Orthopedics
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Orthopedics lead
G
oing by definition orthopaedics is the branch of medicine that deals with the correction of deformities of bones or muscles. Orthopedics is the medical speciality that is related to the preservation, restoration, and development of form and function of the musculoskeletal system, extremities, spine, and associated structures by medical, surgical, and physical methods. Ortho has become a term that is loosely used to talk about bone and joint related disorder and diseases. In the era where life has become fast and when everyone is constantly on the move, bone and joint trouble is taken lightly until the trouble becomes unbearable. The human body has more than 200 bones and there are over 200 joints that are connected to the bones. Like heaven has a solution to earth’s every problem, the medical fraternity has a treatment if not at least a solution for the most challenging orthopaedics disease and disorder. Blame it on the lifestyle change or eating habits or the work culture, we must accept the fact that orthopaedics disease and disorder or Musculoskeletal disorders (MSDs) have become younger. Such disorders and diseases know no age. On one hand, while more and more people have become prone to MSDs these days, thanks to research and advancements in the field of medicine, there is a cure for orthopaedics disease and disorder. Day after day there is remarkable progress being made across the world in the field of orthopaedics disease and disorder. Knee and hip replacement surgery and reducing the crippling pain of arthritis are to name a few examples of how research in this field has made life easy for patients. Despite the fact that musculoskeletal disease and disorder has become younger, medical treatments and technological advancements have enabled people suffering any form of this disease or disorder has ensured that people live longer. Almost every household in India has at least one family member suffering from one form of orthopaedics disease and disorder. Doctors have warned that joint damage can happen at any age. Depending on the condition of the disease, doctors prescribe medication and other forms of treatment like physiotherapy, massage and stretch exercise. The possible solution is to replace the damaged joint through surgery. The term Musculoskeletal disorders (MSDs) is used to describe a variety of conditions that affect the muscles, bones, and joints. There can be severe pain that results in the patient not being able to perform daily routine activities. Doctors have warned that the risk of MSDs can increase with age. However, the possible solution to MSDs is early diagnosis. Diagnosing MSDs at an early stage can also reduce the damage caused.
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neutral posture, heavy force or repetition are more prone to MSD risk factors. Psychological There is a growing awareness among people about the fact that how psychological factors can cause increased muscle tension, increased blood and fluid pressure, reduction of growth functions, pain sensitivity reduction, pupil dilation, body remaining at heightened state of sensitivity.
connective tissues in the body are the most common symptoms of arthritis.
Other factors The risk of people getting MSDs can vary from person to another. Various differences like gender and obesity can determine people’s tendency of getting MSDs.
Inflammation of the meeting place of two or more bones; a joint actually refers to more than 100 different types of arthritis. Rheumatic diseases are classified as those that cause pain, stiffness, and swelling in joints or other supportive body structures, such as muscles, tendons, ligaments, and bones.
Diagnosing MSDs A doctor’s visit on time can save the patient a lot of pain. A specialist will carry out a physical examination to test if the muscles for weaknesses or atrophy. Unusual reflexes are a clear indication of the nerve being damaged. Swelling and redness may be signs of the forms of arthritis: gout, osteoarthritis, and rheumatoid arthritis. MSDs can affect all major areas of the body areas including •
Neck
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Knees
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Feet
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Wrists
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Shoulders
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Back (upper and lower)
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Hips
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Legs
Key elements in the history of determining the severity of MSDs are •
Loss of function
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Pain
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Stiffness
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Deformity
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Swelling
What causes MSDs? Depending on several factors MSDs have a range of causes. However, a few factors can determine the
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severity of the problem. The exact cause of the disease can depend on factors like •
Age
•
Lifestyle
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Activity level
•
Occupation
Causes of MSDs MSDs can arise from interaction of physical factors with economic, psychological, and social factors. Biomechanical Physical activity involving heavy load can result in acute injury. In many cases, physical activity that does not involve heave weight but when repeated quite often at short intervals can also cause muscle damage. People who are involved in doing tasks which involve maintaining a non-
If bone fractures are suspected, the doctor will likely ensure that the X-rays are taken in order to get a better look at the bones. X-rays may also indicate areas of increasing bone loss. Blood tests may be used to investigate rheumatic diseases.
The most common types of arthritis are Osteoarthritis. Treating MSDs
1. Arthritis
Treatment for musculoskeletal disorders solely depends on the severity of the disease. Pain on and off and mild discomfort is treated with over the counter medications. When the disease is in its advance stage, along with prescribed medications physical and occupational therapy is recommended. Such therapy helps in keeping inflammation and pain under control.
Most common among men and women, arthritis and other rheumatic diseases are often mistakenly associated with old age. However, arthritis and other rheumatic diseases are common among men and women of all age groups. This is a chronic disease and it is progresses slowly. The specific causes of most of the arthritis are yet unknown.
Preventing MSDs
Pain, swelling and limited movement in joints and
Prevention is better than cure, for any disease and disorder. The same holds god for MSDs as well. Lifestyle changes are regarded as one of the sure ways such disorders and diseases can be prevented. Regular stretch exercises do go a long way in keeping the bones, joints and the muscles strong and in shape. Above all a maintaining a correct while carrying out the physical activities can help in not causing damage to bones, joints, muscles and tissues.
