Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

Being diagnosed with cancer is something no one looks forward to and Gynaecological Cancer is every woman s worst nightmare. However, if diagnosed in time, it can be treated. Cancer in any part of a woman s reproductive system is termed as gynecological cancer. It is of five types:
Cervical cancer
Ovarian cancer
Vaginal cancer
Vulvar cancer and
Uterine cancer
Paying attention to your body and understanding its natural rhythm can help you recognize signs of gynecological cancer. This is because signs of gynecological cancer can be difficult to identify unless you know your body. Here are a five signs to watch out for-
Abnormal Vaginal Bleeding: Bleeding in between periods is okay once in a while but if it happens continuously over a period of 2 to 3 months, do not ignore it. Vaginal bleeding after menopause should also never be ignored. Abnormal bleeding could be triggered by a number of conditions including cancer of the lining of the uterus. Sudden changes in your menstrual blood that persist for over 2 cycles such as heavy bleeding can also be a symptom of uterine cancer. Heavy bleeding can be defined as a period that lasts for over 7 days.
Changes in the Vulva: Any change in colour of development of bumps, sores of thickened skin should be immediately shown to a gynecologist. Any form of vulvar itching or burning should also not be ignored. These conditions could be symptoms of vulvar cancer. Hence, it is important to know what your vulva looks like normally.
Bloating: Persistent bloating that lasts for over a fortnight can be a sign of ovarian cancer. This is especially true in cases of bloating accompanied by sudden weight loss or between-period bleeding.
Change in Bathroom Habits: Due to the proximity of the bladder to the reproductive organs, a tumour or swelling in the reproductive organs can trigger symptoms similar to those of a urinary tract infection. This includes pain while urinating, difficulty passing urine, diarrhea or constipation. Urinary incontinence could also a sign of gynecological cancer.
Abdominal or Back Pain: In rare cases, lower back pain could be a sign of ovarian cancer or uterine cancer. Pain in the lower abdomen or pelvic area can also be a sign of ovarian cancer.
The above could also be signs of other health disorders. The only way of knowing for sure is by consulting a doctor. Hence, understand your body and if you notice any of these symptoms consult your gynecologist at the earliest. 

Signs of Gynecological Cancer

Knee is a hinge joint where the lower leg bone tibia meets the thigh bone femur. During osteoarthritis, cartilage or ligament defects and degenerative arthritis, knee replacement surgery is recommended world-wide to get relief from extreme pain. Knee replacement surgery, also known as knee arthroscopy, is a surgical procedure, in which the affected knee joint is replaced with synthetic material. The most likely candidates for total knee replacement are the patients with severe destruction of the knee joint coupled with progressive pain and impaired function.

Modern technological advances have made computer assisted knee replacement surgery extremely popular around the globe. In this surgery, the surgeon is assisted by a computer to remove the optimum amount and angle of the bone, which otherwise is done by inspecting manually. This is an excellent example of surgery through small incision and it eliminates the chances of human error. A perfect alignment and balance is achieved and hence longevity is also increased to 20 - 30 years. Knee replacement surgery is also specific to gender as the anatomy of male and female patients is different.

There are many types of knee replacements, most common being the total knee replacement or Total Knee Arthroplasty. In addition, there is partial knee replacement, bilateral knee replacement, revision knee replacement and knee arthroscopy.

In knee replacement surgery, the worn out surfaces of joints of knee are replaced with artificial implant of plastic and metal. The lower end of the femur bone is removed and replaced with a metal shell. The upper end of the lower leg bone (tibia) is also removed and replaced with a channelled plastic implant with a metal stem. A plastic ball is also added under the kneecap depending on its condition. These artificial components are commonly referred as prosthesis. The design of these highly flexible implants replicate knee, with the rotating knee replacement implants assist in backward and forward swing of the legs.

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. Post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping.

Knee Replacement

Are you prone to slipped disc problem? + the ideal way to treat it

A slipped disc, also known as a prolapsed disc or herniated disc, is the term given to the phenomenon that occurs when a cartilaginous disc found between the vertebrae in the spine becomes slightly displaced or protrudes, thereby pressing on the nerves in the adjacent areas and causing back pain.
This happens when the soft inner part of the disc, known as nucleus pulposus, bulges out through a weakness in the exterior part of the disc. A prolapsed disc usually occurs in the lower region of the spine and can be of varying sizes. There might even be the development of inflammation around the disc in some cases.

Who is likely to get affected?
Most cases of herniated disc occur in patients between the ages of 30 and 50. The number of men affected is twice as many as the number of women.
Although the root cause of this problem is not yet known, there are a number of factors that may trigger it. These factors include working at a job that requires a lot of lifting, an occupation that involves remaining in a seated position for a long time, weight-bearing sports, obesity, smoking habits and increasing age.

Effective ways of treating the problem
The different methods that are commonly used to treat the problem are:
Medications
There are many different kinds of medicines that are effective in providing relief. These include painkillers, muscles relaxants, anti-inflammatory pills, etc.

Spinal injections
A number of spinal injections are used to treat slipped discs. The injection is done at the opening where the inflamed nerve roots are found and reduces pain, swelling and irritation in the area.

Radiofrequency ablation
This procedure makes use of an electrical current produced by radio waves to reduced pain and sensitivity in the affected area.

