Bone cancer is a rare form of cancer in the cancer family. It affects one of the bones of your body and spreads to other bones. But, more often, it has the tendency to affect the long bone in the legs and the arms. There are many types of bone cancers. While some of them can affect children, the others typically affect the adults. This type of cancer is different than those cancers which get initiated from other parts of the body and spread to the bones.

What are the symptoms of bone cancer?
The typical signs and symptoms of bone cancer include acute pain in the bone, tenderness in the affected area, swelling of certain bones, a tendency of bone breakage, fatigue with little or no effort, unexplained weight loss, shortness of breath etc.

What are the causes of bone cancer?
There is no particular reason for bone cancer. Studies have shown that an error in the structure of the DNA leads to bone cancer. This error leads the bone to grow and divide in an uncontrolled manner leading to non-extinction of cells. These cells keep growing and form a mass invade to other parts of the body, leading to cancer.

What are the different types of bone cancer?
The type of the bone cancer can be distinguished from where cancer originates from. Some of the common bone cancer type includes the following:

Osteosarcoma: This is the form of cancer that originates from the bone cells and is often witnessed in young adults and children. They often attack the arm and the leg.
Chondrosarcoma: This form of cancer begins from the cartilage cells. The exact place of damage appearance includes legs, arm, and pelvis. This is typically observed in middle-aged persons in older adults.
Ewing's sarcoma: Though researchers are yet to find out the location this form of bone cancer originates from, it is mostly considered to affect the legs, arms, and legs of young children.
What are the risk factors?
While doctors are yet to researching for the exact reason of bone cancer, there are certain risk factors which have been associated with the bone cancers.

Inherited genetic syndromes: Certain genetic condition such as the hereditary retinoblastoma and Li-Fraumeni syndrome which are passed on from generations are a prime culprit of bone cancer.
Paget's disease: This is a bone-related disorder that affects the bone and increases the chance of bone cancer.
Radiation: Exposure to a huge amount of radiation increases the chances of bone cancer and other associated cancers.
How is bone cancer detected?
Imaging tests such as the bone scan, x-ray, MRI, PET scan and the CT scan can diagnose bone cancer. Apart from these, oncologists might order a biopsy that includes removing a part of the tissue and test the same in a laboratory can also help to detect bone cancer.

Bone Cancer - Risk Factors Associated With It!

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!

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

It is normal and alright to feel pain in the knees occasionally after a physical activity or prolonged walking. However, it is a serious cause of concern if the pain is experienced every now and then. Not responding to your knee pain for long can lead to the extreme disability. Knee pain does not crop up in a day and it may surprise you when it first appears. 

Initially, you may notice slight pain and discomfort. If you have identified knee pain at this level, managing it is easy. You can perform different exercises to prevent pain from occurring. If the pain severe, you need to go consult a doctor, who will then help identify the real cause of pain. The following exercises, along with medications, can help you overcome knee pain and restore the mobility of the joint.

Stair Step ups: Choose a comfortable stairway. Place your hand on the wall or banister. This is to ensure that you are balanced. Your left foot should be on the taller step. Your right foot should be on the ground. Stay in this posture for a second. Now, step back, and bring left foot to the right foot. Repeat this 6 times. Reverse the legs and continue doing for 6 times. If you want to take rest between the steps, feel free to do so.
Ups and Downs: You need an armless chair that is strong. Sit on the edge but comfortably. Your arms should be at your side, relaxed and loose. Sit erect and your feet should be flat. If you feel you need balance, and then cross your arms. Start standing up. This should not be instant but deliberate, controlled, and gradual movement. Stand slowly up to the full height, and hold on for 2 seconds. Again sit down. Repeat this 5 times.
Straight Leg Raise: This can be a part of your everyday exercise regime. This is a strengthening workout that does not put too much effort on the knees. Lie down on your back. One leg should be straight on the ground and the other one should be bent. Now, slowly lift the leg that is straight, and the toes should point upward. Raise your leg up to 30 degrees, but you can start with 15 to 20 degrees in the initial stage. Repeat 15 times and perform at least 3 sets of this exercise. Keep alternating legs. This workout strengthens the knees, thigh muscles, and the ankle joints, thus offering multifold benefits.
Wall Hamstring Stretch: Hamstring muscles too can be the cause of knee pain and discomfort. To strengthen the hamstring muscles and alleviate knee pain, this exercise helps a lot. Lie down on the floor flat. Your feet should be flexed. Choose a space that is close to a wall, or a sturdy table. Your right leg should be propped on the wall or table. If you don t prefer any, a resistance band is a good alternative. When stretching, you can find your flexibility level and when you feel that you have reached the deepest point, start relaxing. Keep alternating contracting and relaxing every 5 seconds. After 10 to 15 sets, you can try the same with the left leg.
Knee Rolls: Use an exercise mat or a carpet that is cozy. Lie on your back. Bend the knees, and ensure your feet are flat. Your arms should be stretched on the sides. Look at the ceiling, and hold the knees together. In the same posture, slowly roll the knees towards the right. When you feel a gentle twitch or after 5 seconds, move to original position. Then lower the knees to the left. Hold and release. For each side, repeat 10 times.
These exercises strengthen the knees and improve the quality of life by bidding bye to the pain. Understanding that these are magic remedies that work overnight is the key to stay focused and keep going without quitting.

