the causes of Greenstick Fracture? Following factors result in the Greenstick Fracture:

• Falls while playing or participating in sports • Blow on the forearm or shin • Activities with high risk of falling What are the treatment options available for treating Greenstick Fracture? Bone fractures, even [8]Greenstick Fractures needed to be immobilized to get healed and grow back together. Most of the fractures require 4-8 weeks for complete healing. Following treatment techniques are employed by the doctors of orthopaedics to treat Greenstick Fractures:

• Casts are used to keep the bones in good alignment during healing • If the bones have misaligned, doctors may have to reposition them before using casts • Removable splints may also be used • To reduce swelling, doctors may advise to raise the limb higher than the heart level But once the cast is removed, make your child to avoid high impact activities for one or two weeks in order to avoid re-injury. [9]Contact Center of Advanced Orthopedics and Sports Medicine for the advanced and avant-garde treatment of any of your musculoskeletal problems. Our [10]certified surgeon goes over an extra mile to provide you quality care and help you to regain your function and mobility. 1. http://www.centerforadvancedorthopedics.com/ 2. http://www.centerforadvancedorthopedics.com/ 3. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 4. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx

5. http://centerforadvancedorthopedics.files.wordpress.com/2014/04/dsc_0008.jpg 6.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 7.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 8.

http://www.centerforadvancedorthopedics.com/

About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx 9. http://www.centerforadvancedorthopedics.com/ 10. http://www.centerforadvancedorthopedics.com/board-certified-orthopedic-surgeons-maryland.aspx

3.5

May

Legg- Calve Perthes Disease (2014-05-27 11:21) Legg- Calve Perthes Disease is a [1]childhood disorder affecting children between 4 to 10 years of age. This disease is more common among boys than girls. After 2 years of treatment, children normally return to their routine life without any major limitations. What do we mean by Legg- Calve Perthes Disease? [2]Legg- Calve Perthes Disease (LCP or Perthes Disease) is a pathological condition affecting hip, where pelvis and thighbone meet in ball and socket joint. It is a temporary condition under which, blood flow supply to ball shaped head of thigh bone is temporarily lost, resulting into collapse of thigh bone. As the bone collapses or becomes flat, ball no longer moves smoothly in the hip socket and the area becomes inflamed and irritated. The child may begin to limp with or without pain and there is reduced range of motion. Over a period of time, blood supply retraces back and new blood cells start replacing the dead ones gradually. How is Legg- Calve Perthes Disease diagnosed? After your child’s through [3]physical examination and taking notes of his medical history, your [4]doctor of orthopedics may ask for diagnostic procedures including; x-rays, bone scans, MRI, arthrograms and blood tests. How is Legg- Calve Perthes Disease treated? Proper and adequate non-surgical or [5]surgical treatment is prescribed to lessen the pain and help the femoral head to retain its shape. For the children under 6 years of age and usually for the children with less severe symptoms, non- surgical treatment options are adopted including:-

• Initially to help patient to regain his motion and reduce pain your [6]doctor of orthopedics may suggest rest and limit the activities involving jumping and running. • Anti- inflammatory medication is prescribed to lessen the swelling. • Bed rest in traction may be prescribed for some patients. • Stretching exercises may be prescribed to retain the flexibility of hip and as well to keep the hip in socket. 94

• If the[7] doctor feels that your child need to avoid bearing weight on the involved hip, crutches are prescribed to protect hip joint. • Casts may be prescribed to keep the femoral head with in the socket. • Night- time brace may also be used to maintain hip flexibility . Orthopedic Surgical Treatment Children who are more than 6 years of age and who experience more severe symptoms and pain are advised [8]surgical treatment. The surgical treatment aims at preventing dislocation or collapse of hip. Surgical treatment may include:-

• Contracture Release procedure is employed to lengthen the shortened tissues. • Joint realignment is conducted where plates are used to hold the bones in place. Realignment of joint helps to restore the normal shape of hip joint. • Surgery is performed to remove loose bits of bone and torn flaps of cartilages. [9]Contact Center Of Advanced Orthopedics and Sports Medicine for any of your musculoskeletal pathologies and disorders. Our [10]board certified surgeon goes over an extra mile to provide you with the care and treatment you require and deserve. 1. http://www.centerforadvancedorthopedics.com/ 2. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 3.

http:

//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx 4. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 5. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx 6. http://www.centerforadvancedorthopedics.com/board-certified-orthopedic-surgeons-maryland.aspx 7. http://www.centerforadvancedorthopedics.com/board-certified-orthopedic-surgeons-maryland.aspx 8. http://www.centerforadvancedorthopedics.com/board-certified-orthopedic-surgeons-maryland.aspx 9.

http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons.

aspx 10. http://www.centerforadvancedorthopedics.com/board-certified-orthopedic-surgeons-maryland.aspx

BlogBook v0.4, EX 2Îľ & GNU/Linux. http://www.blogbooker.com LAT

Edited: June 6, 2014