This is one of the most common types of arthritis and it is classified as a chronic disease involving the joints, particularly the weightbearing joints such as the knee, hip, and spine. Osteoarthritis is characterized primarily by the destruction of cartilage and narrowing of the joint space. It can also include bone overgrowth, spur formation, and impaired function. Osteoarthritis is common in people as they age, however, it may also occur in young people as a result of injury or overuse.
Types of disorders and diseases There are many conditions that affect the working and functioning of the musculoskeletal of our body. Listed below are the most common of them.
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Common types of bursitis Bursitis can occur almost anywhere in the body where bursae are located. Listed below are the most common types of bursitis.
of this disease. Rheumatoid arthritis may result in low red blood cells, inflammation around the lungs, and inflammation around the heart. Till date the cause of this disease remains unclear. However, it is believed that the combination of genetic and environmental factors can cause rheumatoid arthritis. Juvenile idiopathic arthritis (JIA) or juvenile rheumatoid arthritis (JRA): As its name suggests, this form of arthritis affects children and teens. It is a chronic autoimmune disease. Based on their symptoms, number of joints involved and the presence of antibodies in the blood JRA are classified into three main types. In most cases, juvenile arthritis is caused by the body attacking its own healthy cells and tissues causing the joint to become inflamed and stiff. Gout: Gout most commonly known as podagra when it involves the big toe is characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. Elevated levels of uric acid in the blood may cause gout. Through lifestyle and diet changes, the level of uric acid in the blood can be brought down. Nicknamed as the ‘disease of the kings’, gout has not spared anyone. Recommended treatment for arthritis Fibromyalgia: This is a rheumatic condition characterized by muscular or musculoskeletal pain with stiffness and localized tenderness at specific points on the body. Other symptoms may include sleeping disorders and feeling tired to eve carry out the normal activities of the day. Some patients also report difficulty with
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swallowing, bowel and bladder abnormalities, numbness and tingling and cognitive dysfunction. Rheumatoid arthritis: This is an inflammatory disease that involves the lining of the joint (synovium). The inflammation is most common in the wrist and hands and it can affect all of the joints. Fever and low energy levels are symptoms
There is no cure for arthritis. However, pain and inflammation can be brought under control. Depending on the severity of the disease and the condition of the patient, the doctor recommends treatment and medications for arthritis. This disease can be treated with medication, joint immobilization, massage, acupuncture, medications, corticosteroids, weight reduction among other forms of treatment.
2. Bursitis A closed, fluid-filled sac that functions as a cushion and gliding surface to reduce friction between tissues of the body is often referred to as a bursa. Bursae often occur in locations adjacent to the tendons that lie in close proximity to the large joints like the knees, shoulders, elbows and hips. Bursa in its inflamed condition is known as bursitis. This condition does not cause deformity. It is a temporary condition that may restrain motion.
Retromalleolar tendon bursitis: Also known as Albert disease where the extra strain on the anterior part of the Achilles tendon, that may caused due to such as injury, disease, or shoes with rigid back support, thus causing this condition.
It is characterized by inflammation of the bursa located in front of the attachment of the tendon to the heel. Posterior bursitis:
Causes of bursitis Injury is the most common cause of bursitis. However, arthritis, gout, tendinitis, diabetes, and thyroid disease can also cause bursitis.
Achilles
tendon
Also known as Haglund deformity and it is located between the skin of the heel and the Achilles tendon. Most common among young women, this condition is aggravated by a type of walking that presses the soft heel tissue to the hard back support of a shoe. Hip bursitis: Injury, overuse, spinal abnormalities, arthritis, or surgery can cause hip bursitis. This condition
is more common in middle age and the older women. Knee bursitis. Located between the shin bone and the 3 tendons of the hamstring muscles, on the inside of the knee, knee bursitis is popular by the name goosefoot bursitis or Pes Anserine bursitis. Lack of stretching before exercise, tight hamstring muscles, being overweight, arthritis, or outturning of the knee or lower leg are believed to be the common cause of this type of condition.
Kneecap bursitis: This type of bursitis is common among people who use their knee to sit. This condition is common among carpenters and plumbers. Elbow bursitis: Inflammation of the olecranon bursa located between the skin and bones of the elbow can cause elbow bursitis. It can also be caused by injury or constant pressure on the elbow (for example, when leaning on a hard surface). Elbow bursitis can cause pain and also restrict movement. Recommended treatment for bursitis Regardless of the type of bursitis, the treatment will highly depend on the weather or not the bursitis involves a infection of any kind. Listed below are the recommended treatments for bursitis. A specialist will decide on the treatment based on age, medical history and the condition of the patient. The severity of the disease also will play in a major role in determining the kind of treatment that has to be followed. Lastly, the individual patients tolerance towards specific medications, procedures, or therapies are taken into consideration.