Ozone discectomy
As opposed to the surgical removal of the prolapsed disc, this new process makes use of an ozone-oxygen mixture that is injected into the spine to treat the problem. Many international studies have proved its superiority to traditional methods and surgeries.

Those affected by this problem are advised to keep exercising and continuing with their everyday activities as best as possible.



Why You Can Get a Slipped Disc Problem?

Knee pain or injuries are very common and have numerous causes. Knee pain can emerge from delicate tissue wounds like ligament sprains and muscle strains. Bone conditions like knee joint pain, Osgood Schlatters, and biomechanical dysfunction can also cause knee pain. Treatment can include basic knee mobilization techniques, taping, massages or knee strengthening exercises completely through a careful recovery method after knee replacement or reconstruction.

Physiotherapy can help you overcome the pain and increase your strength and flexibility. A physiotherapist can suggest you a number of treatments and also help you understand your issue and get you back to your everyday routine. Physiotherapists are said to be successful in getting rid of the source of the knee pain by diagnosing a cause. This includes tightness around the knee and treating it with stretching and exercises.

Following are some of the exercises a physiotherapist might generally recommend for knee pain:

Hamstring stretch: Stretching keeps you flexible and increases your scope of movement, or how far you can move your joints in different directions. It additionally helps you reduce your chances of injuries and pain. Continuously warm up with a five minute walk first. Lie down when you are prepared to stretch your hamstring. Circle a bed sheet around your right foot, use the sheet to pull the leg up and hold for twenty seconds and then lower the leg. Repeat twice and switch legs.
Calf stretch: Use a chair for balance. Bend your left leg. Step back with your right leg and gradually straighten it behind you. Press your left heel toward the floor. You should feel the stretch in the calf of your back leg. Hold for 20 seconds. Repeat twice and then switch legs.
Straight leg raise: It helps build muscle strength to give support to the weak joints. Lie on the floor. Twist your left knee, foot on the floor. Keep the right leg straight, toes pointed up. Tighten your thigh muscles and raise your right leg.
Quad set: With these, you don't raise your leg. Just tighten the thigh muscles, also called the quadriceps, of one leg at once. Begin by lying on the floor. Keep both legs on the ground, loose. Flex and hold the left leg tense for five seconds and then relax. Do three sets of ten repetitions. Switch legs after every set.
Cushion squeeze: This move strengthens your legs from the inside so that they can support the knees. Lie on your back, both knees facing inwards. Place a cushion or a pillow between the knees. Press your knees together, squishing the cushion between them. Hold for five seconds and then relax. Do three sets of ten repetitions. Switch legs after every set.
Heel raise: Stand tall and hold the back of a seat for support. Lift your heels off the ground and rise on the toes of both feet. Hold for three seconds. Gradually lower both heels to the ground. Do three sets of ten repetitions. 

Knee Pain - How Physiotherapy Can Heal Knee Pain?

The hand is one of the most commonly used parts of our body and is susceptible to damage, wear and tear as well as injury. Pain in the hand can be attributed to numerous causes, including damage and other conditions that can affect the joints, cartilage, nerves and other parts of the hand.

Causes

De Quervain's tendinitis: This is also known as de Quervain's tendinosis. It causes pain on the thumb side of the wrist. The pain may grow slowly or suddenly. It can also spread to every part of the thumb and up the lower arm. On the off chance that you have de Quervain's tendinitis, you may experience pain while performing the following actions:

- Clenching The fist

- Handling on or holding objects

- Turning the wrist

Treatment for this includes the following:

- Wearing a prop to rest the thumb and wrist

- Calming drugs

- Cortisone infusions

Carpal tunnel disorder: This is common amongst the well-known nerve issues. It can cause pain in the following parts of the hand:

- Palm and a few fingers

- Wrist

- Lower arm


The treatment methods includes the following:

- Resting the hand and wrist

- Painkillers

- Wrist support

- Steroid infusions

- Active recuperation

- Breaks

Fracture: It's a crack or break in a bone that can cause immense pain in the hand. Other than this, the hand may also experience the following:

- Stiffness

- Swelling

- Loss of proper motion and movement

The kind of treatment depends on the kind of fracture. Braces are usually used for small fractures. Sticks, wires, or plates might be used to treat severe fractures. Likewise, surgery may also be recommended to set the broken bone properly.

Arthritis: This is a disease causing joint inflammation and stiffness of the joints. It causes the joints to lose the ligament that permits them to move easily against each other. This tears the ligament, giving rise to crippling pain and swelling.

In the hand, the regions where this regularly happens are as follows:

- Base of the thumb

- Center joint of one or more fingers

- End joint, which is nearest to the fingertip

The treatment depends on the seriousness of the injury and the following may be used:

- Painkillers

- Props for the fingers or wrist

- Heat

- Non-intrusive treatment

Trigger finger: Also known as stenosing tenosynovitis, this defect causes the fingers or the thumb to bend. It can be difficult, particularly when bowing or fixing the influenced finger or thumb.

Knobs may form on the influenced ligaments. Also, the sheath itself may thicken. In the long run, the ligament may get to be adhered when you attempt to fix a twisted finger or thumb.

Resting now and again while wearing a support may help resolve the issue. Over-the-counter torment pharmaceuticals can facilitate the agony. Corticosteroid infusions can mitigate side effects. Surgery might be recommended for extreme cases.

Causes of Common Hand Pain and How to Find Relief

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