Osteochondroma: Symptoms, Diagnosis and Treatment

Osteochondroma is the most common bone tumor. It is a abnormal growth of a bone. Microscopically it is composed of normal bone tissue. Most common location of this tumor is

around the knee joint andat the upper end of the humerus bone

It is usually found in two forms

a pedunculated form which is shaped like a club, being narrow close to the parent bone and broad away from itor a sessile form that is spread out over the parent bone like a carpet

It is usually discovered in the second decade of life. The tumor is three times more common in males as compared to females. These tumors continue to grow till skeletal growth continues and there after stop growing.

Usually these tumors are found incidentally during x ray examination for some other condition. Apart from this the usual presenting feature is the presence of a painless mass in a limb.
Occasionally they may present as pain. Pain can occur if the tumor compresses some structure in its vicinity such as a nerve, tendon or muscle. Pain is also seen if a fracture occurs in the tumor following injury.

Diagnosis is confirmed by x ray examination. If pain is the presenting feature and the diagnosis is not clear then a MRI should be undertaken.

Treatment of a osteochomdroma that is causing no symptoms should be just wait and watch. No active treatment is required in such tumors.

Treatment of symptomatic tumors is by surgical excision of the tumor

What are the chances of tumor recurrence?

The chances of tumor recurrence are up to 2%

How can the chances of recurrence be minimized?

Chances of recurrence can be minimized by complete removal of the tumor and ensuring that even a small piece is not left behindhaving the surgery after skeletal maturity when the tumor is not growing any more

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was created on 24th October 2010

Other bone tumors

Fibrous Dysplasia

Osteoid Osteoma

Chondroma

Bone Cyst

Aneurysmal Bone Cyst

Go back from Osteochondroma to Bone Tumor page

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Osteoid Osteoma: Symptoms, Diagnosis and Treatment

Osteoid Osteoma is a bone tumor that is commonly seen in young males. Any bone of the body can be involved, but it is more common in the bones of the upper and lower limbs.

Most common bone in which it occurs is the femur or thigh bone. It can also occur in the vertebral column or spine.

The predominant symptom of osteoid osteoma is pain. Pain of the tumor is deep, dull and continuous in nature. Often the pain may be present for many months to years.

Typically the pain is worse in the night and is relieved by aspirin. If the tumor is located close to a joint then it can cause swelling, stiffness and deformity in the joint.

A tumor of the spine can cause pain and abnormal bending of the spine called scoliosis.

Occasionally there may be no pain and the only presenting feature may be swelling.

Diagnosis is made by x rays. As pain comes first then the tumor appears so at times the x rays may appear normal. X rays show thickening of the bone along with a area of clarity near the center of the thickening. This area is called the nidus of the tumor.

This is a x ray showing a osteoid osteoma in the femur. The red arrow points to the nidus.

A CT scan may be required if the nidus cannot be pin pointed accurately on x rays. This nidus is between 1 to 1.5 centimetre in size.

At times if the tumor is not visible even after repeated x rays then a bone scan may be required to establish the diagnosis if a osteoid osteoma is suspected by the history.

Treatment of this tumor can be of two types

Medical treatment is done by giving aspirin or other pain killer drugs as pain is the main symptom that the patient has. It has been observed that some tumors disappear spontaneously over time. So the basis of medical treatment is to provide relief from pain till the tumor resolves spontaneously.

This is only recommended for patients that are willing to take pain killers for months to years and have x rays every few months.

Medical treatment is not indicated or withdrawn in patients who have a deformityare sensitive to or can not tolerate pain killersand who have recurrence of pain at the regular doses of pain killers

Surgical treatment is done in patients who don't want medical treatment or in whom medical treatment is contraindicated.

During surgery the nidus has to be completely removed with a margin of surrounding bone or else the tumor will develop again. For complete removal it is essential that the surgeon can pin point the location of the nidus during operation.

Complete removal of the nidus results in a 100% cure. If the nidus remains then the tumor will recur. Recurrence usually occurs within a year.

At times a significant portion of bone may be removed and the remaining bone may require some support in the form of bone graft or implant.

Complications that may occur with this surgery include

fracture of the bonestiffness of jointsinfection

As the nidus is the main crux of the treatment and it is a small 1 to 1.5 centimetre zone hence other minimal invasive methods of surgery have been developed that include

Radio nucleotide guided surgical excisionCT guided percutaneous excisionPercutaneous radio-frequency ablationPercutaneous photo ablationComputer assisted surgery

These methods of treatment have a higher recurrence rate than conventional surgery. More than one sitting of these procedures may be required.

There main advantage is shorter hospital stay, faster recovery, minimal chance of bone fracture and joint stiffness.

How long can medical treatment be taken?

Medical treatment can be taken for 1 to 2 years easily. Minimum dose required for pain relief should be used.

Can this tumor become malignant?

No malignant transformation of the tumor has been observed.

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was created on 22st October 2010

Other bone tumors

Fibrous Dysplasia

Bone Cyst

Aneurysmal Bone Cyst

Chondroma

Osteohondroma

Go back from Osteoid Osteoma to Bone Tumor page

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Tibial Plateau Fracture: Classification, Diagnosis and Treatment

Tibial plateau fractures involve the upper end of the tibia bone that carries the weight of the body across it.

This part of the tibia bone has important ligaments attached to it that help in maintaining the stability of the knee joint. So any fracture in the upper end of the tibia can have a profound effect on the functioning of the knee joint. Before going further lets know about the anatomy of the upper part of the tibia bone.

The upper part of the tibia bone is expanded like a cone with the base of the cone located upwards and the tip pointing to the foot.

This can be divided into two parts. One inner part and one outer part. The outer part is called the lateral condyle and the inner part is called the medial condyle. Posteriorly or behind, the condyles extend out like a platform. The upper surface is covered with cartilage and articulates with the corresponding part of the femur.

In the center some part is devoid of cartilage and this is where important ligaments attach. In the front there is a slight projection that provides attachment to the patellar tendon.

You can see more at the knee anatomy page.

Usual way of sustaining a tibial plateau fracture is by a road traffic accident. A bumper of the vehicle hitting the pedestrian on the leg. Other ways in which this fractured can be sustained include a fall from height, domestic and industrial accidents and during sports. These fractures can also occur as a result of osteoporosis.

Usual symptoms after sustaining the fracture include

painswellingdifficulty or inability to walk or move the limbbruising may be seen over the skin

Sometimes in low energy fractures the symptoms may be mild and the patient may be able to walk with difficulty. In such patients the fracture can be missed and a diagnosis of sprain may be made. So it is best to have a x ray unless one is absolutely certain.

During examination it is important to see for the pulse, loss of ankle and toe movement and loss of sensation. This helps to rule out the injury to blood vessels and nerves.

Ligaments may be torn, but at the time of acute injury it is difficult to clinically assess the integrity of the ligaments due to the pain, swelling and bony instability.

Schatzker classification of tibial plateau fracture is given below. It is the most commonly used classification for this fracture.

Type 1 is a split fracture involving the lateral condyleType 2 is a split fracture of the lateral condyle along with depression of the boneType 3 is a depression fracture of the lateral condyleType 4 is a fracture of the medial condyleType 5 is a fracture involving both the condylesType 6 is a fracture of both the condyles that extends downwards to the shaft of the tibia bone

Type 1 to 4 are usually low energy injuries where as type 5 and 6 are usually high energy injuries. Therefore type 5 and 6 may be associated with lacerations, contusions and bruises to the skin. Compartment syndrome, ligament injuries and injuries to the nerves and blood vessels may also be present.

Diagnosis of tibial plateau fracture is made by x ray examination of the knee joint in two planes perpendicular to each other. At times x rays in a diagonal plane may be done if the fracture is not clear on the routine views. CT and MRI scans may also be required to have a clear assessment of the fracture pattern and to find out injuries to the ligaments.

Aim of treatment is to provide a stable, congruent and smooth joint surface of the upper end of tibia so that there is complete recovery of the knee joint function.

Treatment of tibial plateau fracture depends on the classification and the degree of displacement of the fracture. Displacement or depression of the fracture fragment up to 5mm can be treated by non-operative methods. If the depression or displacement is greater than 5 mm then surgery is indicated.

Methods of non-operative treatment for tibial plateau fracture include the following

plaster cast immobilizationskeletal tractionfunctional cast bracing

Methods of operative treatment include the following

Internal stabilization of the fracture with screws alone or with a combination of plate and screwsExternal stabilization with a fixator frame applied around the limb

Method of treatment to be used is decided by the following factors

Classification of the fractureDisplacement of the fracture fragmentsCondition of the skin, subcutaneous tissue and muscles

All undisplaced fractures from type 1 to 4 can be treated by non-operative methods.