Exercises That Can Help Relieve Knee Pain!

Facial paralysis is a loss of facial movement because of nerve damage. Your facial muscles may seem to hang or may become distinctly weak. It can happen on one or both sides of the face. Usual reasons for facial paralysis include:

Infection or swelling of the facial nerve
Head injury
Head or neck tumor
Stroke
Facial paralysis can increase all of a sudden or happen slowly over a span of months (mostly if one has a head or neck tumor). Based upon the cause, the loss of movement may keep going for a short or a long period of time. However, physiotherapy can prove to be very beneficial. Here is how:

1. Electrical stimulation: A few specialists suggest utilizing electrical stimulation and biofeedback as technique for physiotherapy for facial paralysis, yet different specialists believe that it does help in recovery. Talk with your specialist or advisor about whether electrical stimulation is ideal for you. Electrical stimulation uses little amounts of electricity to relieve the muscles in your face. This causes your muscles to jerk as though electrical signals from your brain reacted to them. During this time, your face is most incapacitated, which might be the main cause for you to enact these facial muscles.

2. Manual massage: Face rub can be performed in conjunction with other treatment choices. It is possible to enhance mental relief. Massage methods on the face include:

Effleurage
Finger or thumb massage
Tapping
Stroking
3. Kabat rehabilitation: Kabat recovery is a sort of engine control restoration procedure. During Kabat, specialists increase the compression of the weakened muscle by applying a global stretch and then massaging the solid segment. They encourage movement by verbal info and manual contact. While performing Kabat, there are namely three phases - the upper (temple and eyes), intermediate (nose), and lower (mouth). Before Kabat, ice compression needs to be performed to the particular regions, with a specific end goal to build its contractile power.

4. Icing: Ice helps in decreasing the aggravation surrounding the facial nerve, which might be in charge of the loss of nerve movement or conduction leading to facial paralysis. You can either use an ice pack or any cold compressor.

5. Facial exercises: These include doing essential activities with the distinctive muscle surrounding your face. In case you consult a specialist or physical advisor for your facial paralysis, he or she will suggest particular exercises for your level and stage of paralysis. If not, have a go at flexing the different muscles in your face through and through. Frown, raise your eyebrows, gradually flicker your eyes, and proceed down to your jaw.

Facial Paralysis - How Can Physiotherapy Help You Get Better?

Osteoporosis is a skeletal disorder, which causes fragility of bones. In the absence of proper prevention and treatment modalities, osteoporosis can cause a painless progression and subsequent fractures. Such fractures (broken bones) mostly occur in the hip, spine, or wrist. As per several past data-driven studies conducted in the United States of America, 1.5 million new fractures are witnessed in people with osteoporosis every year. Of these, spine fractures are seen in 700,000; hip fractures in 300,000; wrist fractures in 250,000; and fractures of other bones in 250,000 people.

Possible Causes of Osteoporosis

Hormonal imbalances Pregnancy
Metabolic diseases Cancer
Age beyond 60-65 years
Symptoms of Osteoporosis-Induced Compression Fractures 
Significant upper or lower back pain
Changes in posture
Difficulty with breathing and digestion 
Decreased ability to walk 
An overall decrease in the quality of life Increased tendency for fracture of adjacent vertebrae
Treatment

Compression fractures are usually managed with pain medications; narcotic pain medicines are administered for a few months until the pain decreases. Also, few available medications are known to increase the bone density. It is hoped that by building the bone density, future fractures can be prevented. Another method is immobilization of the spine with a brace that helps decrease pain from a broken vertebra; however, such braces are helpful only for the fractures of the lower back.

Role of Kyphoplasty in the Management of Osteoporosis

Kyphoplasty is a procedure that involves a new technology whereby an osteoporotic compression fracture can be treated with relief in pain, restoration of the lost bone height, and immediate stabilization of the fracture with the injection of bone cement. 

How is kyphoplasty done?

The procedure is carried out via two A  incisions on each side of the affected vertebra. The technique utilizes X-ray equipment to place working tools into the collapsed vertebra. This step is followed by an insertion of an inflatable bone tamp or expander into the fractured vertebra on each side, after which, the balloons are slowly inflated, lifting up the fractured portion of the vertebra to a more normal height. The balloons are then deflated, and cement is slowly injected. Excellent restoration of fractures, which are less than 4-6 months old and better than 90% success at reducing pain associated with the broken vertebra, is seen with kyphoplasty. 

Which patients can benefit from kyphoplasty? 

Patients with a recent vertebral compression fracture due to osteoporosis 
Patients with fractures which are less than 4 months old
Patients with fractures who are on chronic prednisone or steroids 
Complications from this procedure have been primarily related to patients who have been on blood thinner medications. 
Potential complications also include cement leaking out of the vertebra and into inappropriate areas. 

Kyphoplasty In The Management Of Osteporosis!

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