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Medication, stretching and strengthening exercises, wrist braces, straps and cortisone shots are used to treat tennis elbow. However, surgery is recommended when the above mentioned treatment does not work. Medial Epicondylitis (Golfer's and Baseball Elbow)
3. Elbow Pain and Problems Cubital Tunnel Syndrome The pain that is caused by Cubital Tunnel Syndrome is a similar kind of pain that occurs when the funny bone in the elbow is hit. This syndrome occurs when the ulnar nerve, that passes through the cubital tunnel that is a tunnel of muscle, ligament, and bone found on the inside of the elbow, becomes compressed due to chronic irritation, injury, or pressure. Cubital Tunnel Syndrome may be caused when a person constantly leans on the elbow or sustains direct injury to that area. It can also occur when the elbow is constantly bent in order to perform activities such as reading, pulling or lifting. Numbness in the hand, pain in the hand and weakness of the hand muscle are the symptoms of Cubital Tunnel Syndrome. Nerve
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conduction test and Electromyogram (EMG) are the most common tests to diagnose cubital tunnel syndrome in addition to complete medical history and physical examination of the patient. As treatment for this syndrome, doctors recommend that patients use an elbow pad as this one serves as a protection against chronic irritation from hard surfaces. At night an elbow pad can be worn in order to restrict movement and bring down the irritation. Tennis Elbow Lateral Epicondylitis
Inflammation of the tendons (tendinitis) attached to the outside, or lateral side, of the elbow at the bony prominence of the arm bone (humerus) condition is known as tennis elbow. This bony prominence is called the lateral epicondyle; hence this condition is also called "lateral epicondylitis." Those who suffer from tennis elbow may experience pain in the lateral side of their elbow. Such kind of pain is usually accompanied with weakness may become especially unbearable when the hand is used to grasp something. Sudden violent injury can cause tennis elbow. Activities because of which tendons are essentially overloaded, may also cause this condition. People who play a lot of tennis experience the overload of tendons. They are more prone to develop pain in the outer elbow. This is why this condition is also called tennis elbow. This condition is not a serious problem. However, if undetected and untreated, tennis elbow can become severely painful. A majority of cases of tennis elbow do not require surgery.
Also nicknamed as golfer's elbow, baseball elbow, suitcase elbow, or forehand tennis elbow, Medial Epicondylitis is characterized by pain that occurs in the elbow to the wrist on the inside (medial side) of the elbow. It is believed that damaged to the tendons that bend the wrist toward the palm cause this pain. A tendon is a tough cord of tissue that connects muscles to bones. Such injury is caused when using the force to bend wrist toward the palm. This condition can especially occur when swinging a golf club or pitching a baseball. Throwing a javelin, chopping wood with an axe, operating a chain saw, frequent usage of hand tools on a regular basis for long durations, weak shoulders and muscles, while playing tennis serving with great force, carrying a heavy suitcase can also cause Medial Epicondylitis. Pain in the palm side of the forearm, from the elbow to the wrist, on the same side as the little finger is the most common symptom of Medial Epicondylitis. Such pain can be experienced while bending the wrist toward the palm against resistance, or when squeezing a rubber ball. Through physical examination the doctor can identify if the patient suffers Medial Epicondylitis.
Treatment may include ice pack application (to reduce inflammation), anti-inflammatory medications, corticosteroid injections, strengthening exercises and surgery if required. 4. Fibromyalgia Widespread pain in muscles and soft tissues surrounding the joints throughout the body is termed as fibromyalgia. It is believed that this disease affects middle age women. The symptoms of fibromyalgia are common similar to the symptoms of other joint diseases like arthritis. However, fibromyalgia is actually a form of soft tissue or muscular rheumatism that can cause pain in the muscles and soft tissues. Sleep disturbance, psychological stress, or immune, endocrine, or biochemical
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abnormalities are believed to be the most common causes of this condition. Fibromyalgia can affect the muscles and also the points at which the muscles attach to the bone (at the ligaments and tendons). Fibromyalgia is a chronic condition and pain is the most common symptom of fibromyalgia. In this condition, pain normally occurs in one particular part of the body and it spreads across the entire body. Depending on the severity pain is classified as burning, soreness, stiffness, aching, or gnawing pain. Depression, sleepless nights, headaches, anxiety, moderate to severe fatigue, restless legs and decreased exercise endurance are the symptoms of fibromyalgia. While there are no tests to diagnose fibromyalgia the doctor concludes if the patient suffers from this medical condition based on the physical condition and the medical history of that patient. Antidepressants, pain killers, anti-inflammatory medications (to relieve pain and improve sleep), exercise and physical therapy (to stretch muscles and improve cardiovascular fitness), massage and occasional cold applications are used to treat fibromyalgia. 5. Foot Pain and Problems Made up of 26 bones connected by numerous joints, muscles, tendons, and ligaments, the foot is regarded
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as one of the most complex parts of the human body. The foot is also prone to stress and when damaged, the foot can restrict mobility.
Bunion Bunions may occur at the base of the great toe or at the base of the little toe, and often occur when the joint is stressed over a period of time. A bunion is a protrusion of bone or tissue around a joint. It is believed that women are prone to this condition as they are known to use wear tight, pointed, and confining shoes. Bunions can also be a result of arthritis, which often affects the big toe joint. Treatment can vary depending on the nature and severity of bunions. Treatment can include surgery, application of pads, medications and wearing comfortable footwear.