Type 1 displaced fractures are surgically stabilized with screws alone or with a plate and screws.Type 2 displaced fractures are surgically stabilized with screws alone or with a plate and screws after elevating the depressed bone fragment.Type 3 depressed fractures are surgically stabilized with screws after elevating the depressed bone fragment.Type 4 displaced fractures are surgically stabilized with screws alone or with a plate and screws.Type 5 and 6 displaced fractures are surgically stabilized with screws and one or two plates if the skin condition is normal and with a external fixator frame if the skin is lacerated, contused or bruised.

Complications of tibial plateau fracture include the following

InfectionLoss of knee movementIrritation of skin from plates and screwsLate collapse of the fractureArthritis of the knee jointHow long does the fracture take to heal?

The fracture takes 12 to 18 weeks to heal completely

How can loss of knee movement be prevented?

Loss of knee movement can be prevented by early mobilization of the knee joint after the surgery. For this surgical stabilization should be strong enough to allow movement of the knee joint without displacement of the fracture fragments.

How long does it take to reach the activity and strength level as before the fracture?

Muscles atrophy after any fracture. These weak muscles can make moving around painful and slow. To strengthen them, intensive physiotherapy is required.

With out physiotherapy it can take 8 to 10 months to reach the the pre-fracture level of muscle power and agility.

If you want to return quickly to the pre fracture level of activity following a tibial plateau fracture you need to do intensive physiotherapy at home or at a physiotherapy centre.

How can late collapse be prevented?

Late collapse of the fracture usually occurs if the patient starts walking before the fracture has healed adequately. This can be prevented by starting to walk only after complete healing of the fracture.

How can arthritis be prevented?

Arthritis is a late complication of this fracture that usually occurs after a few years. If can be prevented by accurate re-alignment of the fracture fragments as close to normal as possible. Nothing less than perfect should be accepted, but this is not always possible to achieve.

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was updated on 25th January 2011.

Other fractures of the knee joint...

Knee Fracture

Patella Fracture

Other causes of knee pain include...

Knee Osteoarthritis

Knee Bursitis

Meniscal Injury

Ligament Injury

Osgood Schlatter Disease

Knee Anatomy

Knee Replacement Surgery

Go back from Tibial Plateau Fracture to Knee Pain

View the original article here

Hip Replacement, Types, Indication, Contraindications, Surgery and Complications

Hip replacement is a type of surgery in which part or whole of the diseased natural hip joint is replaced with artificial components.

Before reading on it would be a good idea to learn about the hip anatomy. Skip this if you have already done so.

Hip replacement surgery can be classified into different types. On the basis of number of components being replaced it can be

Partial, in which only the femoral component is replacedTotal, in which the femoral and the acetabular components are replaced

Total hip replacement can be of two types

Classical total hip in which the neck and head of the femur are removedArticular surface replacement or ASR in which neck is preserved and a artificial head is implanted on it

On the basis of the material used in the components it can be

polyethylene on metal meaning that the acetabulum is of polyethylene and the head is of metalmetal on metal meaning both components are of metalceramic on ceramic meaning both components are of ceramic

Sometimes cement is used to hold the components within the bone. So depending upon the use of cement or not it can be

cemented in which cement is usedUncemented in which no cement is used to anchor the components

So we can have a polyethylene on metal cemented or uncemented type of hip replacement or a partial cemented or uncemented replacement. All this depends upon the requirement of the patient under going surgery.

Cemented prosthesis is usually used for older patients who have a life expectancy of 20 years and are unlikely to require revision surgery. The function of cement is to act as a filler in between the bone and the prosthesis there by providing a stable fixation.

Metal on metal, ceramic on ceramic and uncemented prosthesis are indicated for young and active people. These prosthesis conserve bone and are designed to allow bone to grow and develop an intimate contact with the prosthesis. This increases the stability and longevity of the implant.
Revision surgery is easier in these patients, as the patient has good bone stock for the surgeon to work on.

This is a x ray of a cemented hip replacement. You can see the cement layer around the implant.

This is a x ray of a uncemented hip. Screws have been used to fix the acetabular component.

The only indication of total hip replacement surgery is painful osteoarthritis of the hip joint. The cause of the osteoarthritis can be manifold. Such as avascular necrosis, rheumatoid arthritis, ankylosing spondylitis, trauma, infections etc. All these conditions can eventually lead to the development of hip osteoarthritis. The diseases or conditions can be different but the end result is the same ie, osteoarthritis.

The only indication of a partial hip replacement is a fracture neck femur in a elderly person. This person has a life expectancy of 5 to 10 years and is required to move around in her/his house

Contraindications for hip replacement include the following

Infection in or around the hip joint such as an anal fistula or urinary tract infection.A well functioning painless arthrodesis (a condition in which the hip joint is fused eliminating all movement) of the hip joint.A well functioning painless excision arthroplasty (a condition in which due to tuberculosis, infection or a late presenting fracture neck femur the head and neck of the femur are surgically removed and the patient is put on vigorous physiotherapy so that a pseudo joint is formed between the pelvis and remaining part of the upper end of the femur) of the hip joint.Uncontrolled diabetes mellitus, heart disease, lung disease, neurological disease, vascular disease and other systemic diseases that make the surgery very risky for the life of the patient.

Before under going hip replacement surgery your doctor will see and document the following things

he will assess the amount of disability by asking about day to day activities including activities that require squatting or sitting cross leggedthe requirement of a walking aidexamine the hip for stability, pain, range of motion and amount of shortening of the limblook for any previous surgery around the hipmeasure the degree of movement in the hip joint and the presence of deformitieshe will exclude other causes of pain such as arthritis of the sacroiliac joint and spine and pain due to vascular or neurological causeswill look for muscular weakness, sensory loss and palpate the pulses in the limbask about the presence of any systemic disease such as diabetes mellitus, hypertension, liver disease etcinquire about any addiction such as smoking or alcoholism

Investigations that will be under taken before hip replacement include the following

Complete blood countrenal function testsliver function testsurine analysisassessment of cardiac and respiratory function by a specialist or through testsassessment of bone mineral density for osteoporosisx rays of both the lower limbs in standing position from the hip to the ankle joint, taken in two planesA CT scan or MRI of the hip may also be required

After all the investigations are complete the surgeon will plan the hip replacement surgery. The planning can be done over the radio-graphs of the patient or by taking their tracings. Now templates of the implant are used to determine which size of the implant will be required and how much the bone has to be cut.

Anesthesia used is of two types

General anesthesiaRegional anesthesia

The choice of anesthesia depends on the patient, the surgeon and the anesthesiologist. Regional epidural anesthesia is preferable because it can provide pain relief for up to 2 hours before surgery. This results in less use of morphine based drugs for post-operative pain control.

After anesthesia the patient may be turned and placed on his side or may continue to lie straight. It depends on which position the surgeon is comfortable with. A brief description of the surgery is given below.

A incision is applied on the side of the upper part of the thigh centered over the greater trochanter of femur. After the skin and subcutaneous tissue have been cut a sheet of tissue is exposed that is the fascia lata.This is then cut in the middle longitudinally.This exposes the greater trochanter of the femur along with its various muscular attachments.At this juncture the surgeon has two choices. He can either expose the hip joint by cutting the anterior capsule in front or by cutting the posterior capsule behind.If he goes in front then he has to tag and cut part of the tendon of the gluteus medius muscle.If he goes behind then he has to tag and cut the external rotator muscle tendons.After the capsule has been cut the hip joint is dislocatedNow the arthritic head of the femur and the acetabulum can be visualized.The bone spurs and dead bone is removed from the head and acetabulum.Either the acetabulum or the femur can be prepared first.The acetabulum is prepared by by removing the cartilage and bone tissue till a bed of bleeding bone is obtained.After the acetabulum has been prepared it is packed with a sterile mop.Now the femur is prepared by cutting the neck at a predetermined level and removing bone from the neck and the upper femoral canal with a special instrument called a reamer or rasp. This creates a cavity that mimics the shape of the femoral stem of the prosthesis.Every implant manufacturer provides trial components which are duplicates of the original implant that is to be inserted. These trial components are now inserted in the bone. The hip is relocated and stability and range of motion is assessed. If the surgeon is not satisfied then the trail components are changed till a satisfactory size is obtained.Now the final implants of correct size are removed from their sterile packs and implanted into the prepared femur and acetabulum with or without cement depending on the type of prosthesis being implanted.A final check of stability and movement is done.Drains are inserted to remove collected blood and tissue fluid.The incision is closed in layers beginning with the capsule, then muscles and tendons, then fascia lata and finally the subcutaneous tissue and skin.

