The Anterior cruciate ligament (ACL) is an important ligament that gives stability to the knees. An injury to this ligament can result in a host of complications and discomfort. Children or adults who are into sports such as gymnastics, volleyball, tennis, basketball, soccer, football, often injure this ligament. As per various studies and surveys, ACL injury is more likely to affect female athletes as compared to their male counterparts.

Depending on the severity and extent of the damage, an Anterior Cruciate Ligament Injury may be ranked on a grade of 3.

Grade 1 sprains indicate a mild injury or stretching of the ligament, seldom affecting the stability of the knees.
Grade 2 sprains are indicative of a partial ligament tear (the ligament loosen up). The damage is still under control.
Grade 3 sprains are extensive and severe, indicating a complete ligament tear (the ligament often breaks in two pieces). With a complete ligament tear, the stability of the knee is also affected (the knee becomes highly unstable).
What causes Anterior Cruciate Ligament (ACL) Injury?
While a host of sports activities mentioned above increases the risk of the injury, a person may also suffer a partial or a complete anterior cruciate ligament tear under the following situations.

A jump down a ladder, a tree, or a wall. An incorrect jump or a landing may be equally responsible for the ligament tear.
A collision or a hit, especially on the knee (while playing football).
Slowing down suddenly while still in running motion. A person suddenly stopping or missing a step can also injure the ligament.
Symptoms associated with ACL injury

An excruciating pain (especially in the back and outside of the knee) is often seen in people with a complete ligament tear (the movement is yet not affected). However, within a few hours, there may a swelling around the knee, indicating the severity of the injury with internal bleeding within the knee joints.
There may be restricted knee movement. The knee also feels unstable, further limiting the movement.
Sometimes a pop in the knee can be heard just at the time of the ACL injury.
Prolonged ACL injury left unattended can result in a painful complication such as knee osteoarthritis.
Diagnosis
To diagnose the extent of the damage, the doctor may suggest

Physical examination, including a quick brief about the case history.
Imaging tests such as X-rays and MRI can go a long way to analyze the ligament injury.
In the case of extensive swelling of the knees, the doctor may carry out an arthroscopy to have a closer look inside of the knee.
An accurate and timely diagnosis is important to avoid the aggravation of the injury. In the case of swelling and knee pain, consult a doctor, and get yourself thoroughly examined.

Anterior Cruciate Ligament Injury- Causes, Symptoms, and Diagnosis

Treatment of frozen shoulder varies depending on the stage it is at, and how severe is the pain and stiffness. There is no outright cure and the aim of treatment is to keep the joint as mobile as possible. The most effective treatment is that which maintains a good range of movement until the shoulder starts to heal. 

Treatment may Include the following:

1. Shoulder exercises: Regular, gentle exercise can help to keep the shoulder joint mobile. If your shoulder is very stiff, exercise may hurt, and it should only be carried out with the guidance of your doctor or physiotherapist. If you are able to, continue using your shoulder as normal saving' the shoulder can cause the muscle to waste and may make stiffness worse.
2. Painkillers: Over-the-counter painkillers such as paracetamol or prescription-only drugs such as codeine may be taken to ease pain and you should discuss this with your general physician or pharmacist.
3. Anti-inflammatory painkillers: Such as ibuprofen and diclofenac, are often prescribed to ease pain and inflammation. Any medication that you take should be discussed with your general physician or pharmacist.
4. Steroid injections into or near the shoulder joint may be effective at relieving pain and inflammation for a few weeks. However, injections are not a cure, and symptoms may return.


Treatment of frozen shoulder

When is your pain chronic?

Your pain is chronic if it last for more than a period of six months. Chronic pain is a long-term pain whose nature can vary from mild to excruciating, and it may trouble you either continuously or at short and regular intervals. Chronic pain is so dangerous that it does not only cause discomfort and inconvenience but also robs you entirely of your capacity to work for a long time.

