Knee pain: causes and tips to manage knee pain

The knee is the largest joint of the body and is made up of upper and lower bones that are separated by two discs known as menisci. While minor knee pain may be experienced by many people, it should be handled with medical intervention when it becomes a serious and debilitating problem. Sudden injury or injury due to overuse as well as myriad conditions that affect the joints and muscles can bring about knee pain. Underlying conditions like osteoporosis or arthritis, which affect the bones and joints, can also cause knee pain. The symptoms include painful swelling and stiffness as well as severe discomfort. Let us learn more about the causes of knee pain and the ways in which it can be managed-

Injury: exercise and sports injuries are one of the most common causes that can be the start of acute knee pain, as well as chronic condition. These kinds of injuries can affect the ligaments and cartilage which leads to severe pain. The pain can even affect the way one functions in one's daily life. Knee ligament injuries can also cause this kind of pain. These ligaments are bands of tissues that connect the thigh bone with the lower leg bones. Sprains and tears in the acl or pcl are common in sports injuries, and may even require surgery in many cases. Knee cartilage tears can also take place in the hard yet flexible cartilage of the knee which can affect the meniscus around the knee. This condition may also require surgery.

Arthritis: this condition can affect the knees specifically and is one of the most common types of arthritis. This is a chronic condition which gets progressively worse over time and may even require surgery. Stiffness and inflammation are common symptoms. Rheumatoid arthritis is also a degenerative auto-immune disease that can affect the knees and cause knee pain. Furthermore, post traumatic arthritis can also be experienced after an injury. Osteoarthritis is another common condition that leads to knee pain. It basically occurs due to wear and tear of the knees over a prolonged period and is usually experienced by patients over the age of 50.

Managing knee pain: while pain medication and anti-inflammatory drugs may be prescribed for most cases, along with surgery in the long run, it is also possible to manage knee pain with the help of better lifestyle choices like regular knee and muscle strengthening exercises as well as rest - rest, ice, compression and elevation. These methods can help in relieving inflammation and pain. But very severe cases will require medical intervention, so it is imperative to get in touch with your doctor if the condition does not improve.

Knee Pain: Causes and Tips to Manage Knee Pain

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

Carpal tunnel syndrome is a painful one that is born from a strain on the median nerve, which loops through the wrist bone to connect it with the rest of the hand and fingers so as to promote motion. This condition can be a painful and debilitating one that usually starts at night, and affects the various fingers, especially the thumb and index finger. The symptoms include numbness, a tingling sensation, a weak grip, and the inability to do many tasks that involve the thumb and index finger. There are many ways of treating this condition with the help of physiotherapy, steroids and corticosteroids. There are easier ways of dealing with this issue on an everyday basis, as follows.

1. Wrist splint: it is a good idea to wear a wrist splint at night which will keep the bones and muscles stationary as the pain in this condition usually starts at night. This will also prevent further damage to the median nerve. 

2. Activity: keep your activity to a minimum to give your hand and rest, in particular, some much needed rest from the pain, numbness and tingling. Further, you need to avoid activities that cause too much pain and numbness. Also, take care to keep your thumb and wrist straight during other activities so that there is less strain on the median nerve.

3. Strength and flexibility: many times, the pain from the wrist and fingers can spread towards the arm as well. In order to prevent this and to treat the pain on a more long term basis, it is important to turn to some mild exercise which can make the area more flexible and strong. This can include wrist twists which can be done ten times for each hand. One can also try yoga to strengthen the joints in the upper body.

4. Ice pack: use an ice pack or ice compress on your wrist for ten to fifteen minutes each every few hours to help in relieving unbearable pain.

5. Anti-inflammatory medication: patients suffering from this condition can also turn to non steroid medication that will help in bringing down the inflammation. This inflammation is usually responsible to a great extent for symptoms like numbness and pain which can halt various activities. These drugs may include aspirin, ibuprofen, and even naproxen sodium. 

6. Taking breaks: one must take regular breaks at work and flex the fingers and the wrist so that the painful bending posture does not make matters worse.
 
Ensuring that you manage your everyday functioning despite carpal tunnel syndrome is a matter of balancing your activities with rest.

Easy Ways to Deal With Carpal Tunnel Syndrome

Radiology is a special branch of medical science that uses various techniques of imaging for the diagnosis and the treatment of several types of diseases in the body. The different types of imaging techniques used in radiology are X-rays, Computerised Tomographic scan (CT Scan), ultrasound, Magnetic Resonance Imaging (MRI) and nuclear medicine which includes Positron Emission Tomography(PET).

Role played in evaluating hip replacement
Hip replacement surgeries have become extremely common in the recent times, and radiological evaluation remains the mainstay of the overall hip replacement procedure. Thus, the role played by radiology is quite significant in such situations. All the specific anatomical landmarks and the measurements are used to make sure the placement is perfect during the hip replacement surgery. Radiological imaging helps in the assessment of the following conditions that are as discussed below.

The length of leg
The inequality in the length of the two legs is prevalent after a hip replacement surgery which can create a great deal of discomfort and inconvenience to the patients. A greater difference in the length of the two legs increases the chances of dislocation, and this is a situation where radiological evaluation plays a crucial role. With the help of radiological imaging, the length of the legs can be made almost equal.

