The deltoid muscle is situated around the shoulder joint that makes up the shoulder. It is classified into three parts - front, side and rear deltoids. It is one of the most frequently used muscles in the body, its major functions are abduction and forward elevation of the arm.

Causes
A deltoid strain is a condition where you experience pain and tenderness in the shoulder area due to various causes like overuse of the deltoid muscle. It is very common in weightlifting and various sports such as cricket. It may even lead to partial loss of function in the deltoid muscle. Deltoid strain may be caused due to overworking of the muscle without adequate rest. It may also be caused due to lengthening of the deltoid muscle under stress or direct trauma to the muscle.

There are three types of deltoid strains

Grade 1 deltoid strain: It is characterized by tight muscles with some possible swelling. There may be mild pain when you use your shoulders for any activity.
Grade 2 deltoid strain: This strain is a result of a major injury to the deltoid muscle; there may be visible swelling and pain while carrying out activities that require movement of the shoulder. Lifting your arm to the front or the sides becomes difficult and painful.
Grade 3 deltoid strain: This form of deltoid strain is the most severe of the three; it may cause the shoulders to become immobile. You usually will experience excessive pain and severe swelling. You might not be able to move your arm and carry out any activity that requires the shoulders.
Diagnosis
The diagnosis of a deltoid strain starts with a physical exam where the doctor will understand the symptoms of the deltoid strain. Various imaging tests such as x-rays may be required for the diagnosis. The basic treatment for shoulder strain comprises of the RICE protocol (rest, ice, compression and elevation) which is used to treat grade 1 and grade 2 strains. Grade 3 strains may require surgery in addition to the above treatment methods. In case of excess pain, the doctor may prescribe non-steroidal anti-inflammatory drugs to ease the pain.

All About Deltoid Strain!

The pain in the lower extremity of the body caused by the irritation of the sciatic nerve (the large nerve running down from the lower back of the body to each one of the legs) is referred to as Sciatica. Sciatica is caused by injury, inflammation or compression of the sciatic nerve and causes pain or numbness spreading to leg, buttocks, and hips. In Ayurveda, Sciatica is known by the name of Gradhrasi. It is believed to be aggravated by the imbalance of Vata Dosha.


Causes -

Sciatica can be caused by strenuous physical activity such as heavy weight lifting, or to exposure to extreme cold. Pressure on buttocks due to sitting or lying continuously for long hours, injury due to a fractured pelvis or trauma to thighs also damages the sciatic nerve.


Symptoms -

Pain in the back and the lower extremity of the body is the primary symptom of Sciatica. Also, there is a burning or tingling sensation in the affected area. It can also become numb. One may even find it difficult to walk. In severe cases, it becomes impossible to bend the knee or move the foot.


Treatment Through Ayurveda -

Through Ayurveda, Sciatica can be treated internally and externally by balancing the energies involved in the doshas:

Internal methods of treatment: Yogaraja Guggulu is the herbal pill consisting of Guggulu resin, twenty-five types of herbs and ghee effectively treats all types of pain associated with the nervous system. Dashamula Arishta, an elixir having sixty-three herbs, jaggery, plums, honey, and water has anti-inflammatory properties which help in toning up the affected nerve.

External methods of treatment: Application of Sarshapadi medicinal oil (made up of camphor, mustard oil, and vegetable turpentine as a base) on the affected area helps in relieving pain.

Panchakarma therapies are very effective in the treatment of this condition. They aim to relieve inflammation and release nerve compressions and spasms for strengthening the entire spine and the surrounding tissue. Generally, treatment through the Panchkarma therapies takes four to five weeks depending upon the severity of the condition. Following are some of the processes involved in treatment through Panchakarma:

Kativasti and Elakizi, Naranga Kizhi, Navarakizhi are very important in the treatment of sciatica.

Sarwang Abhyang is the full body massage with medicated warm oils for lubricating and nurturing the body for the pacification of Vayu.

Swedana refers to steaming the body for detoxification.

Vasti refers to the administration of medicated oils and decoction through anal route for treating the vatic disorder that is Sciatica as per Ayurveda. It pacifies dryness and strengthens intestines and is one of the permanent cures for most of the vatic disorders.

Siravedha is the venous puncture or venesection.

Agnikarma is the Cauterisation or burning the affected part.

Raktamokshan is the process for Blood purification.

Take Away-

Sciatica refers to the pain in the lower body due to an irritated sciatic nerve, caused due to nerve compression or trauma or injury. Through Ayurveda, Sciatica can be treated through internal or external methods as well as through Panchakarma therapies.