Most common foot problems Improper foot functions and continues of footwear that is not comfortable to wear can cause foot problems. It is recommended to use footwear that fit well and also can support the parts of the feet and the skin. There are several problems that can affect the toes, nerves, tendons, ligaments, and joints of the foot. A few common foot related problems have been discussed. Heel spurs Heel spur is the growth of the bone that is usually located underside of the heel bone where it attaches to the plantar fascia, a long band of connective tissue running from the heel to the ball of the foot. This connective tissue acts like a shock absorber and it holds the arch together. Performing activities like running, or wearing poor-fitting shoes and being overweight can result in the plantar fascia being overstretched. This can result in can result stress and inflammation of the tissue pulling on the bone. Over some time, the body builds extra bone in response to this stress resulting in heel spurs. Cold packs, proper footwear or shoe inserts, corticosteroid injections, antiinflammatory medication, such as
Morton neuroma ibuprofen, rest and proper stretching prior to activity are regarded as the best treatment for heel spurs Corn Yellowish, callus growths that develop on top of the toes is called corn. Stress and abuse can cause corn. Known to cause extreme pain and discomfort, it is believed that corn is caused when a toe rubs against another or when a toe rubs against a shoe. Treatment may include surgery, using a footwear lager than normal size, applying pads around corn affected area and trimming the corn by shaving the layers of dead skin.
When two bones rub together squeezing the nerve that lies inbetween them the condition is termed as Morton neuroma. Morton neuroma is a buildup of benign (noncancerous) tissue in the nerves running between the long bones of the foot. Most often, neuromas develop between the bones leading to the third and fourth toes. Swelling, tenderness, and pain is caused by this condition. Severe pain can cause tingling, numbness, and burning in the toes. It usually occurs post standing or walking for a long period of time. Treatment for this condition may include rest or a change in footwear that does not restrict the foot. If the problem
persists, cortisone injections or surgery is looked as an option. Hammertoes When the toe buckles, causing the middle joint of the affected toe to poke out, this condition is referred to as hammertoe. Using tight-fitting shoes that put pressure on the hammertoe aggravate this condition. Application of toe pads that are specially positioned over the bony protrusion, changing the footwear to accommodate the deformed toe and surgical removal are regarded as the best treatment for hammertoes. Ankle sprain Injury caused to the foot's ligaments in the ankle is referred as ankle
sprain. Ligaments are tough bands of elastic tissue that connect bones to each other. Rolling, twisting or bending the ankle beyond the normal permissible range can cause a sprain in the ankle. Awkward foot placement, irregular surfaces, weak muscles, loose ligaments, or wearing shoes with spiked heels can also cause ankle
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sprain. The symptoms of a sprain will depend on how severely the ligaments are stretched or torn, but usually include swelling, pain, or bruising. Treatment may include resting the ankle, elevating the ankle, application of ice pack, wrapping the ankle with elastic bandage or tape, physical therapy and Surgery (for severe sprains). Foot fracture When a foot is fractured it is swollen and painful. A majority of fractures do not require surgery or a cast as the fractured foot tends to heal on its own. The most common fractures are Ankle joint fracture: If the bones in the fractured ankle are separated or misaligned the doctire may call for surgery. Metatarsal fractures:
bone
When the bones that are located in the middle of the foot are fractured, it is referred to as metatarsal bone fracture. Most often this kind of fracture does not require a cast. However, the fractured region must be supported preferably with
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a stiff-soled shoe. In some cases doctors recommend surgery to correct the misaligned bones. Sesamoid bone fractures: There are two small round bones that are located at the end of the metatarsal bone of the big toe. A fracture in this region of the big toe is referred to as sesamoid bone fractures. In some severe cases of fracture, doctors recommend surgery. In most cases, padded soles can help relieve pain. Toe fracture: Fractures in the toe are not very serious and occur due to careless movement of the toe. They can be healed with or without a cast. Foot pain Pain in the foot is normally occurs due to lifestyle change. Foot pain can have many sources, from fractures and sprains to nerve damage. However, the most common areas of foot pain and what causes such pain have been discussed. Pain in the ball of the foot: This kind of pain occurs in the bottom area of the foot right behind the toes. Such pain can damage the nerves and joints located in this area. In addition, a benign (noncancerous) growth, such as Morton's neuroma, may cause the
pain. For this condition, doctors recommend corticosteroid injections and advice wearing supportive shoe inserts. Plantar fasciitis: Severe pain in the heel of the foot especially when standing up after resting signals the possibility of plantar fasciitis. Doctors share that this condition can occur due to an overuse injury of the sole surface (plantar) of the foot. It can result in inflammation of the fascia, a tough, fibrous band of tissue that connects the heel bone to the base of the toes. This condition is common in women and especially in obese people. People who are involved in the occupation that require a lot of walking or standing on hard surfaces are also prone to this condition. People with flat feet and people with high arches have high chances of developing plantar fasciitis. Walking or running, especially with tight calf muscles, may also cause the condition. Application of ice pack, rest, non steroidal anti-inflammatory medications, stretching exercises of the Achilles tendons and plantar fascia are used to treat this condition. Achilles tendon injury: The tendon that connects the calf muscle to the heel bone is the achilles tendon and it is the largest tendon in the human body. However, this
tendon is also the most common site of rupture or tendonitis, an inflammation of the tendon due to overuse. Achilles tendonitis condition is caused by overuse of the tendon and calf muscles. Symptoms may include mild pain after exercise that worsens gradually, stiffness that disappears after the tendon warms
up, and swelling. Treatment for this condition may include Massage therapy, strengthening exercises, supportive devices, bandages for the affected muscle and tendon, nonsteroidal anti-inflammatory medications, rest and in severe cases surgery is recommended. 6. Fractures Complete or partial breakage of the
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bone is called fracture. A fracture may be classified as open or close depending on its nature. An open fracture also known as bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin. When the bone is broken and the skin is intact, the fracture is classified as closed or simple fracture. Fractures have a variety of names. A few common names given to fractures are Greenstick fracture: When a portion of the bone is broken, causing the other side to bend it is termed as Greenstick fracture. This fracture is most common in children. Transverse fracture. The bone breakage is in a straight line perpendicular to the bone. Spiral fracture. The breakage spirals around the bone; common in a twisting injury. Oblique fracture. The breakage of the bone is diagonal across the bone. Compression fracture. The bone is crushed, causing the broken bone to be wider or flatter in appearance. Comminuted. The bone break is in 3 or more pieces and fragments are present at the fracture site.
