Breaking a bone no matter how small is painful. This pain is caused both by the actual break in the bone and the damage to surrounding muscles, ligaments, nerves and other soft tissue. There are three stages of pain caused by a fracture:

Acute Pain: Pain that occurs immediately after a bone is fractured
Sub-Acute Pain: Pain experienced while the one and soft tissues heal
Chronic Pain: Pain experienced after the fracture has healed
Any kind of fracture can cause these types of pain. However, it is not essential for everyone who has had a fracture to experience all the three kinds of pain. Many people experience pain only when the fracture occurs but in few cases, a person may break a bone and not realize it. Each type of pain needs to be dealt with in a different way.

Acute Pain: Acute pain reduces as the fracture heals. For this, the fractured bone must be reset in place and held together with a splint, brace or cast so as to immobilize it. In some cases, surgery may also be needed. Over the counter pain medication is often prescribed to help deal with this type of pain. The patient is also advised to rest the broken bone and avoid certain types of movement that could worsen the break. A broken bone takes a minimum of 6 to 8 weeks to heal. However, in cases of other conditions such as osteoporosis, this time period could be much longer.
Sub-Acute Pain: As the injury heals, the sub-acute pain experienced reduces. Immobilizing a broken bone to help it heal causes the muscles and soft tissues around it to stiffen and weaken thus triggering this type of pain. Physical therapy can be very helpful in dealing with this type of pain. Along with strengthening the muscles and reducing stiffness, physical therapy also helps reduce inflammation and scar tissue. Physical therapy can be provided in many ways including exercises, electrical stimulation, ultrasounds, massage etc. It is important to remember that at this stage of treatment, the more the affected limb is used, the faster it will heal. However, it is advisable to avoid putting too much pressure on the bone.
Chronic Pain: Some people may experience pain for several months and even years after a fracture has healed. This is usually caused by nerve damage or the development of scar tissue. Underlying conditions such as arthritis could also trigger this type of pain. Management of chronic pain varies from individual to individual. Treatment usually takes the form of medication, exercises and physical therapy. It is important not to avoid this type of pain and consult a doctor to ensure that it is not being caused by any other condition.

Fracture Pain - How To Deal With It?

Rotator Cuff Tear is one of the most common disabilities observed amongst adults above 40 years of age. Rotator Cuff is a group of four muscles that keep the Humerus (arm bone) attached to the socket of the Shoulder. The Rotator Cuff keeps the Shoulder Blade attached to the arm, and when there s a damage (tear) in one of these muscles, excruciating pain is felt by the patient.

Kinds of Rotator Cuff Tear-

  Partial Tear: This happens when one of the Tendons amongst the four Tendons is damaged or torn.
  Full Tear: This occurs when all the Tendons are torn; this is also called Complete Tear. Severe pain is experienced in this type of tear and surgery might be required.

Symptoms-

  A person may experience excruciating pain while performing daily tasks like Combing hair, Picking up Laundry, etc.
  Muscle weakness and stiffness on Shoulder.

Diagnosis of Rotator Cuff Tear-

  Ultrasound is used to check the internal structure of the shoulder and the damaged muscle pattern. The waves directed into the shoulder create images of the Tendons and ligaments of the shoulder. This allows the doctor to access the severity of the damage on the shoulder.
  MRI: When the doctor needs a better look at the Tendon damage, radio waves provide a better imagery than Ultrasound.

Treatment of Rotator Cuff Tear-

  RICE (Rest Ice Compression Elevation): In Case of partial rotator cuff injuries with very little damage, RICE is a good treatment option to treat temporary partial damage in the shoulder. Applying cold water and moving the hands slowly helps the muscles to get into shape.

  Injections: Non-inflammatory drugs are prescribed to the patient suffering from Full Rotator Cuff injury to deal with the pain. A Tendon tear can cause extreme pain, which might give the patient some sleepless nights. Non-inflammatory painkillers temporarily numb the shoulder, allowing the patient to sleep.

  Physical Therapies: Physical therapy is one of the most sought out treatment option. Physical therapy allows a person to recover from a rotator cuff injury through exercises and mild movements of the arms and shoulders.

  Surgery: When the injury is too severe for conventional treatment and medication, a patient might have to go through some complex surgeries.

A) Arthroscopic Tendon Repair: In this surgery, the doctor makes a small incision on the shoulders and then inserts a Laparoscope type instrument (Arthroscope) into the muscles, with a camera attached on the top. This instrument allows the surgeon to see the muscle structure and also helps in re-joining the tendons.

B) Open Tendon Repair: Arthroscopic Tendon Repair can be a bit complex, that s why an open tendon repair is preferred by most doctors. In this surgery, the surgeon makes a bigger incision and attaches the Tendons surgically. 

Conclusion-
Rotator Cuff Tears is a severe problem for the locomotion of body, but it is treatable, as long as one doesn t delay going to an experienced doctor.

Rotator Cuff Tear - Know The Treatment Options!

Muscle contusion is a condition that is characterized by bruising in the muscles. It generally tends to occur in athletes who play a lot of contact sports. Repetitive blows in any part of the body may cause damage to the underlying muscle tissues. These blows may lead to internal bleeding, resulting in blood clot formation. The most common site where it occurs are the quadriceps.