Chronic pain can occur in a number of organs of the human body like head, joints, back, shoulders, neck etc. In fact, pain in any part of your body can turn into chronic pain. Here are a few symptoms that can help you identify if what you are going through is, in fact, chronic pain:

- persistent and severe body pain

- burning sensation accompanied by the body pain

- fatigue and sleeplessness

- weak immune system

- stiff and sore joints

The 4 types of chronic pain disorders that you should be aware of are:

1. Nociceptive pain

The pain that affects the soft tissues of the body such as the skin and the muscles or the organs that have sensory nerves present in them is called nociceptive pain. The sensory nerves, known as nociceptors can detect the stimuli of pain and send information to the brain and the spinal cord for interpretation. The pain could be either somatic (originating in the outer body) or visceral (originating in the internal organs).

2. Neuropathic pain

This pain is caused when the nerves stop functioning normally. It is caused due to nerve disturbances that result in pain stimuli being spontaneously transmitted to the brain and spinal cord. If you are suffering from this type of chronic pain disorder, you will feel a sharp, shooting and stabbing pain. Neuropathic pain can also be caused due to the formation of neuroma (abnormal growth of the nerve tissue).

3. Psychogenic pain

The pain that is caused by psychological disorders like depression and anxiety is known as psychogenic pain. Sometimes this pain can be accompanied by physical complications like fatigue, body pain and muscle weakness.

4. Idiopathic pain

The pain that exists even though there is no physical or psychological cause for it is known as idiopathic pain. This pain is more common in people who have suffered from a pre-existing painful disorder. Some common examples of idiopathic pain are fibromyalgia (intense pain all over the body) and tmj disorders (pain in the jaw area).

If you would like to consult with me privately, please click on 'consult'.
Related Tip: Why does PAIN occur? Understand the Mechanism of Pain

Your Pain is Chronic if it Falls Under These 4 Types of Chronic Pain Disorders!

Problems with the arteries and veins present in the hands or legs can lead to vascular disorders. The arteries carry blood from the heart to other parts of the body in order to deliver nutrients and oxygen. The veins carry the blood back to the heart, after the nutrients have been used up. If these blood vessels of the arteries or veins become blocked or narrowed, it can lead to a vascular blockage.

A vascular blockage that occurs in the hands or legs comes under the category of Peripheral Artery Disease or PAD. These type of disorders are less common in the upper extremities of the arms or hands than in the lower extremities of legs. Few of the signs for the same are:

Pain and difficulty in movement due to decreased blood flow
Numbness or weakness of leg or fingertips
Sores on the toes or feet
If the blockage is deep, symptoms of redness, swelling, extreme pain or cramping can be experienced
Abnormal color changes in the fingertips
Ulcers or wounds that don t heal
Skin sensitivity problems when in cold temperatures
How can it be diagnosed?
The blockage can be detected by various methods namely-

Physical Examination   Your doctor may find decreased pulse at armpit, wrist or fingers, full veins, masses, wounds or gangrene.
Doppler or Ultrasound examination to determine the blood flow in the arteries and veins
MRI Scan of the affected area to pay special attention to the blood vessels
Cold Stress Test
Arteriography to show clear blood vessel details
Angiography to map blockages and narrowing of the arteries
What are the Risk Factors for Peripheral Artery Disease?
An individual is at risk for developing vascular blockages in the hands or legs if one or more of the following factors are present:

Smoking
Diabetes
Heredity Factors   A personal or family history of blood vessel disease
High blood pressure
High cholesterol
Aging   People aged above 50 years and older are more prone to vascular blockage
Can it be treated?
Treatments for vascular blockage can vary depending on the age, cause of the blockage, intensity and overall well-being.

Treatments can include:

Self-care   Reducing risk factors and making lifestyle changes to quit smoking, sedentary life or diabetes, blood pressure and cholesterol management can reverse symptoms of vascular disease.
Medications   A variety of drugs can be prescribed to lower the risk and progression of narrowing blood vessels or prevent blood clotting.
Interventional Procedures   Minimally invasive surgery like saloon angioplasty, stenting or removal of artery plaque build-up.
Surgery   If the blockage is severe, surgery may be performed to lessen the vessel narrowing, reconstruct the artery or tie it off, depending on the circumstances.

Pain in the Hands or Legs!

Acupuncture is a kind of therapy that combines needles with pressure and pain points in order to delicately apply pressure for pain relief. This form of physical therapy is being increasingly recognised as an efficient method of treating pain in joints, muscles, bones and even for migraine pain. So let us find out more about Acupuncture and pain management.