The horizontal center of rotation
In this case, horizontal center of rotation helps in the assessment of the acetabular component of the prosthesis. This is calculated by the measurement of the distance between the center of the head of the femur and the acetabular teardrop. This distance should be bilaterally equal, and it is just not possible without the help of the imaging techniques of radiology.

Acetabular inclination
The acetabular inclination is the angle formed between the face of the cup and the transverse axis. If the angle is less, then it results in a stable hip, but the abduction is limited. On the other hand, if the angle increases then there are high chances of dislocation of the hip. Thus, with the help of radiological evaluation, proper and effective angular inclination is given which is optimum for the patient.

The stem positioning of the femur
The main aim of the stem positioning of the femur in a hip replacement surgery is placing the stem in a position which is neutral within the shaft. To get a proper idea of the positioning, the imaging techniques are of utmost importance which cannot be achieved perfectly without the imaging.

Thus, the crucial role the different techniques of radiological imaging plays during the overall procedure of a hip replacement surgery can be perceived. With the use of the different imaging techniques, the results obtained are closer to perfection.

How Radiological Evaluation Can Help In Case Of Hip Replacement?

A broken bone or a fracture can be painful and it requires medical attention for the fracture to heal properly. Proper healing is necessary for the right alignment of the bone. A doctor chooses to either reduce or set the bone in terms of new alignment. The bone reduction can happen manually or surgically depending on the severity of the injury. A Surgical procedure known as the open reduction internal fixation is performed for serious fractures. It ensures that the all the broken pieces are fixed together and the injury can heal properly.
Post the fracture, the bone need to be immobilised for proper healing. This is generally achieved by imposing a cast. For fractures that are not severe in nature, a doctor might choose to impose a temporary cast so that simple motion can happen around the site of the injury. For serious fractures, a permanent cast is placed around the injury site. In the case of a shoulder injury, a patient is required to wear a sling so that the bones are immobilised.


Time Duration of a Therapy Session:
While the exact duration of physiotherapy can vary from individual to individual, it takes a minimum of 2-8 weeks for the fracture to completely heal. Certain fractures take more time to heal. The rate of healing also depends on the severity of the injury, pain threshold level of the patient, extent of work with the physiotherapist, the robustness of the physiotherapy program, extent of the injury of the soft tissue and certain other factors. Typically shoulder and neck injuries heal quicker than a fracture of the legs. The time duration of fracture healing also depends on the type of bone that has been affected.


Physiotherapy in a Hospital:
If the fracture happens in the ankle or leg, a physiotherapist might have to intervene in the hospital in order to teach patient about using assistive devices such as crutches and cane. Things that are taught during this time include using the device in order to climb stairs, right walking posture, getting into a car, taking the device off while sitting and such other techniques.


Physiotherapy at Home:
Physiotherapy can also happen from home if the doctor specifically instructs to do the same. This is typically done for people where the condition is too serious to go outside and get the physiotherapy done. Certain weight bearing restrictions are imposed around this time. The training remains the same as in the case with a hospital.


In the Clinic:
Once the patient becomes mobile enough, a doctor might suggest a patient go to a clinic to get the physiotherapy done. A physiotherapist evaluates certain things such as pain, range of motion, gait, flexibility etc. of the patient before suggesting a certain exercise plan. 




How Long Do You Need Physiotherapy Post-Fractures?

Today  working  usually implies sitting at a desk from morning to evening. While this may seem more comfortable than working in the fields, sitting at a desk can trigger a host of back problems. This is because sitting in the same position all day makes the spine bend forward and lowers the efficiency of the back muscles. Working at a desk not only strains your back, but also restricts your movements to typing on a keyboard and moving a mouse. 

Once a back problem begins, it usually lasts a lifetime hence; here are a few tips to save your back.

Get yourself a good chair: Your chair is crucial to your back s health. Avoid the hard backed plastic chairs and pick a more flexible mesh backed office chair if you sit at the table for a long span of time. Ergonomic chairs may seem expensive, but are worth the expense in the long run.
Stretch your muscles: Sitting in the same position all day, puts the muscles under stress and with time can constrict the muscles. Make it appoint to stand up every 30 minutes and stretch your back and sides. Also try rotating your hips and shoulders form time to time.
Take a break: No matter how much work you have in front of you, take a break at the end of each hour. Taking even 2 minutes off out of 60 every hour can have a huge impact on your health. If you still feel guilty skip using the phone to connect with your colleague and walk over to their desks instead.
Get a pedometer: Keeping a pedometer will help you track the number of steps taken in a day. Ideally, a person should take 10,000 steps a day to stay healthy. If you sit at a desk for majority of the day, take every opportunity you can to up the count on your pedometer. Go for a walk around your office after lunch or park your car a little way off from the office to create opportunities to walk.
Take the stairs: As far as possible avoid escalators and elevators. Instead climb stairs for a quick workout. If your office is on the 20th floor, walking up may not be feasible, but you could get off the elevator on the 18th floor and walk up the remaining two floors.
Eat healthy: Lastly, pay attention to what you eat. Avoid eating at the office canteen or picking up a bite at the coffee shop and carry lunch from home. This ensures that you eat a balanced meal.

World Spine Day-6 Back Saving Tips for People Who Sit at a Desk All Day

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