The various causes of this condition are:
1. Direct repetitive blows to a part of the muscle in contact sports such as football
2. If you fall on a hard surface 
3. It may also occur if the muscle comes in contact real hard with sports equipments like soccer balls

The symptoms of a muscle contusion are:
1. You may experience swelling of the muscle
2. Excessive pain
3. Decrease in range of motion in the concerned body part
4. It may lead to leaking of blood vessels
5. You may also experience hematoma where a lump is formed over the affected spot
6. Symptoms of broken bones, dislocations and fractures may also occur

Complications
This disorder may also lead to various complications such as compartment syndrome, which leads to compression of blood vessels resulting in pain. 

Treatment
The basic treatment for this condition is the rice protocol which is rest, ice, compression and elevation. You should rest the muscle, then apply ice to the affected area to reduce the pain. You can also take nsaids (non steroidal anti-inflammatory drugs) to reduce the pain. In severe cases, the doctor may drain the lump surgically.


It is advisable to not return to your normal sports routine in order to allow the muscle to recover. If you carry on with your regular routine, it may result in further complications like the formation of scar tissue. You may undergo various stretching exercises to relieve the pain and make a gradual return to your normal sporting activities.


Causes and Symptoms of Muscle Contusion

Knee pain is something that can affect anyone - irrespective of their age. While sometimes it may be of minor importance - and can easily be handled by self-care, often, lingering pain is a manifestation of some other serious underlying problem, such as arthritis. In this case, it is imperative that you consult a doctor and take appropriate measures to combat it.

Causes :

Arthritis: The chief cause of lingering knee pain, arthritis itself can be of a number of types:
 Osteoarthritis, which is a result of deterioration of cartilages due to wear and tear
 Rheumatoid Arthritis, an inflammatory chronic disorder
 Septic Arthritis, causing pain, swelling and redness.
 Gout caused due to the development of uric acid crystals in the joints
Fractures: These are caused by the breaking up of the kneecap due to falls or collisions.
ACL Injuries: Caused due to the tearing of the anterior cruciate ligament (that connects the femur and the shinbone). Especially common in sportspersons such as footballers or basketball players.
Meniscus tears: The meniscus or the rubber-like cartilage (that acts as a shock absorber) can be torn by sudden jerks or excess pressure.

Symptoms:The major symptoms of knee pain include weakness, redness, instability, stiffness or the inability to properly straighten or move the leg. Often, a deformity is also visible, such as a bone sticking out of the leg - in which case it is advisable to consult a doctor immediately.

Possible risks :Factors which include the odds of being inflicted by knee pain and cause serious complications include :
Being overweight: This exponentially increases the stress or pressure that is applied on the knee joints - even in doing mundane tasks like walking up and down stairs.
Excessive physical activity: Some activities, such as sports apply excess stress on the knees as compared to other tasks.
Loss of muscle flexibility: Tightness or weakness in muscles causes increasing number of problems in the knees.

All About Knee Pain

The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.
Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in   Acute radicular pain due to irritation or inflammation.

Symptomatic herniated disc with failed conservative therapy
Acute exacerbation of discogenic pain or pain of spinal stenosis
Neoplastic infiltration of roots
Epidural fibrosis
Chronic LBP with acute radicular symptoms
Epidural- lumbar injection
ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

There is minimal or no radiological finding.
Multilevel imaging abnormalities
Equivocal neurological examination finding or discrepancy between clinical & radiological signs
Postop patient with unexplainable or recurrent pain
Combined canal & lateral recess stenosis.
To find out the pathological dermatome for more invasive procedures, if needed
Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Procedures That Can Help Treat Slip Disc & Sciatica!

Our body is a mechanical wonder and it is truly amazing how each part, from head to toe, has its own role to play. Our feet has one of the most complex mechanisms in the body. The way it works is just so intricate and fascinating! But, due to being so complex, there are a lot of things which have the potential to go wrong and cause a foot to begin to pain.

Taking into account the various troubles the foot can have, does it not make sense to learn what some of the causes are?

Sprains and strains are just so common when it comes to the causes of foot pain. That being said, there are quite a lot of people who do not really know how to tell the difference, exactly, between an injury such as this and something which is more serious. This is what causes a lot of terrible injuries to go untreated for quite some time, leading to them getting progressively worse.

While the name of the condition may be difficult, plantar fasciitis is the fancy name for a swelling up of a certain ligament and too much pressure is the reason behind it. The ligament is the one which is responsible for connecting the heel bone to the toes. When it comes to what is to be done in order to treat this sort of condition, the most important thing is to make sure the foot is rested to a sufficient extent. After all, it is too much use which got the injury to occur in the first place, right?

In addition to this, heel and foot stretches are of high importance and if the pain is very bad, pain relief medicines are to be taken, but a person should make sure that he or she does not become too reliant on these sort of medicines.

A stone bruise is something, which need not take place due to a stone, but the term does quite a good job of explaining why such an injury occurs in the first place. If a hard object is stepped on, it can cause an injury to the heel or to the ball of the foot. Again, in a case like this, it is important to rest the area. Also, applying ice to it will help it go away sooner than it normally would have.

A heel fracture may have similar causes to a stone bruise, but is more intense. Serious medical attention is required as it may not only break the heel but also cause related damage. A wheelchair or crutches are the way to go and a cast is required in most cases.

Understanding Foot Pain: Causes And Treatments

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