Now the operated person is shifted to a post-operative care ward. Vital signs are monitored and kept stable. Here he or she is kept for 24 hours. The drain is removed after 24 to 36 hours.

Movement of the limb is started. Exercises of the hip and knee are encouraged. Walking with or without support is usually allowed from the third or fourth day.

Complications can be of two types

Immediate complicationsThromboembolismInfectionNerve injuryFracture of femur boneLate complicationsDislocation of the hipLoosening of the implant

Thromboembolism is the formation of blood clots in the veins of the lower limbs and their subsequent dislodgement, migration with blood and obstruction of the pulmonary arteries that take blood to the lungs. This is a potential fatal complication with a reported incidence of 0.1 to 1%. It is more frequently seen in the following conditions

female sexage above 40 yearsobesitydiabetes mellitussmokingvascular heart diseaseprevious thrombosis episodes

Many methods are used to prevent this complication which include

compression stockingsfoot pumpsanti-coagulant drugs such as low dose warfarin, low molecular weight heparin and aspirin

Infection is another important complication that can occur. The incidence is less than 1%. Infection can be prevented by Good cleaning and disinfection of the operation theater with the use of formalin fumigation, UV light and vertical laminar air flow.Keeping the operation theater personnel as minimum as possible and preventing their movement in and out of the theater.Using prophylactic antibiotics.Fast and precise surgical technique

More chances of infection are present in persons who have the following conditions

Diabetes MellitusLow grade persistent infection such as ear infection or urinary infectionPrevious surgery on the hip jointObesityRenal failureCancerSkin diseases such psoriasisare Smokers

Nerve injury can occur following hip replacement. It is usually the results from excessive retraction or wrong placement of a tissue retractor.

Fracture of the femur can also occur. This is seen if the bone is damaged during surgery and in osteoporosis. This is very rare.

Dislocation of the hip can by trauma or by trying extremes of movement early after the surgery. It is more common when the surgical approach is from behind the hip joint.

Loosening of the implant is seen in 5 to 10% of hip replacements after 15 to 20 years. It occurs due to the absorption of the bone around the artificial hip. The cause of this loosening is not clear but it is thought to occur from the release of plastic debris from the acetabular component of the artificial hip.

There have also been instances of loosening of the artificial hip, dislocations and pain due to faulty implants. These have resulted in earlier than expected revision surgeries. If you have these problems then you can click here to know more.

Treatment of loosening is by revision surgery with bone grafting and use of hip implants which promote in-growth of bone around them.

How long does if take to fully recover from hip replacement surgery?

Full recovery can take 3 to 6 months. Physiotherapy is essential for full recovery.

What can be done to enhance the life of the artificial hip?

Best way to increase the longevity of the artificial hip is to minimize the intensity of load that acts across it by

reduce weight if you are over weight or obeseavoid excessive jumping, running, squatting and climbing too many stairsprevent or treat osteoporosis

I hope the information provided was useful. If you have any query you can ask me at the contact me page.

This page was updated on 22th April 2011.

Causes of hip pain...

Hip osteoarthritis

Avascular Necrosis of Hip

Hip Fracture

Perthes Disease

Congenital Dislocation of Hip

Hip Anatomy

Go back to Hip Pain from Hip Replacement

View the original article here

Elbow Fracture in Children

Elbow fracture in children includes two important fractures that occur around the elbow joint. One of these is the fracture of the lateral condyle of humerus and the other is the Supracondylar fracture. Here on this page we will learn about the fracture of lateral condyle of humerus. Supracondylar fracture can be seen by clicking here.

Lateral condyle elbow fracture in children occurs by a fall on the hand which creats a force that tends to wedge open the elbow joint. The lateral collateral ligament of the elbow joint becomes taut and pulls the lateral condyle of the elbow along with it as the force continues to act, resulting in the fracture. See the red arrows in the graphic. They show the direction of the force.

Classification of this elbow fracture in children is on the degree of separation of the bone fragments.

Type 1 are undisplaced or minimally displaced fractures are those with less than 2mm gap between the fractured bone parts.Type 2 are displaced fractures with greater than 2mm gap.Type 3 are displaced fractures along with rotation of the bone fragment.

Symptoms include pain, swelling and inability to move the elbow joint following injury. In undisplaced fractures the symptoms are mild whereas in displaced fractures they are more severe. There may be a delay in diagnosis of undisplaced fractures because the symptoms are mild. This may result in the fracture being labeled as a elbow sprain.

Diagnosis is confirmed by taking a x ray of the elbow joint. A x ray of the opposite normal elbow may be required for comparison in very young children, because the bone is mainly cartilaginous and does not give a clear picture on x rays.

Treatment depends upon the classification of the fracture.

Type 1 fractures are treated by immobilization of the fracture in a plaster splint.Type 2 fractures are treated surgically. Stainless steel pins are used to stabilize the fracture under fluoroscopy.Type 3 fractures are also treated surgically. A incision is given over the elbow. The fracture is exposed and aligned in proper position and stabilized with stainless steel wires.

The above x rays show a Type 2 fracture. The red arrows show the fractured condyle.

This is a x ray of a Type 3 fracture. The black arrow points to the fractured lateral condyle.

Many complications can occur after this fracture. They include the following

The fracture may fail to unite or there can be considerable delay in healing of the fracture. Failure to unite is called non-union. Many times this non-union can remain asymptomatic or may result in some weakness when performing unusual and demanding activities.
It can also result in increasing deformity of the elbow joint called as cubitus valgus.
In cubitus valgus the forearm and hand is shifted more outward as compared to normal. If this deformity is progressive then it can cause paralysis of the ulnar nerve.Some children may develop the opposite deformity called cubitus varus in which the forearm and hand are shifted inwards more than normal.Excessive bone formation may occur around the elbow joint causing limitation of motion.Avascular necrosis or death of bone tissue following disruption of blood supply to the lateral condyle may develop. This usually occurs when extensive surgical dissection is required to align the fracture fragments.

These are x rays of a child who sustained a type 3 fracture (red arrow). His father was not ready for surgery so a reduction of the fracture was done. Next x ray was taken after the reduction. You can see that it has now changed to a type 2 fracture. About 2 weeks later I was able to convince him for surgery. The last x ray is of the fracture after surgery. You can see the two steel pins holding the fracture in aligned position.

This is a x ray of a 2 month old lateral condyle fracture. The fracture was treated by a quack who applied a plaster cast for 1 month. The patient came to me 1 month after removal of plaster, when the father noticed a bony lump and decreased movement in the elbow joint. It is a type 3 fracture. You can see that the fragment (enclosed within red semi-circle) has rotated by 90 degrees. To realign the fracture we had to rotate the fragment clockwise and push it, so that the yellow arrows overlap each other. Due to shortening of the ligaments (green line) there was difficulty in re-aligning the fracture. Only after release of the ligaments (green line), were we able to achieve a satisfactory reduction.

Below is the post-operative x ray. Some gap remained. This was filled with callus (new bone which is formed to heal a fracture) obtained from the fracture site. See black arrow. Some deformity will persist, but hopefully fracture union will occur. This is the best that could be done without compromising the blood supply of the fragment.

How long does it take for an elbow fracture in children to heal?

The fracture usually takes 3 to 4 weeks to heal.

How can complications be prevented?

If your child has sustained an elbow injury. However innocent the injury may look you should take him/her to the doctor and get the elbow region x rayed. These fractures are known to be missed. A diagnosis of elbow sprain is made and the fracture goes untreated leading to complications.

I hope the information provided on elbow fracture in children was helpful. If you have any query you can ask me at the contact me page.

This page was last updated on 18th March 2011.

Another important elbow fracture in children is Supracondylar Fracture

Other causes of elbow pain...

Tennis elbow

Golfers elbow

Olecranon bursitis

Olecranon Fracture

Radial Head Fracture

Elbow dislocation

Pulled elbow

Little leaguer's elbow

Elbow Joint Anatomy

Elbow Fracture in Adults

Go back from Elbow Fracture in Children to Elbow Pain

View the original article here

Knee Fracture: Diagnosis, Classification and Treatment

Knee fracture or fractures of the knee joint can include the following

Here on this page we will know about fractures of the lower end of femur that are called Supracondylar and Intercondylar femur fractures.

The lower end of the femur bone is broad and forms two curved structures that are called condyles. The one located on the inner side is called medial condyle and the one on the outer side is called lateral condyle. In the front the condyles are united with each other. Behind they are separated by a space called the intercondylar notch.

The supracondylar area of the femur is the part that lies between the condyles and the shaft of the femur. Intercondylar area is the part between the two condyles.