Common symptoms of fracture Every patient may or may not experience the same symptoms of fracture. Listed below are the most common symptoms of fracture.
Segmental. The same bone is fractured in two places, so there is a floating segment of bone.
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Pain and swelling in injured area
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Deformity of the injured area
Causes of fracture
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Warmth, bruising, or redness in the injured area
When force more than what the bone can take and absorb is applied, it results in a fracture. However, doctors say that breaks in bones can also occur from falls, trauma, or as a result of a direct blow or kick to the body.
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Difficulty in moving the injured area
Diagnosing a fracture A broken bone not always is declared fracture by a doctor. These are the most common techniques
to determine if the broken bone is a fracture are X-ray, Magnetic resonance imaging (MRI) and Computed tomography scan (also called a CT or CAT scan). Treatment for fracture Depending on the nature of the fracture, the doctor will determine what kind of treatment method needs to be adopted. Treatment will also be based on health and medical history of the patient, the level of tolerance towards medication and location and type of fracture. Treatment may include cast, medication and surgery (depending on the case).
Low back pain can range from mild, dull, annoying pain, to persistent, severe, disabling pain in the lower back. Pain in the lower back can restrict mobility and interfere with normal functioning. Low back pain is one of the most significant health problems that people face these days. Doctors say that change in lifestyle and incorrect posture are the reasons why people can experience low back pain.
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Abnormal growth (tumor)
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Obesity (often caused by increased weight on the spine and pressure on the discs)
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Poor muscle tone in the back
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Muscle tension or spasm
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Sprain or strain
Causes of low back pain
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Ligament or muscle tears
In the era of science and technology, it is difficult to determine the exact reason for low back pain. In most cases, back pain may be a symptom of many different causes, including any or several of the following:
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Joint problems (such as, spinal stenosis)
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Infection
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Trauma, injury, or fracture
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, strenuous activity, or improper use (for example, repetitive or heavy lifting, or exposure to vibration for prolonged periods of time)
Prevention of low back pain
Degeneration
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•
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(often caused by stresses on the muscles and ligaments that support the spine, or the effects of aging)
7. Low back pain
of
vertebrae
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Smoking
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Protruding or (slipped) disk
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Exercising regularly (with proper stretching before participation)
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Avoiding smoking
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Maintaining a healthy weight
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Reducing emotional stress which may cause muscle tension
Low back pain can be diagnosed by using the following techniques •
X-Ray
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Computed tomography scan (also called a CT or CAT scan)
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Magnetic (MRI)
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Radionuclide bone scan
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Electromyogram (EMG)
herniated
resonance
imaging
Treatment for low back pain
Low back pain can be prevented by using the following techniques: correct
Maintaining correct posture while sitting, standing, and sleeping
Diagnosing of low back pain
Disease (for example, osteoarthritis, spondylitis, or compression fractures)
Practicing techniques
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lifting
Depending on the severity of the low back pain, the doctor decides the nature of the treatment that can include:
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8. Hand pain and problems. There are many hand problems that can interfere with activities of daily living (ADLs). A few of the most common hand pains and problems have been discussed below: Arthritis Arthritis is joint inflammation and can occur in multiple areas of the hand and wrist. Arthritis of the hand can be very painful. Osteoarthritis
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Medication
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Occupational therapy
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Weight loss for obese patients
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No smoking
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Activity modification
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Surgery
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Assistive devices (for example, mechanical back supports)
Low back pain rehabilitation Generally, there are 3 phases to low back pain rehabilitation. These include the following: Phase I: Acute Phase. This is the initial phase where the physiatrist and treatment team focus on making a diagnosis, developing an appropriate treatment plan, and implementing the treatment regimen to reduce the initial low back pain and source of inflammation. The treatment may include the utilization of ultrasound, electrical stimulation, or specialized injections. Phase II: Recovery Phase. Once the initial pain and inflammation are better managed, the rehabilitation team then focuses on helping the patient to restore working function of the body. This may include returning the patient to normal daily activities that the patient used to perform before experiencing low back pain. It is in this stage that a specialized
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exercise program is implemented that is designed. The aim of this is to help the individual regain flexibility and strength. Phase III: Maintenance Phase. The goal of this phase of low back pain rehabilitation is 2-fold — educating the individual on ways to prevent further injury and strain to the back, and helping the individual to maintain an appropriate level of physical fitness to help further increase strength and endurance.