Sciatica - Panchakarma Therapy To Heal It!

Cervical spondylosis a special type of arthritis. The region of its occurrence is in the cervical vertebrae and the problem is more prevalent in men who belong to the middle age groups. In the language of Ayurveda, this problem is known as Greeva graham. The condition falls under the category of Vata condition.

What are the causes of cervical spondylosis?
The several factors that cause cervical spondylosis are as follows:

When the Vata Dosha increases in magnitude, the tissues start degenerating even in the neck joints.
Intake of food that leads to the formation of gas in the body is also one of the reasons of cervical spondylosis.
When people take too many gaps during two consecutive meals, then it leads to the formation of gas as well which causes cervical spondylosis.
Those who have night shifts frequently have a tendency to develop cervical spondylosis.
Overindulgence in activities of mental, physical and sexual nature can also cause cervical spondylosis.
What are the symptoms of cervical spondylosis?
The main symptoms of cervical spondylosis are listed below.

A persistent headache is one of the most common symptoms.
People often complain of feeling a stiffness in the neck region in case of cervical spondylosis.
A numbness or tingling feeling in arms is also one of the symptoms of this condition.
The posterior region of your back and shoulders will also pain in case you develop cervical spondylosis.
People also find it difficult to walk at times and face a lack of coordination as well.
What are the Ayurvedic treatment measures for cervical spondylosis?
The main treatment measures in Ayurveda for cervical spondylosis are:

Mridu Shodhana   This procedure is also known as mild purgation. In this procedure, a mixture is made with milk or the fruit pulp of Cassia fistula and castor oil.
Greeva Basti   A black gram paste is applied to the back of the neck and this will aid in retaining the medicaments in that region. Several medicated oils like Ksheerbala oil are heated and then the compound helps in retaining this oil within it for a time. The reason for this is that when the heated oil is applied to that area, it helps in giving relief from disc herniation. The disc cartilage nourishment is improved and thus, the degeneration process of the tissues is reversed.
Secondary Ayurvedic procedures are also effective against cervical spondylosis. Some of these procedures are Patrapinda Sweda, Shirodhara, Abhyanga, and Pizhichil.
Pacifying Herbs   Some of the Ayurvedic herbs act as a pacifier in cervical spondylosis. These are Bala or Sida cordifolia, castor root or Ricinus communis, Amalaki or Emblica officinalis, Shunthi or ginger and Gambhari or Gmelina arborea.
Medicines   Some of the effective Ayurvedic medicines include Rasnairandadi kashaya, Yogaraja Guggulu and Sahacharadi Kashaya.
Above ayurvedic treatments not only give you relief from cervical spondylosis but also stop further degeneration of the affected tissues.

Cervical Spondylosis And Ayurveda - What To Know

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

The knee is the largest joint in the human body and is a complex structure formed of bone, muscle and cartilage. Development of pain in the knees can be caused by numerous factors such as aging, injuries, diseases, dietary deficiencies, etc.

Arthritis is the most common cause of knee pain and usually affects the elderly and aged. It occurs due to an inflammation of the joint and causes pain, swelling, redness and inflexibility of the knees.

What are the factors that determine treatment method?

Diagnosis for knee pain varies from patient to patient as each case is different and must be approached differently. Some of the factors that determine the treatment method are as follows:

- Cause of the problem
- Nature and intensity of pain
- Age of the patient
- Medical history of the patient
- Diet and lifestyle of the patient

There are a number of different types of arthritis which can affect the knees in different ways and, consequently, require different types of treatment methods.

What are the various treatment methods for knee pain?

1. Conventional Remedies - These are used in case of conditions that are not too severe or chronic. It includes keeping on bed rest, using an ice pack, taking a painkiller and anti-inflammatory medicines, wearing knee braces, etc.

2. Physical Therapy - There are many stretching and strengthening exercise routines that help alleviate knee pain and treat the condition. Recovery is achieved by making the muscles around the knees stronger and increasing stability and flexibility.

3. Injections to the Knees - A number of anti-inflammatory substances and supplements, as well as lubricants, can be injected into the knee joint which helps reduce pain and makes the joint more supple.

4. Stem Cell Therapy - This involves drawing platelets from the patient's blood and injecting it into the knee joint for repairing damage caused to ligaments, tendons or cartilage.

5. Surgery - Surgical procedures for treating knee pain include partial or complete knee replacements.



What kind of treatment does your knee pain require?

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!

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