In young adults these fractures result from high energy injuries such as road traffic accidents. In the elderly they occur following a minor fall with the knee joint flexed in weak osteoporotic bone.

Symptoms include the following

Patient will give a history of a fall or accident.Severe pain and swelling will be present.Deformity is seen in the thigh or knee.Inability to lift the leg and inability to walk.The ankle and the toes can be moved freely unless there is a neuro-vascular injury along with the fracture.

In elderly people there may not be much pain and swelling. History of injury may also be vague. Inability to walk and lift the leg should alert us to the possibility of a fracture.

Diagnosis of the fracture can be easily made with x rays of the knee joint taken in two planes. At times it is difficult to understand the fracture pattern on x rays. In such conditions if is advisable to get a CT scan with three dimensional reconstruction of the fractured knee. This greatly helps in planning of definitive treatment.

These fractures are classified in three types based on the pattern of the fracture. They can be Extra-articular or supracondylar in which the fracture does not extend to the knee joint line.Partial-articular or condylar in which the fracture extends to the knee joint line but part of the condyles remain attached to the femur shaft.Complete-articular or intercondylar in which the fracture extends to the knee joint line but the condyles are completely separated from the femur shaft.

Treatment of knee fracture is decided by the classification of the fracture along with the degree of displacement, which can be either displaced or un-displaced.

All un-displaced knee fractures can be treated by a groin to toe plaster cast. This cast is applied for a period of 6 to 12 weeks depending on the age and general condition of the patient. Early removal of the cast followed by the application of knee brace is advisable. This allows movement of the knee while maintaining fracture alignment. When to remove the cast and apply the knee brace has to be decided by the treating doctor.

During cast treatment it is essential to repeat x rays every 10 to 15 days as these fractures can displace within the cast. Maintaining fracture alignment in a cast is more difficult in obese people.

All displaced fractures are treated surgically. Surgical fixation of the fracture can be done with either screws only, a plate and screws or a nail.

Extra-articular or supracondylar fractures are usually treated with a nail.Partial-articular or condylar fractures are usually treated with screws only.Complete-articular or intercondylar fractures are usually treated with plate and screws.

Common complications seen with knee fracture include the following

Loss of knee movement. This is seen more in partial-articular and complete-articular fractures, delay in surgery and after cast immobilization.Non-union or failure of the fracture to unite. This is seen more in the extra-articular or supracondylar fractures.Arthritis of the knee joint following fracture healing in a wrong position or due to damage of knee joint cartilage at the time of injury.InfectionDeep-vein thrombosisHow much time does it take for the fracture to heal?

Most fractures heal enough within 8 to 12 weeks so as to allow walking.

How can loss of knee movement be prevented?

Loss of knee movement can be prevented by

Stable and strong surgical fixation of the fracture allowing early postoperative mobilization of the knee joint.Meticulous handling of the skin and muscles around the knee during surgery so as to minimise scar tissue formation.

How long does it take to reach the activity and strength level as before the fracture?

Any fracture results in muscular weakness, and muscles take time to recover. For quick recovery stimulating the muscles in a organised and goal oriented way is essential.

With out physiotherapy it can take 8 months to a year to reach the the pre-fracture level of muscle power and agility.

If you want to return quickly to the pre fracture level of activity following a knee fracture you need an intensive physiotherapy program.

This above is a CT scan of a young male showing a complete articular knee fracture. This fracture was sustained in a motor cycle accident. The patella bone was fractured in multiple pieces and so had to be removed. The remaining femur pieces were stabilized with a locking plate and screws as shown in the x ray below.

The x ray shown below is of a 70 year old male with severe osteoporosis and a extra-articular fracture that he sustained when he slipped on the way to the bathroom. When I first examined him there wasn't much swelling and he was not complaining of much pain. His inability to lift the limb alerted me to the possibility of a fracture. He was treated by the insertion of a titanium nail. A knee brace was used in the post-operative period.

I hope the information provided was helpful. If you have any query about knee fracture you can ask me at the contact me page.

This page was last updated on 25th January 2011.

Other causes of knee pain include...

Knee Osteoarthritis

Knee Bursitis

Meniscal Injury

Ligament Injury

Patella Fracture

Tibial Plateau Fracture

Osgood Schlatter Disease

Knee Anatomy

Knee Replacement Surgery

Go from Knee Fracture to Knee Pain

View the original article here

Ganglion: diagnosis and treatment

Ganglion is a small swelling filled with thick, viscous and clear fluid usually located around the wrist joint.

It is more common in females and can appear any time between teenage and sixth decade. Back of the wrist is the favored site.

It feels tight. Tenderness may be present. Skin over the swelling moves freely. Mild to moderate pain may be present. It is fixed to the deeper structures but not to bone. At times the ganglia may disappear spontaneously.

Ganglia formation is thought to be the result of a developmental defect in the capsule or tendon sheath.

Diagnosis is by clinical examination and history.

Treatment includes the following methods

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was last updated on 30th March 2009.

Other causes of wrist pain...

De Quervain Disease

Carpal Tunnel Syndrome

Scaphoid Fracture

Wrist Fracture

Madelung Deformity

Wrist Anatomy

Go back to Wrist Pain from Ganglion

View the original article here

Trigger Finger: Causes, Diagnosis and Treatment

Trigger finger can be

congenital (since birth)acquired

Before reading further it would be good to first see Finger Anatomy (skip if you have already done so).

First we shall see the acquired type which is commonly seen in adults around the age of 45 years. It can result from overuse of the hand or no obvious cause may be present.

Other causes of acquired type include

collagen diseases such as scleroderma and Sjogren's syndromerheumatoid arthritisosteoarthritis

Symptoms include

following flexion the finger extends with a jerka nodule can be palpated near the distal palmer creasethe nodule moves with finger movementpain is present over the nodule

Snapping of the finger occurs when the covering of the tendon becomes constricted. Following this constriction a nodule develops in the tendon. The sliding in and out of this nodule through the constriction causes the snapping.

Diagnosis is by clinical examination. Investigations are hardly required.

Treatment of the acquired type includes

injection of steroid into the involved tendon sheath (I have had good results with this technique)surgically cutting the constricted sheath to allow free movement of the tendon

Surgery is only done when there is no improvement after steroid injection or the triggering recurs after a single injection of steroid.

Congenital Trigger Finger or Thumb

This condition is more common in the thumb and involves both sides in 1/4 patients. It has been found to be associated with trisomy 13 (triplication of chromosome 13)

Only abnormality evident is persistent flexion posture of the involved digit. No snapping is present.

In about 25% patients it is detected at birth in the rest it is diagnosed within 2 years of age.

In 30% patients spontaneous resolution occurs. Rest require surgery.

Surgery should be done within three years of age as beyond this age chances of permanent deformity increase.

Is there any medicine that can be effective in trigger finger?

Anti-inflammatory medicine can be given. I have found that it reduces pain and tenderness but has no effect on snapping.

Can it recur after surgery?

Yes it can. Adequate release of the tendon sheath can prevent it.

How long will I have to stay in the hospital after surgery?

You can be discharged on the same day.

When will I be able to use my hand after surgery?

As soon as the pain permits. Your doctor will encourage active use of the hand.

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was last updated on 13th March 2009.

Other causes of finger joint pain...

Finger Fracture

Finger Amputation

Glomus Tumor

Paronychia

Mallet Finger

Swan Neck Deformity

Boutonniere Deformity

Kirner Deformity

Felon

Bowlers Thumb

Thumb Dislocation

Go back from Trigger Finger to Finger Joint Pain

View the original article here

Cocktails That Improve Your Skin: As Bogus as It Sounds

 

Quite some time ago I wrote a post about how taking expensive supplements aimed at helping you have great skin are a waste of your money (see my post Nutritional Supplements and Your Skin for more information).  Yet I was still surprised to come across the following article recently in The New York Times,  Improve Your Skin by Imbibing: Radical or Fadical?, in which the author describes a bunch of cocktails at an exclusive club in NYC that claim to even out your skin tone or diminish fine lines.  Now wouldn’t that be nice – to have a cocktail and get glowing skin as a bonus?  I found the article very funny for a few reasons.  One was the complete enthusiasm and idiocy of the guy who help create the drinks that include his “crystallines” of vitamins, minerals and fruit extracts.  I mean really – does he really believe throwing back a bunch of drinks with a few added vitamins will improve anyone’s skin?  Apparently yes.  The fact that anyone considers this a true way to help improve the look of one’s skin made me snicker. 