    Chronic or Long Term Pain: There are many ailments that cause chronic or long term pain. These include back pain, neck pain, stiffness in the joints, osteoarthritis, headache and migraine, and pain in the shoulders. All this can be treated over a long period of time with the help of simulated acupuncture which uses pointed apparatus for activating better blood circulation for overall improvement in the pain that is being experienced in the area. The use of this apparatus helps in avoiding the harmful medication that can have adverse side effects.
    Menstrual Cramps: A fine needle method at the right points can help in bringing down the symptoms of the painful condition called dysmenorrhoea during menstrual cycles. With acupuncture, the acupuncturist can administer acupoint therapy to relieve menstrual cramps. This will help in moving the qi, or life force, in a better way so that the pain will stop. 
    Acute Pain: Over use of muscles, joints and repetitive, work related movements and strain can lead to acute pain. This includes wrist pain, shoulder pain, elbow pain, back pain, lower back pain, neck pain and even leg pain. With acupuncture, the patient gets rid of the pain in close to twelve sittings.
    Pain due to Cancer Treatment: Cancer and its treatment can take a heavy toll on the body and lead to a series of complications which also includes pain. A clean needle procedure can be followed along with the chemotherapy and radiation or after it, so as to relieve the patient of the pain experienced. Also, it can be used to replace traditional chemotherapy and radiation. 
    Better Rest: When the needles or apparatus touch the pressure points and circulate the blood and life force, it actually creates a soothing effect and helps the patient sleep and get better rest. This is also a requirement for pain relief. It can bring better blood flow to the area and help in removing anxiety and stress related to pain so that there is better chance of getting rest. 

With the use of acupuncture, pain can be taken care of with the needles and various tools that come in various shapes. These tools and equipment can also use laser treatment along with the point focused treatment.

Acupuncture and Pain Management

Repairing shoulder tendons through a telescope! When doctors talk about shoulder tendon repair, often they may be refering to rotator cuff surgery. The rotator cuff is a set of tendons and muscles that together form the cuff above the shoulder joint. The rotator cuff is responsible for stabilizing & keeping the arm within the joint, at the same time enabling the joint to move freely without any hindrance.

Thus it is responsible for maintaining strength of the shoulder. The tendons can become damaged due to injury or even overuse. When this occurs, the rotator cuff can be repaired with the help of surgery. Generally, a rotator cuff surgery makes use of an incision.

A shoulder arthroscopy, on the other hand, makes use of smaller incisions and repair is done with the help of a telescope.

Here are some of the commonly used techniques to repair a rotator cuff tear:

  When going for an open repair, the surgical incision is made and the deltoid gently moves out of the way making room to perform the surgery. Rarely an open repair method may prescribed for complex and larger tears or if any associated procedures are to be performed.

  In the case of the arthroscopy procedure, the small camera referred to as an arthroscope is put inside the small key hole incision that has already been made. The arthroscope, which connects to a video monitor, enables the surgeon to view the complete interior region of the shoulder. Further, few more incisions are made in order to allow insertion of various other instruments. During this surgical procedure, the damaged tissues are removed, or they are repaired depending on the damage levels. All of this is done with the help of an arthroscope.

Repairing the rotator cuff:

  In order to do so, the tendons need to be re-affixed to the bone.

  Small rivets referred to as suture anchors help to refasten the tendon and the bone. The suture is usually made of a special strong material that holds the repair for a long duration.

  The sutures are responsible for tying the tendon to the bone.

Why is this surgery recommended?

The physician recommends a rotator cuff tear or tendon surgery when the patient experiences pain while sleeping at night or faces difficulty carrying out daily physical activities, or when it has shown little improvement over the months in spite of exercising. This procedure is also recommended for people who lift heavy weights or are involved in sports activities. Moreover, the risks associated with this procedure are few and common to all surgical procedures.

A rotator cuff surgery performed arthroscopically has a very high success rate as it is performed under magnification. The procedure is far more precise than an open surgical procedure. Any associated injuries within the shoulder can be tackled simutaneously thus leaving very little room for errors. The recovery is therefore complete and faster due its minimally invasive nature.

Repairing Shoulder Tendons Through Surgery!

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