Osteoarthritis is one of the most common forms of arthritis in the hands. This may develop after an injury. Osteoarthritis usually develops in more than just one place. It can develop at the base of the thumb, at the end joint closest to the finger tip, or at the middle joint of a finger. Signs and symptoms of osteoarthritis include: •
Stiffness
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Swelling and pain
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Bony nodules at the middle or end joints of the finger
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Pain and possibly swelling at the base of the thumb
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Loss of strength in the fingers and the grip of the hand
Treatment for osteoarthritis Depending on the nature and severity of osteoarthritis, the doctor will recommend a combintation of the following: •
Nonsteroidal anti-inflammatory drugs
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Resting the affected hand • Wearing splints at night • Using heat to soothe the pain • Using ice to reduce swelling • Possible injections
cortisone
• Possible surgery when no other treatments work Carpal tunnel syndrome Carpal tunnel is a narrow confined space in the wrist. Carpal tunnel syndrome is a condition in which the median nerve is compressed as
it passes through the carpal tunnel. There are multiple symptoms of this disease. This is because the median nerve provides sensory and motor functions to the thumb and 3 middle fingers. Pain, numbness, swollen figures, pins and needles like feeling in figures, burning or tingling in the fingers, especially the thumb and the index and middle fingers are the most common symptoms of this disease. The symptoms of carpal tunnel syndrome may resemble other conditions such as tendonitis, bursitis, or rheumatoid arthritis. This disease can be treated using oral or injected anti-inflammatory medications, splinting of the hand as it can help prevent wrist movement and decrease the compression of the nerves inside the tunnel, surgery or changing position of a computer keyboard, or other ergonomic changes. Ganglion cysts Soft, fluid-filled cysts can develop on the front or back of the hand for no apparent reason. These are called ganglion cysts the most common, benign (noncancerous), soft-tissue tumor of the hand and wrist. Symptoms of Ganglion cysts Each individual can experience a different set of symptoms of ganglion cysts condition. However, the most
common symptoms of the disease are wrist pain that is aggravated with repeated use or irritation, a slow growing, localized swelling, with mild aching and weakness in the wrist and an apparent cyst that is smooth, firm, rounded or tender. Treatment for ganglion cysts Doctors do not recommend any treatment for ganglion cysts condition when the cyst is small and painless. However, when the cyst begins to grow and interferes with the functionality of the hand is treatment is usually recommended.
Treatment may include: •
Rest
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Splinting
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Nonsteroidal anti-inflammatory medications
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Aspiration
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Cortisone injections
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Surgery
Tendon problems Tendonitis and tenosynovitis are the two major problems that are associated with tendons. Tendonitis condition is known as inflammation
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of a tendon. Tendons are the tough cords of tissue that connect muscles to bones. This condition is most commonly seen in the wrist and fingers. When the tendons become irritated, swelling, pain, and discomfort will occur. Tenosynovitis is the inflammation of the lining of the tendon sheaths which enclose the tendons. The tendon sheath is usually the site which becomes inflamed, but both the sheath and the tendon can become inflamed simultaneously. The cause of tenosynovitis is often unknown, but doctors usually blame it on strain, overuse, injury, or excessive exercise may be implicated. Tendonitis may also be related to disease like as, diabetes or rheumatoid arthritis. Common tendon disorders Common tendon disorders include Lateral epicondylitis (commonly known as tennis elbow), medial epicondylitis (commonly known as golfer's or baseball elbow) and Rotator cuff tendonitis, DeQuervain's tenosynovitis, trigger finger/trigger thumb. Treatment of tendon disorders Depending on the nature and severity of the disorder, doctors recommend treatment for tendon disorders. Treatment of tendon disorders may include the following. •
Activity modification
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Ice
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Splinting or immobilization
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Steroid injections
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Nonsteroidal anti-inflammatory medications
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Surgery
9. Knee pain and problems. Most often associated with the wear and tear from daily activities like walking, bending, standing and lifting, knee pain has become a common complain among adults. Apart from older people, athletes who are involved in a sporting activity that requires them to run and plan are also prone to knee problems. An individual suffering from knee problem can be caused due to aging or injury. Stress can
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also cause knee problem. Common knee problems Pain in the knee can be a result of more than just problem. here’s taking a look at the most common knee problems people experience. Sprained or strained knee ligaments and/or muscles. A sprained or strained knee ligament or muscle is usually caused by a blow to the knee or a sudden twist of the knee. Symptoms often include pain, swelling, and difficulty in walking. Torn cartilage. Trauma to the knee can result in tear of the menisci (pads of connective tissue that act as shock absorbers and also enhance stability). Cartilage tears can often occur with sprains. Treatment may involve wearing a brace during an activity to protect the knee from further injury. Surgery may be needed to repair the tear Tendonitis. Tendons can suffer from Inflammation from overuse of a tendon during certain activities such as running, jumping, or cycling. Tendonitis of the patellar tendon is called jumper's knee. This often occurs with sports, such as basketball, where the force of hitting the ground after a jump strains the tendon. Arthritis. Osteoarthritis is the most common type of arthritis that affects the knee. Osteoarthritis is a degenerative process where the cartilage in the joint gradually wears away, and often affects middle-age and older people. Osteoarthritis may be caused by excess stress on the joint such as repeated injury or being overweight. Rheumatoid arthritis can also affect the knees by causing the joint to become inflamed and by destroying the knee cartilage. Rheumatoid arthritis often affects persons at an earlier age than osteoarthritis. Diagnosing problems
knee
When unusual pain and discomfort is experienced in the knee, a doctor must be consulted. The doctor uses the techniques of
X-ray, Magnetic resonance imaging (MRI), Computed tomography scan (also called a CT or CAT scan), arthroscopy and radionuclide bone scan to determine the what trouble the knee is facing. Treating knee problems Different problems are treated differently. However, the doctor decides which treatment method will work best for the patient depending on the age, medical history, tolerance for specific medications, procedures or therapies, overall health. In severe cases, joint replacement surgery for the knee is recommended by the doctor. 10. Kyphosis On observing the spine if you come across evidence of a forward curvature of the back bones (vertebrae) in the upper back area, giving an abnormally rounded or "humpback" appearance, it can be concluded that the spine is affected by kyphosis. A normal spine when viewed looks straight. Kyphosis is defined as a curvature of the spine measuring 50 degrees or greater on an X-ray. The normal spine can bend from 20 degrees to
45 degrees of curvature in the upper back area. Kyphosis is a type of spinal deformity. Causes of Kyphosis Kyphosis is congenital, a birth problem. However it can be acquired due to the following conditions •
Neuromuscular conditions
•
Osteogenesis imperfecta (also called "brittle bone disease"). A condition that causes bones to fracture with minimal force.