Before you think that perhaps there is some truth to this club’s claims that drinking their cocktails will make you look like a super model remember the following – alcohol will dehydrate your skin and can give some people undereye circles and puffiness.  As long as the alcohol stays in those expensive cocktails no one’s skin is going to be looking any better.  Luckily the article ends with a good dose of real fact from Dr. Patricia Wexler, a celebrity dermatologist based in NYC.  She explains:

that alcohol actually had a dehydrating effect, and that it could lead to puffiness, especially if plenty of other, nonalcoholic fluids weren’t consumed along with it.

As for the notion that a measured amount of alcohol in a carefully composed elixir could turn back time, “Nothing in a cocktail will give you younger skin,” she said in an e-mail. “But your judgment might be impaired, and you might see Angelina in the mirror.”

So if you happen upon a cocktail in your neighborhood club that promises to fight acne or make your fine lines disappear just remember that this cocktail won’t make you look better, but it can, as any alcoholic drink can, make you feel better.  Bottoms up!

View the original article here

Nail Health

 

I can’t remember the last time I got a manicure though recently I did try those Sally Hansen real nail polish strips which say they last 10 days.  Mine lasted about 4 days which made me sad since they did look cool when they were on (I tried the bright flower pattern), and when I went to remove the strips I literally had to scrape/file the nail polish off my nails with a nail file.  Regular nail polish did not remove the strips at all even though that is what the manufacturer said would work.  It was so time-consuming to remove the strips, and my nails were left looking horrible – all beat up and scratched up.  Such a disappointment.  So there went my experiment with those nail polish strips.  I’ve also learned from lots of trial and error that it is best to get professional pedicures during the summer instead of trying to paint my own nails.  The professional pedicures always look better and last longer than any DIY pedicure.  Anyhow, I started thinking more about nails since I scheduled my first pedicure of the season for this week.   My problems with getting the right manicure and pedicure are nothing compared to having real nail problems.  So how does our health affect our nails?  And what is the best way to take care of our nails?

What Our Nails Tell Us About Our Health

It fascinated me to learn how much our nails can reveal about our overall health.  Before I give some explains I think it is important to point out that the growth cycle of a nail is six months.  And what exactly make up our nails?  In her book The Beauty Bible Paula Begoun explains (pages 376-377 , 2nd edition):

 Physiologically speaking, the nail is simply a protective covering composed of dead cells filled with a thick protein called keratin, quite similar in essence to the hair.  Although the part of the nail you can see is dead, the matrix (the part of the nail under the skin) is very much alive.  The white crescent area of the nail is called the lunula and is part of the matrix.  The nail grows out from the matrix and as the growth of new cells build up and dies it is pushed forward and out toward the surface.  The cuticle is the protective layer of skin between the outside environment and the matrix.  Keeping the cuticle intact is perhaps the single most important element in preserving the health of the nail.

It turns out that a lot about your nails is genetically predetermined so you cannot alter the why your nails naturally grow just as you cannot alter how your hair grows.

Ok so what can our nails reveal about our health?  Concave, spoon shaped nails, or koilonychia, can show that you have an iron deficiency.  Those white horizontal line that you sometimes have on some nails but not others?  That is called a Beau’s line and shows that the nail actually stopped growing during a period of physical or emotional stress.  Even a case of the flu can cause those lines to form.  Even the shape of your nails can be informative about a health issue.  Some people have nails’ whose tips are curved and slightly bulbous.  This occurs in people who don’t have enough oxygen reaching the tips of their fingertips because they smoke or have congestive heart failure.  This is actually almost like having a scar.  If the person stops smoking or is able to improve their heart condition their nail shape will change.  If your nails are discolored, for instance blue-gray, that could mean that you suffer from a collagen vascular disease or are having a negative reaction to medication. 

 Brittle and peeling nails are chiefly caused by wetting and drying your hands and nails.  Chronic exposure to harsh detergents, water, toluene and formaldehyde in nail polish, and harsh nail polish remover solvents can stress our nails once again making them brittle.  Genes and diet definitely play a role in nail health as do medical conditions (as illustrated above).  And of course many people add to their nail problems by biting and picking at their nails when they are stressed, anxious, or bored.

According to an article in the Fall-Winter 2010 issue of New Beauty - pages 46-48 (New Beauty used to put issues of their magazine online but no longer do which is too bad in my opinion):

If your nails have white spots then you may have a vitamin or mineral deficiencyIf your nails are brittle and separate easily from the nail bed, you may have a thyroid conditionIf your nails are thin and concave, then you may have an iron deficiencyIf your nails are overly thick or flakey you may have a fungal growthWhen nails have a yellow case to them, it can be from a variety of causes, and a common culprit is dark nail polish. …  But, if you don’t regularly wear dark shades and your nails are yellow, it may be the sign of a health condition.  Discolored nails can hint toward fungal infections, psoriasis, diabetes or liver, kidney or lung conditions that require medical attention.

Suffice it to say, if your nails don’t look right go see a doctor immediately to have them checked since your nails could be revealing a larger and more serious health issue. 

What Can or Cannot Help Your Nails

Can using a product on top of your nails help them grow or make them stronger?  Sadly no.  You cannot change the way your nail grows by applying a topical product.  In order to see a real change in the health or appearance of your nails you need to either treat a health problem or perhaps tweak your diet.  Remember that no matter what a manufacturer claims neither topical applications of fluoride or calcium will improve your nail health.

According to Dr. Amy Wechsler in her book The Mind-Beauty Connection (page 159):

Contrary to popular belief, our nails do not contain much calcium, so supplementation, while good for our bodies, may not help our nails.  In fact, vitamin and mineral deficiencies are rare causes of nail problems.  More often than not, brittle nails are caused by excessive exposure to harsh soaps, irritants, polish remover, and the wetting and drying of nails (all typical of a busy, kitchen-maven mom).  Brittle nails can also be seen with medical conditions like psoriasis, fungal infections, and thyroid problems.  Age also factors in, and the older you are the more likely your nails will become brittle.

That said, one little nutrient that may help give your nails a boost is biotin.  Found abundantly in foods like cauliflower, peanuts, and lentils, biotin is absorbed into the core of the nail, where it may encourage a better, thicker, nail to grow and prevent splitting and cracking.  In one study, people who consumed 2.5 milligrams of biotin daily had marked increases in nail thickness after six months.  To get this much biotin, ask your doctor about taking it in supplement form.

Nail Care 101

Wear gloves when washing dishes and doing house workApply hand cream frequently and especially after you wash your handsDon’t soak your nails for long period of timeDon’t use your nails as tools to open things such as letters or anything elseAvoid nail polish with toluene and formaldehyde and nail polis remover with acetone

Sources and Further Reading:

View the original article here

Teens and Tanning Beds

Hopefully you don’t know a teen who uses a tanning bed, but the scary thing is that too many teens do use tanning beds since they are completely unaware of the dangers involved with their use.  Once a teen starts tanning it is really hard to get them to stop (it has even been proven that tanning is addictive which is very scary).  The US lags behind other nations in banning the use of tanning beds by teens; for instance the UK has banned the use of tanning beds by anyone under the age of 18.

According to The Skin Cancer Foundation:

Despite a link between indoor tanning bed use and an increased risk of melanoma, the deadliest form of skin cancer, 2.3 million teenagers visit tanning salons every year. In the spring, many tanning salon patrons are college students getting ready for spring formals, and high school students gearing up for prom season. So it’s no surprise that melanoma is now the most common form of cancer in young adults 25-29 years old, and the second most common form of cancer in adolescents and young adults ages 15-29.

“The damage caused by the ultraviolet (UV) radiation from tanning beds and the sun is cumulative and often irreversible, and the earlier people start to tan, the higher their risk of developing skin cancer in their lifetimes,” said Perry Robins, MD, President, The Skin Cancer Foundation. “In fact, melanoma risk increases by 75 percent when indoor tanning begins before age 35.”

If the threat of skin cancer isn’t enough to scare young people away from tanning salons, they should know that 90 percent of visible skin changes commonly attributed to aging are caused by exposure to UV radiation. Tanning accelerates the signs of aging, including wrinkles, leathering and fine lines, which can be seen as early as in one’s twenties.

Despite the fact that The American Academy of Pediatrics supports a ban on the use of tanning beds by minors it is still legal for teens to use tanning beds.  The Skin Cancer Foundation points out:

In the US, tanning is regulated by the states, some of which allow children as young as 14 to tan. The US Food and Drug Administration (FDA) classifies UV-emitting tanning machines as Class I Medical Devices, meaning that it considers them to “present minimal potential for harm to the user.” Last year, the General and Plastic Surgery Devices Panel of the FDA’s Medical Devices Advisory Committee unanimously recommended that the FDA upgrade its classification of tanning devices to better reflect the serious health risks tanning machines pose. The majority of the panel was also in favor of an age restriction to limit minors’ access to UV tanning devices.

