Carpal Tunnel Syndrome can be said to be one of the most painful disorders to have. There is a high likelihood that a lot of people can agree with this statement as the number of people who suffer from this issue is just so high! Yet, a funny thing to take note of is the fact that even people who are experts on CTS, which is the abbreviation of Carpal Tunnel Syndrome, are not really aware as to what its causes are!

That being said, it really does not mean that a person whose life has been affected negatively by it does not make a conscious effort to get better so that the condition is not as painful. In order to do this, what he or she would do is to commit to doing some exercises which directly address the problem at hand.

To start with the exercises, it makes sense, to begin with, the one which is the simplest and this happens to be an exercise which is often known as the shake. What this requires the person to do is to shake his or her hands while making sure to keep them flexible. This action is pretty much the same as a person would do, if he or she were to try to air dry his or her hands without making use of a towel.
Another simple exercise which is prescribed by quite a lot of doctors who are accomplished experts when it comes to Carpal Tunnel Syndrome is one in which the person who has the condition makes his or her hands a fist. After this is done, what he or she needs to do is to release the fist and go on to stretch the fingers out as wide as possible. The extension should attempt to be in the shape of a fan.
It may be surprising, but it can be said that the ill effects of something which is as troublesome as Carpal Tunnel Syndrome can be improved if these simple exercises are done with regularity. However, if a person is looking for a drastic change, it can be expected that he or she would have to do more by the way of complex exercises, at least on a relative scale.

One of these exercises is to join the hands in a prayer position and then separate the palms, but make sure the fingers stay pressed to each other; an act known as steepling the fingers. With these simple exercises in place, you can avoid the pain of dealing with Carpal Tunnel Syndrome for good! 

Carpal Tunnel Syndrome (CTS) - How Physiotherapy Can Help?

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!

You must have often heard about sports person, especially those associated with tennis or baseball (that involves continuous arm movement) suffer from rotator cuff injury. But what exactly is this injury? To understand the condition better, you need to know what is a rotator cuff. A rotator cuff is a group of tendons and muscles that keep the shoulder joints stable enabling a person to rotate or lift their shoulders freely.

With time, certain activities may cause a wear and tear of the rotator cuff injuring them. The injury sustained can result from a partial or a complete tear.
A partial tear of the rotator cuff may damage the tendons, but it will remain attached to the bones. However, in the case of a complete tear, the injury is more severe that penetrates deep within detaching the tendons off the bone (humerus).

Who can suffer from a Rotator Cuff Injury?
While the condition can affect anyone, people under the following situations stand a greater chance of injuring their rotator cuff.

People in their old age may suffer from the Rotator Cuff injury as with age the tendons and muscles may undergo a degeneration.
The injury may also be genetically linked.
The problem is found to be common among tennis and baseball players.
Painters, as well as carpenters who need to move their arms and shoulders continuously in a particular direction, stand at a risk of injuring the rotator cuff.
Symptoms associated with a Rotator Cuff Injury
People with a Rotator Cuff Injury may exhibit the following symptoms and associated discomfort.

The rotator cuff ensures the free and comfortable rotation of the arm and the shoulder. An injury will limit this rotation. As a result, a person may experience great difficulty and pain in lifting and moving the arm.
Lying on the affected shoulder can be a painful experience.
There is instability of the shoulder joints followed by weakness.
A person finds it difficult to carry out the basic activities such as bringing a glass of water close to the mouth or combing the hair.
Treatment

Anti-inflammatory drugs and painkillers (Acetaminophen) may be used to reduce the pain and swelling associated with the injury.
Physiotherapy and various strengthening exercise can go a long way to deal with shoulder weakness, stiffness, and restricted movement. However, one needs to have patience as the treatment may take time to produce the desired results.
In extreme cases, the doctor may opt for a surgery.
Arthroscopic surgery: The procedure is simple and involves a small incision on the affected shoulder to place an arthroscope (that comes fitted with a camera and the surgical instruments) to treat the condition.
The doctor may also carry out an open surgery or a mini-open surgery (an amalgamation of open and arthroscopic surgery) to fix the tear.

Rotator Cuff Injury - Symptoms Associated With It!

Why does PAIN occur? Understand the Mechanism of Pain

Pain is an unpleasant and distressing physical sensation caused by disease or injury, which induces hurt and anxiety in those suffering from it.
There are many different manifestations of pain, ranging from short term (acute pain) to long term (chronic pain). Other classifications include pain in the internal organs (visceral pain), injured tissue (inflammatory pain), nerves (neuropathic pain), etc.

The reason for the occurrence of pain depends on the cause and kind of pain being experienced. In most cases, pain acts as a warning sign that the body has been afflicted by a disorder of some sort, which may have arisen due to internal sickness or external wounding. Acute pains are generally cured on their own through rest or simple medication. Chronic pains, on the other hand, are more complicated in nature and the treatment requires more elaborate diagnosis.

The mechanism of pain

Pain is an extremely personal and subjective experience and affects each individual to varying degrees. The pain signals, which can arise in any part of the body, travel through the spinal cord to the brain along thousands of specialized nerves and nerve fibres. In the brain, it is processed in the centres associated with anxiety, emotions, memory, appetite, etc. Signals and pain inputs are then returned from the brain to the spinal cord, which may heighten or diminish pain.

In some cases, pain may also be induced by damage to the brain and spinal cord, which happens after a stroke.
A constant barrage of pain signals may cause the cells at the end of nerve fibres to become over-sensitized. This is known as 'wind-up' and is one of the most common causes of chronic pain that occurs even though the root of the problem has been identified and treated.

The causes and effects of pain differ from case to case depending on the signals received by the brain and its interpretation. It affects the individual's day to day activities and if persistent, can also have a harmful impact on mental health and psychosis. Pain is always handled, diagnosed and treated differently in all patients by drawing out the best possible solution to the problem.





Why does PAIN occur? Understand the Mechanism of Pain

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

Rheumatoid arthritis is an auto-immune chronic disorder that might cause abnormal swelling in the joints when the joint tissues are attacked by the human immune system. The more frequently used body joints, such as the knees, fingers, shoulders, wrists, elbows and hips commonly get affected by the disease. Rheumatoid arthritis can also occur in the ligaments or tendons and might affect areas such as the kidney, bone marrow, eyes, lungs, and heart.

If rheumatoid arthritis is not diagnosed on time, it might lead to future complications, such as blood cancer in the lymph regions, osteoporosis (a medical condition resulting in the weakness of the bones), infections, stiffening of the arteries and dry mouth.

What exactly causes the disease is not known, but a significant damage to the immune system might cause the inflammation of the joints, resulting in this condition. Obesity, a family history of this condition and other lifestyle habits such as smoking tobacco put one at higher risks of this disorder.

The symptoms of rheumatoid arthritis might vary among people. The most common symptoms of rheumatoid arthritis are;
1. Severe pain in the morning
2. Episodes of mild fever with severe pain
3. Redness and inflammation of the joints which might cause intense pain
4. Stiffness in the joints
5. The pain might increase in low-temperature conditions
6. Acute lethargy and weight loss

Treatments
The treatment of rheumatoid arthritis includes a prescribed dosage (depending on the intensity of the condition) of non-steroidal anti-inflammatory drugs such as ibuprofen, anti-rheumatoid drugs such as methotrexate and steroid drugs such as prednisone to reduce the swelling and the subsequent pain. Performing regular exercises in order to retain the flexibility of the joints with appropriate consultation from the physiotherapist might cure rheumatoid arthritis. 

Persistent Stiffness in Joints - Can it be a Sign of Rheumatoid Arthritis

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