•
Spina bifida
•
Metabolic problems
•
Scheuermann's disease. A condition that causes the vertebrae to curve forward in the upper back area. The cause of Scheuermann's disease is unknown and is commonly seen in males. • Postural kyphosis. This is one of the most common type of kyphosis. It generally becomes noticeable in adolescence and can be associated with slouching versus a spinal abnormality. Exercise is used to help correct posture.
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Kyphosis is more common in females than males.
and Computed tomography scan (also called a CT or CAT scan).
Symptoms of Kyphosis
Treatment of kyphosis
•
Difference in shoulder height
•
The head bends forward compared to the rest of the body
•
Difference in shoulder blade height or position
Treatment may include one or a combination of observation and repeated examination, bracing and surgery. The goal of the treatment is to stop the progression of the curve and minimize deformity.
•
•
When bending forward, the height of the upper back appears higher than normal Tight hamstrings (back thigh) muscles
The symptoms of Kyphosis may resemble other conditions and deformities. A doctor must be consulted when there is abnormal pain and discomfort. Diagnosing Kyphosis If the patient is a child the doctor obtains the complete medical history of the parents. The doctor may also check for developmental milestones since some types of kyphosis can be associated with other neuromuscular disorders. Developmental delays may require further medical evaluation. Through physical examination, and diagnostic tests Kyphosis is diagnosed. Diagnostic procedures may include X-rays, radionuclide bone scan, bold tests, Magnetic resonance imaging (MRI)
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suggest that this disease can affect the people who are over 50 years of age. 1 in 2 women are known to break a bone due to osteoporosis. They are prone to equal to the risk of breast, ovarian and uterine cancer combined.
11. Neck pain and problems Located between the head and the shoulder, the neck is often unprotected and this maes it prone to injury. Causes of neck pain •
Age-related disorders, or inflammatory disease can cause neck pain. However, the most common causes of neck pain may include the following
•
Injury (damage to the muscles, tendons, and/or ligaments)
•
Herniated cervical disk
•
Arthritis (for osteoarthritis or arthritis)
•
Cervical disk degeneration
•
Congenital (present at birth) abnormalities of the vertebrae and bones
•
Tumors
example, rheumatoid
Diagnosing neck pain
12. Osteoporosis
Blood tests, X-ray, Magnetic resonance imaging (MRI), Computed tomography scan (also called a CT or CAT scan) and Electromyogram (EMG) are used to diagnose neck pain.
The human body is known to replace the components of the bones on a regular basis. When those components are lost too rapidly or not replenished quickly enough (or both), osteoporosis occurs. Study has proved that women are at higher risk for the disease. However, men can develop it, too. Studies also
Treatment of neck pain Treatment may include medication to reduce inflammation and to control pain, rest, physical therapy, exercise, neck brace or immobilization and in severe cases, doctor may recommend surgery.
Only 1 in 4 men are known to break a bone due to osteoporosis. Men are at a risk greater than women to suffer from prostate cancer. Fortunately, osteoporosis is preventable. When it does occur, your doctor can diagnose and treat it before it causes a broken bone. Even after a fracture, further problems are avoidable with the right steps. Symptoms of osteoporosis Osteoporosis is often called the silent disease because it may not cause symptoms. Some patients experience: • Bone and muscle pain, particularly in the back if a
fracture has occurred. •
Broken bones (mainly hips, spine or wrists), even from minor falls or bumps.
•
Collapsed vertebrae — leading to severe pain, a decrease in height or a spine deformity.