So until the FDA and/or the federal government ban the use of tanning beds by minors what can you do to prevent teens from using tanning beds?  First and foremost, I think education is key.  If scaring a teen with the risk of cancer isn’t enough to get them to stop using a tanning bed appeal to their vanity by explaining that they are aging their skin tremendously by using a tanning bed.  If you want to do even more write to the FDA and/or your senator or congressperson asking them to support a ban on tanning bed use by minors.  Recommend to a teen who really likes how their skin looks tan to get a spray tan or fake a tan with a home applied tanning lotion.  There are a tremendous number of products on the market in all price ranges so there is really no excuse not to try one if you like the way your skin looks tan.

If any of the above tactics don’t stop the teens you know from tanning have them hear a personal story about the dangers of tanning beds.  I found this story on the FDA website:

Brittany Lietz Cicala of Chesapeake Beach, Md., began tanning indoors at age 17. She stopped at age 20 when she was diagnosed with melanoma, the deadliest form of skin cancer. The former Miss Maryland says she used tanning beds at least four times a week, and sometimes every day.

“Growing up, until I started using tanning beds, my parents were very strict about me wearing sunscreen,” says Cicala. Although she also tanned in the summer sun during her 3 years of tanning bed use, Cicala estimates that 90 percent of her UV exposure was in tanning beds during this period.

In the 4 years since she was diagnosed with melanoma, Cicala’s surgeries have left her with about 25 scars. Cicala gets a head-to-toe skin exam every 3 months, which usually results in removal of a suspicious growth.

Sources and Further Reading:

View the original article here

The Lowdown on Facial Moisturizers

And How to Choose the Right Moisturizer for Your Skin

A while ago I published a post called Moisturizer Myths  which explained, among other things, the fact that a moisturizer will not get rid of your wrinkles.  Now that I have published that post I decided that it would be helpful to explain how to find the right moisturizer for your skin type.

Right off the bat I want to state that it is actually relatively easy to find a good moisturizer without breaking the bank.  The keys to finding the right moisturizer for your skin is to figure out which formulation is best for you and to find the right ingredients that will benefit your skin the most.

Why a Moisturizer?

In her book The Mind-Beauty Connection Dr. Amy Wechsler makes some great points about moisturizers (pages 31 and 32):

Moisturizers are like aspirin: minimiracles that we take for granted.  While they won’t have an effect on wrinkles per se, they do help protect skin from dryness, chapping, and weathering, and keep it smooth, soft, and healthy.  And a good moisturizer will do more for you than drinking twenty glasses of water per day.  Drinking water does not necessarily make skin moist.  If you’re truly dehydrated your skin can turn dull and peaked, but it’s the moisturizer applied directly to the skin that will keep water from evaporating and give your skin a healthy, dewy appearance.  …It’s important to note that even though moisturizers won’t necessarily affect how the skin functions at the cellular level (that is, they won’t change the production level of collagen and repair of tissue damage), they are an excellent way to keep the skin hydrated, replenishing the natural moisture elements in the upper layers and bolstering the barrier function of the skin.  Yes, that smooth, dewy appearance is temporary but if you moisturize frequently you keep that glow turned on.

Moisturizer Formulations

If your skin is dry:  look for a cream or lotion moisturizer that is oil based.  A rich, creamy formulation is perfect for your skin.

If your skin is oily or acne-prone:  if your skin is feeling tight you can definitely moisturize oily and/or acne-prone skin.  Look for light-weight lotions, gels, serums, or even hydrating mists that are water-based.  Make sure the formulation is oil-free and says either “won’t clog pores” or “non-comedogenic” on the label.

If you have sensitive skin:  look for a water-based lotions and creams that are labeled “fragrance-free”, “for sensitive skin”, or even “hypoallergenic”.  Try to get a moisturizer that doesn’t contain a ton of ingredients.

Moisturizer Ingredients

No matter what your skin type your moisturizer should contain antioxidants.  The number of antioxidants out there is becoming mind-boggling, and I truly don’t believe that one is better than another.  What is important is to apply antioxidants to your skin either in your moisturizer or in an antioxidant serum or both.

All moisturizers contain two types of hydrating ingredients: humectants and emollients.  Humectants attract water to our skin while emollients seal moisture in our skin by forming a protective barrier.  Emollients act as a lubricant on the surface of the skin keeping the skin soft and smooth.  Humectants increase water content in the skin stopping the evaporation of water from the surface of the skin; they can feel more heavy and greasy.

Additionally other moisturizer ingredients are ceramides and collagen.  Once again I’ll quote Dr. Wechsler (pages 31 and 32 in her book):

Ceramides are lipids naturally found in the skin’s top layer of the epidermis, alongside other fats such as cholesterol and fatty acids.  Their chief role is to keep moisturize in the skin, and they have been used to treat eczema, as studies show that people with eczema have significantly fewer ceramides in their skin.  Collagen can help give the illusion of smoothness, but don’t be fooled into thinking that rubbing a collagen-containing moisturizer on your face will suddenly help your skin’s natural collagen.  Large collagen molecules cannot penetrate the skin’s deep layers, so they remain on the surface and do not have an effect on how the skin performs.

Humectant Ingredients Include:

hyaluronic acid (for more information about hyaluronic acid see my post all about this ingredient)

Emollient Ingredients include:

coconut, jojoba, and sesame oils

More good moisturizer ingredients to look for:

cocoa butter (this isn’t good for acne prone skin)stearic acid and other fatty acids

How to Find the Right Moisturizer for You

There are tons of good moisturizers out there.  Finding the right one is just a matter of personal preference and budget.  Some of my favorite moisturizers come from Skinceuticals, PCA Skin, Dermalogica, and Glotherapeutics.  Some good budget buys are Neutrogena, Aveeno, and Eucerin.  But really that is just scratching the surface of what is out there.  For even more recommendations see Paula Begoun’s Beautypedia or read The Skin Type Solution by Dr. Leslie Baumann.

Does Your Daytime Moisturizer Have to Have Sunscreen In It?

Anyone who reads this blog with any consistency knows that I am a sunscreen fanatic so my answer to the above question my surprise you.  I actually don’t think that your daytime moisturizer needs to have a sunscreen in it.  I always want everyone to have a separate facial sunscreen that it at least spf 30.  I believe this for a few reasons.  First off, I am never convinced that people use enough of their moisturizer in the morning to actually get adequate sun protection.  As the seasons change and the weather gets warmer many people don’t need to use moisturizer as much and this is exactly when you need that facial sun protection more than ever.  If you are going to apply too much a one thing to your face let that be sunscreen.  You probably won’t want to reapply your moisturizer throughout the day, but you’ll need to reapply your sunscreen.  For those reasons I always advise people to have a separate moisturizer and sunscreen.  Also if your moisturizer doesn’t have sunscreen in it you can use the same one morning and night.  So in case you were wondering – no you don’t need a different morning and evening moisturizer.  If you want both a daytime and nighttime moisturizer go for it, but it isn’t a necessity.  If you still want to get a daytime moisturizer with sunscreen be sure the moisturizer has at least spf 30 and is a broad spectrum sunscreen which means it protects you from both UVA and UVB rays.

Sources and Further Reading:

View the original article here

Does Anybody Really Know What Fibromyalgia Is?

It seems like the only people who know what Fibromyalgia is are those who suffer from it. People know the name, but until it comes “a knockin” its not relevant to most of us. It’s truly a mystery disease, and as such, is completely misunderstood.
Actually, Fibromyalgia is not a disease, but is a syndrome. So what is the difference, you might ask? Well, a syndrome is a group of problems, not an individual disease. Fibromyalgia took years to be recognized. It was ignored and misunderstood, and there are still doubters who consider this syndrome a legend more than accepted disease entity.

So what are the Symptoms of Fibromyalgia?
Fibromyalgia is characterized by the presence of multiple tender points and a constellation of symptoms.

Pain
The pain of Fibromyalgia is profound, widespread and chronic. It knows no boundaries, migrating to all parts of the body and varying in intensity.

Fibromyalgia pain has been described as stabbing and shooting pain and deep muscular aching, throbbing, and twitching. Neurological complaints such as numbness, tingling, and burning are often present and add to the discomfort of the patient. The severity of the pain and stiffness is often worse in the morning. Aggravating factors that affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.

Fatigue
In today’s world many people complain of fatigue; however, the fatigue of Fibromyalgia is much more than being tired. It is an all-encompassing exhaustion that interferes with even the simplest daily activities. It feels like every drop of energy has been drained from the body, which at times can leave the patient with a limited ability to function both mentally and physically.

Sleep problems
Many fibromyalgia patients have an associated sleep disorder that prevents them from getting deep, restful, restorative sleep. Medical researchers have documented specific and distinctive abnormalities in the Stage 4 deep sleep of Fibromyalgia patients. During sleep, individuals with Fibromyalgia are constantly interrupted by bursts of awake-like brain activity, limiting the amount of time they spend in deep sleep.

Other symptoms
Additional symptoms may include: irritable bowel and bladder, headaches and migraines, restless legs syndrome (periodic limb movement disorder), impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, vision problems, Raynaud’s Syndrome, neurological symptoms, and impaired coordination.

It is estimated that it takes an average of five years for an Fibromyalgia patient to get an accurate diagnosis. Fibromyalgia affects an estimated 10 million people in the U.S. Fibromyalgia affects predominantly women (over 80%) between the ages of 35 and 55. Rarely, fibromyalgia can also affect men, children, and the elderly. For some, the onset of Fibromyalgia is slow; however, in a large percentage of patients the onset is triggered by an illness or injury that causes trauma to the body.
So does anybody really know what fibromyalgia really is? No one is exactly sure what causes it, it comes in many forms with many different symptoms, cloaks itself with other diseases, and can take up to 5 years to be sure you have it! No wonder it is one of the most misunderstood of diseases. Whoops, did I say diseases?—I guess I meant syndromes….

View the original article here

Doctors Recommend Trying Arthritis Supplements First

Arthritis can either be a minor nuisance for some or completely debilitating for others. Whether it’s Osteoarthritis, Rheumatoid Arthritis or one of the hundred other types, arthritis effects people in the joints. It could be as minor as tenderness or stiffness of the joints or complete inflammation and eventual deterioration of the cartilage, bone and ligaments.

If your Arthritis is minor many doctors will recommend starting out with a natural supplement. Supplements can help treat your Arthritis with out all the harsh side effects that come along with Arthritis medication.  For instance, NSAID (Nonsteroidal Antiinflammatory Drugs), can cause nausea, vomiting, headache, fluid retention, ulcers, or in extreme cases kidney or liver failure. Elderly patients are at greater risk. Common NSAIDs include brand names like Aspirin, Aleve, Motrin, Relafen, Celebrex, and Voltaren.

At Medicinenet.com, Dr. William C. Shiel Jr., MD, FACP, FACR, wrote about trying out a supplement for two months before trying other treatments. Notable arthritis supplements with glucosamine, chondroitin, fish oils and/or omega-3 have all been shown to relieve pain, decrease stiffness and reduce inflammation. Another less know supplement ingredient, Cetyl Myristoleate, has been shown to lubricate joints and therefore reduce stiffness and pain. Supplements can be a great alternative to harsh medications and are worth testing out first. For those who have tried medications and don’t like the results or side effects, supplements can be an option since they are all-natural products.

View the original article here

Online Chat Discussing Osteoarthritis & RA

In May the nationally ranked Department of Orthopaedic Surgery and Department of Rheumatic and Immunologic Diseases are presenting two free live online health chats to the public.  Both web chats will feature Cleveland Clinic physicians and will last for 60 minutes. They will allow users to submit questions to the doctors to get answers during the event.

Ask the Arthritis Doctor

On Tuesday, May, 19, at noon (EST) Elaine Husni, MD, MPH, will discuss diagnosis and treatment of osteoarthritis and rheumatoid arthritis.

Joint Replacement

On Thursday, May 28, at noon (EST) Peter Brooks, MD, and Viktor Krebs, MD, will discuss joint replacement and resurfacing options in the knee and hip.

To see a complete list of all upcoming online health chats from Cleveland Clinic, please visit us at

http://www.clevelandclinic.org/webchats

Don’t miss these free live chat events with specialists in arthritis and joint replacement options

View the original article here

Does Exercise “Prevent” Arthritis?

A study released earlier this year in Australia shows that exercise may actually act as a preventative for the stiff, achy joints that accompany arthritis. According to an article recently published in the Journal of Arthritis Research & Therapy, exercising as little as one hour and 15 minutes a week now can make a difference over the next three years. Although the study was performed on women only, it can be assumed that the same benefit results in men. More women than men suffer from arthritis, and the risk increases greatly with age.

The study suggests the more time older women spend exercising, the better their chances are of staying pain-free from one of the biggest chronic conditions plaguing developed countries - arthritis! Doctors have long encouraged exercise among aging patients to keep joints flexible, muscles strong and to keep off weight, which is a leading risk factor for arthritis, but this is the first study that focuses specifically on middle-aged and older women who did not have a previous history of stiff and painful joints. Women in their 70s who exercised 75 minutes a week reported fewer symptoms of arthritis than those who did less, while more spry women who were active at least 2 1/2 hours weekly had even less pain in the three years that followed. The study was performed on more than 8,700 Australian women over a three-year period.

Doctors have long encouraged exercise among aging patients to keep joints flexible, muscles strong and to keep off weight, which is a leading risk factor for arthritis. “I don’t think the results are suggesting that you should just become this maniac exerciser,” said lead author Kristiann Heesch from the University of Queensland, Australia. “What it does suggest is that just adding some walking and moderate activity to your life can make a big benefit.” “Maybe the exercise directly benefits the joints. Maybe exercise makes you lose weight and the latter benefits the joints. Maybe exercise causes pain sensing receptors to become less sensitive so one feels less pain,” said Dr. John Hardin, chief scientific officer at the Atlanta-based Arthritis Foundation, who did not participate in the study.

Arthritis is on the rise, one in five American adults has been diagnosed with it. Fully half of those over the age of 75 have reported it. In both the United States and Australia, arthritis is the No. 1 cause of disability. It is clear that exercise is a contributing factor to relief of arthritis pain. Simple exercises like swimming, walking, aerobics and other action-oriented leisure activities can surely help keep you away from the harmful steroidal prescriptions, that doctors customarily prescribe to mask the pain of arthritis. And since exercise helps keep the weight off, this reduces the strain placed on joints each day.

So as you approach your forties, fifties and beyond, pick up your equipment, put on your sneakers, and get in motion! This study shows clearly that you’ll regret it in a few years if you don’t!

View the original article here

The Frustration of Sports Injury Pain

Injury and pain are a competitive athlete’s worst nightmare, ruining even the best-laid training plans. And when injuries become chronic, they can destroy confidence and even end athletic careers. But a revolution is taking place in our understanding of pain, which has profound implications for the treatment and rehabilitation of many chronic injuries.  With more than 10 million recreational sports injuries occurring every year, as an athlete, you know that the pain associated with old injuries is one of the greatest barriers to your success.

Being able to manage pain can give you a competitive advantage over those who do not know how to apply these valuable skills. Even if you’re not an athlete, the feeling of physical pain can detract from your overall feeling of well-being and can have negative effects on your work performance. It can also prevent you from sticking to a long-term exercise plan.

View the original article here

Gout Risk Linked to Genetic Genes

A study led by a team of scientists in Scotland suggests that genes may play a part in increasing one’s risk of developing gout. The presence of the gene variant appears to impede the ability of the kidneys to filter uric acid from the bloodstream. The level of risk that a person has for gout will depend on which form of the gene they may have inherited.

The study was published in the March 9th online issue of Nature Genetics and is the work of researchers based at the MRC Human Genetics Unit, Western General Hospital, Edinburgh, Great Britain.  The researchers studied the genes of more than 12,000 people and found that a gene variant may increase or lower the risk of a person developing gout. The gene variant in question is called SLC2A9, already known to scientists as a transporter of fructose. This study found the variant also plays a key role in transporting uric acid.

Professor Alan Wright of the MRC Human Genetics Unit and colleagues found that between 1.7 and 5.3 per cent of the variance in blood levels of uric acid was explained by the presence of this gene variant in a Croatian population sample, and that SLC2A9 was also linked with low levels of uric acid excretion and/or gout in population samples from the UK and Germany.

Researchers hope this discovery will lead to the development of improved diagnostics for the condition. The traditional view of gout is often associated with historical stereotypes of overindulgent people who eat and drink to excess, but in reality this often not the case.

There also appears to be a link between this study and another one that suggested excessive drinking of sugary soft drinks also increased the risk of gout, since the gene variant that appears to control the ability of the body to remove uric acid from the blood is the same one that transports fructose, a sugar often found in soft drinks.

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Temporary Relief for Arthritis Joint Pain

In addition to medications and supplements there are many methods to provide temporary  or short term relief for joint pain flare ups. These methods also help make it easier to exercise. Discuss these methods with your doctor before starting.