Such symptoms can also come from other bone disorders or medical problems. It is advisable to consult a doctor in case one experiences any abnormalities. Who can develop osteoporosis? The exact cause of osteoporosis is unknown as yet. However, several factors appear to increase the risk of developing the disease. They may include age, gender, race, menopause, low body weight, not getting enough calcium, protein or Vitamin D, consuming too much alcohol, sodium or caffeine, having an inactive lifestyle, smoking. Certain medications (prednisone, e.g.) and diseases can also cause bone loss and increase the risk of osteoporosis. Prevention of osteoporosis As women are prone to this disease, it is advisable that they are careful once they cross the golden age
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of 50. Firstly, every woman must be aware of the symptoms and the disease. It is recommended that men and women consume a diet rich in fruits and vegetables that includes adequate vitamin D and calcium, with supplements prescribed as necessary. Regular weight-bearing and muscle-strengthening exercises are also recommended. Diagnosing osteoporosis A bone density test (also called bone densitometry or DXA) involves a special X-ray machine and is the only way for doctors to determine whether you have osteoporosis. Such scans are recommended for: •
All women 65 and older
•
All men 70 and older
•
Certain women, factors
postmenopausal depending on risk
•
Certain men ages 50-69, depending on risk factors
•
Certain patients who have fractured a bone, depending on their background
Osteoporosis treatment Early diagnosing and treatment of osteoporosis is the best solution. Depending on the medical
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history, age, gender, extent of the disease, tolerance towards specific medications the doctor recommends a particular set of treatment. Treatment of osteoporosis may include a number of injections, IV infusions, tablets, nasal sprays. 13. Scoliosis Often first diagnosed in children, but treatment and monitoring of Scoliosis may be lifelong. It has been proved that early intervention yields the best results when treating scoliosis. Common signs of scoliosis include a difference in shoulder height when viewed from the back, a head that is not centered with the rest of the body, or a difference in hip height or position. However, Scoliosis does not cause pain. Bracing is a common treatment for scoliosis, but in severe cases, surgery may be required. The spine that is made up of a combination of rectangular-shaped building blocks called vertebrae when viewed from behind a normal spine appears to look straight. However, a spine that is affected by scoliosis is curved often appearing like an S or C with a rotation of the vertebrae. This curvature gives the appearance that the person is leaning to one side.
Scoliosis is determined when the curvature of the spine measures 10 degrees or greater on an X-ray. Spinal curvature from scoliosis may occur on the right or left side of the spine, or on both sides in different sections. Both the thoracic (mid) and lumbar (lower) spine may be affected by scoliosis. Scoliosis is a type of spinal deformity. In more than 80 percent of cases, the cause of scoliosis is unknown — a condition called idiopathic scoliosis. In other cases, scoliosis may develop as a result of degeneration of the spinal discs, as seen with arthritis, osteoporosis or as a hereditary condition that tends to run in families. Different types of scoliosis Congenital Scoliosis: When spinal curvature develops because of misshapen vertebrae it is termed as congenital scoliosis. The diagnosis of congenital scoliosis may be made in early infancy if outward signs are present, but many cases are diagnosed later in childhood. Scoliosis may worsen, and asymmetries in the body may develop as the child grows. Typically, congenital scoliosis is treated with a watch and wait approach. However, surgery is considered only if a curve is clearly getting worse and the child
is facing ongoing deformity and risk of future pain. Idiopathic Scoliosis: Despite the study carried out on scoliosis, doctors are unable to determine the cause of this disorder. However, it is believed that idiopathic scoliosis can develop at t he age of 10 or on the onset of adolescence. Growth can make it worse. When diagnosed in children 2 or younger, this type of scoliosis is called infantile idiopathic scoliosis.
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Neuromuscular Scoliosis
Symptoms of scoliosis
Listed below are the most common symptoms of scoliosis: •
Difference shoulder height
in
•
The head isn't centered with the rest of the body
•
Difference in hip height or position
•
Difference in shoulder blade height or position
•
When standing straight, difference in the way the arms hang beside the body
•
When bending forward, the sides of the back appear different in height
•
Prominence or asymmetry in the ribs seen from the front or back
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A child with an underlying neuromuscular condition is at higher risk for developing scoliosis. A straight spine requires normal muscle balance and strength in the torso. In conditions such as cerebral palsy, spina bifida and muscular dystrophy, the muscles are often weak and unbalanced, leading to the development of a spinal curvature. A child with neuromuscular scoliosis is given the option of wearing a scoliosis brace that may slow or prevent the worsening of the condition. Surgical intervention is offered when the curve has reached the tipping point of 50 degrees. Over time, these curves will continue to worsen, leading to progressive imbalance of the torso. Beyond 80 degrees, breathing challenges develop as space for the lungs decreases.
measures the degree of spinal curvature on the X-ray. However, MRI and CT Scan are also be used in the diagnosis of scoliosis. Treatment of scoliosis The aim of treatment is to stop the progression of the curve and prevent deformity. Observations and examinations at regular intervals may be necessary to determine if the spine is continuing to curve. In order to treat scoliosis in children doctors normally recommend braces. An external torso brace, or TLSO, is worn for a prescribed number of hours. The brace applies a corrective pressure to the growing spine, preventing further worsening of the scoliosis.
Diagnosis of scoliosis Early detection and treatment of scoliosis is the best option. In addition to a complete medical history and physical examination, an X-ray is the primary diagnostic tool for scoliosis. In establishing a diagnosis of scoliosis, the doctor
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