Moist Heat - Use hot packs, warm towels, a bath or shower for 15 to 20 minutes three times a day. Talk to your doctor or therapist about deep heat from short waves and ultrasound. Deep heat can not be used however can not be used on acutely inflamed joints.Cold - Try a bag of ice or even a frozen vegetables wrapped in a towel to reduce swelling for 10 to 15 minutes at a time. Caution, people with Raynaud’s phenomenon should not use this method.Hydrotherapy - Exercise in a pool can decrease the pain and stiffness because it takes the weight off your joints. Some people find that the heat and gentle movement of whirlpools are good at relieving joint pain.Mobilization Therapies - These include traction (gentle, steady pulling), manipulation (using the hands to restore normal movement to stiff joints) and massage. When done by a professional physical therapist or massage therapist these can help control joint pain add joint motion and provide muscle and tendon flexibility.TENS - In TENS (trancutaneous electrical nerve stimulation), electrodes are placed on the skin and an electrical shock is transmitted through them. These machines can be costly, ranging from $80 to $800. The treatment is time consuming, yet the unit can be worn throughout the day and turned on and off during the day.

Details provided by the National Institute of Health. Join the forum discussion on this post - (3) Posts

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An Exercise a day keeps the nightmares away.

Statistics show that nearly 74% of americans have problems sleeping and the average adult gets less than 7 hours of sleep a night. A full NREM sleep cycle consists of 5 stages spanning a total of about 90 minutes so for an average person to get the recommended 7.5 hours of sleep they will get 5 full sleep cycles. How does this tie back to exercising? There are several factors or inhibitors that happen during the course of a day that can impact your sleep cycles and even the length of sleep you get each night.

Exercising and sleep aren’t mutually exclusive. Exercising can have a big impact on how well and how long you sleep. For instance exercising within 3 hours of bedtime can speed up your heartrate and metabolism which in turn increases brain activity and can cause you to have a harder time falling asleep. Conversely exercising earlier in the day or earlier at night can actually help you fall asleep faster and stay asleep longer. Studies have shown that exercise has a direct impact on sleep and on average people that exercise will get in a full night uninterrupted sleep and go through all 5 stages of sleep.

Deep sleep or REM sleep is the 5th stage in the sleep cycle and accounts for almost 25% of your total sleep during the night. Research has shown that stress, anxiety, irritability are a leading cause to nightmares. Exercise works to counteract those effects by creating endorphins that make you feel good, excited, rejuvinated. Nightmares have been shown to be directly affected by the addition of exercise into your daily routine. As well allowing you to get a full nights sleep and cut down on irritability and restlessness. Other factors can play a significant role in this like nicotine, caffeine or other stimulants that can effect the brain activity prior to bed.

Especially during the cold winter months and hot summer months a lot of people find it hard to get out and run or exercise 30 minutes or more a day. Often during the winter people find they have a harder time sleeping because of the lack of activity they get during a day. Something as simple as walking, following an instructional video, yoga program or even running on a treadmill or elliptical 30 minutes a day can provide great rewards for someone both physically and mentally. With summer approaching and the weather changing outside we encourage everyone to try and spend 30 minutes walking, jogging, riding bike, running or just playing a sport and see how it can help you personally.

Also for comedic relief getting in shape will enable you to run away from those monsters in your dreams or fight off the evil villain if you do get them.

Happy Exercising and Peaceful Dreams.

This entry was posted on Tuesday, May 3rd, 2011 at 2:06 pm and is filed under Fitness Tips, General, Health Tips. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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Planning a Fitness Competition at Work

The biggest loser competitions in the workplace are becoming a big craze with a lot of companies.  Inspired by events like the biggest loser TV Show and the Nike Plus competitions, but which one is best for you and your company? How easy are they to setup and manage? We have some helpful tips on how to create a competition that is both fun and helps you get in shape.  

There is one question you need to ask yourself before starting these competitions. What are you trying to achieve, losing weight or being in better physical condition?  These are two things people tend to lump together but they aren’t interchangeable.  As many of you know, 65% of your body comes from water weight and an average person can fluctuate 5lbs on a daily basis depending on how much water the drink or don’t drink, so simply going on the number of lbs lost can be deceiving.  Most weight loss competitions can focus around fasting or depriving the body of the nutrients it needs and it can destroy muscle and not necessarily help you lose fat.  That is why on the surface these types of weight loss challenges are ineffective at achieving their ultimate goal, to make their employees healthier, happier and give them more energy. 

Any challenge you do should be centered on working out or burning calories and not simply losing weight.  Come up with an exercise to focus the competition around.  Many companies choose the Nike Plus running challenge which is pretty simple to get started.  Weather you walk, run, inside or a treadmill or outside it’s a challenge anyone can take part in.  The hard thing is how do you track the progress and keep people honest.  That is the great thing about the Nike Plus or the Garmin Forerunner, they track your mileage for you.  Nike also has a website where anyone can sign up a team or challenge and imports their statistics.  Or there are some new age treadmills and elliptical machines that use iFit Live and you can track all your statistics directly on the screen and send to your facebook or any page created to track.   You base the competition around the amount of miles or time that a team completes in a certain time frame or you can even do it by the number of calories burned.  The end goal is that you will lose fat, but in the process build muscle and get your endorphins flowing.

If that isn’t the challenge for you, and you can’t handle the running, you can also base a competition around a specific fitness or workout videos.  P90x and Insanity are the two big ones on the market today but you can go with any of the ones out there that do circuit training or use aerobic activities.  Teams can either train/workout together or do it individually and track by total time you spend doing these exercises or measure by the amount of calories you burn.  You can get a cheap sport watch that shows calories burned for any given time or exercise and you can log it.  The goal is to make the tracking as simple as possible or most people will forget or neglect to log it.

Another option is to focus a challenge around healthy eating. This is going to have to be based on the honor system for it to work.  You can lay out a regime that everyone has to follow for example.  No fast food and anyone that eats fast food will lose 3 points. For every day you don’t eat fast food you get 1 point.  For every bag of junk food you open or put your hand in you lose 3 points and for every day without eating you get 1 point.  You can apply this to all things like Soda, Snacks, Preservatives, Frozed foods, canned foods and the list goes on.  There are extreme benefits to eating healthier and it doesn’t need to revolve around losing weight for the sake of cutting weight. 

The ultimate goal is to build this program off some sort of reward that will incent everyone involved to really try to compete.  Even if that is just for bragging rights or their name on a trophy or for some companies a few hundred dollars. I recommend anyone interested in doing these types of challenges that you consult with your HR representative first, usually they are more than receptive and usually willing to sponsor an event of this type.  Most companies know the advantage of healthier employees, the more money they save and better productivity they get from those employees.  As always be sure to consult with a doctor or professional before starting any challenge like this if you aren’t properly conditioned.

Good luck with your Company’s Fitness competition.

This entry was posted on Wednesday, April 27th, 2011 at 2:33 pm and is filed under Elliptical Machines, Fitness Tips, General, Health Tips, Treadmills. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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Running With Flat Feet

In a recent study it found that almost 25% of the American population has flat feet, and almost 43 Million American’s suffer from foot problems. For most people that have flat feet or (low arches) it’s extremely hard to exercise on a daily basis, and extremely difficult to run for extended periods of time. There are several ways to combat this with the use of orthotics or insoles for your shoes, but does that alleviate all your issues?

In the course of running for 1 hour you put upwards of 1 million pounds of pressure on your heels, ankles and feet. Orthotics alone are not meant to combat the affects that running can have on your feet, and are intended more to alleviate normal pains during walking and normal daily activity. So what can you do to help reduce the pain, but also be able to exercise and stay healthy?

There are several alternatives. When running on hard surfaces such as concrete or pavement you incur much more resistance than you would have running on grass or dirt surfaces because hard surfaces like pavement have no give, and add more stress to your bones and joints. Running on surfaces like an asphalt track or treadmill can cut down the impact by upwards of 50% and reduce almost 500,000lbs of pressure during a 1 hour workout. So what does this mean? For those of you that don’t want to have reconstructive surgery on our feet you can invest in machines that drastically cut down the impact our feet take during a workout. Also the use of non-impact machines like elliptical trainers or stair machines can help your impact problems because you aren’t going through the same range of motion and continuous pressure with landing, planting and pushing off.

There are a lot of Treadmills (ones that have Im-pression Shock Absorption Cushioning System)

www.Smoothfitness.com/treadmills

Ellipticals with Rear Drive (to reduce necessity to plant/pushoff causing less impact on bones and joints)

www.SmoothFitness.com/Ellipticals-Machines/

This entry was posted on Thursday, April 28th, 2011 at 4:53 am and is filed under Elliptical Machines, Fitness Tips, General, Health Tips, Treadmills. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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