Spinal stenosis is a condition where a part of the spinal column becomes narrow. There are generally two types of spinal stenosis- lumbar stenosis and cervical stenosis. Lumbar stenosis is the form of the condition that affects the lower back. It is also the most common type of spinal stenosis.

Common Causes of Lumbar Spinal Stenosis
Some people may be born with a narrow spinal canal, but in most cases the condition is caused post birth. Here is a look at some of the most common causes for the spinal stenosis.

Overgrowth of bone- Osteoarthritis can sometimes cause bone spur formation, which in turn can lead to the stenosis at the lumbar region of the spine. This usually occurs in adults, as osteoarthritis is common after a certain age.
Herniated discs- A soft cartilage exists between the vertebrae, which cushions any impact on them. However, this cartilage dries up over time, and with age may lead to formation of crack on the exterior, which in turn causes suppression of the inner soft material and nerves of the spine.
Stiffened ligaments- The ligaments in the spine may become thick and stiffened over time and age. Due to the thickness of the ligaments, a bulge may occur in the spinal column and lead to lumbar spinal stenosis.
Injuries to the spine- Lumbar spinal stenosis may often be brought on by an injury to the spine. A spinal fracture resulting from an accident may narrow down the spine, which can cause the issue.
Tumours- A tumour may affect anyone at any point of time. These tumours may occur between the spinal cord and the vertebrae or between two bones in the vertebrae.
Symptoms of Lumbar Spinal Stenosis
Often the spinal stenosis may lie dormant and not produce any noticeable symptoms. However, it can still be diagnosed using an MRI or CT scan. However, all forms of the condition gradually progress and produce severe symptoms. This is why the treatment should be started as soon as the lumbar spinal stenosis is diagnosed, for the best result.

Here are common symptoms associated with the disorder

Numbness and tingling in the leg and foot.
Pain in the back
Leg cramps after long spells of standing or walking.
Weakness in the legs and feet.
If you observe any of the symptoms mentioned above, make sure that you visit an orthopaedist, so that the condition can be diagnosed and treatment can be initiated at soon as possible.

Lumbar Canal Stenosis - What Causes It?

Arthritis is inflammation of one or more of your joints. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is particularly common in the knee.

Knee arthritis can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people. There are 2 types of arthritis the knee joint in the human body can get afflicted with. They are:

Osteoarthritis 

The form of arthritis which, with increasing pain, slowly wears down the joint cartilages is called osteoarthritis. This form of arthritis usually affects people after the age 40. The symptoms of osteoarthritis include:

Severe pain in the knee joints
Pain after walking up the stairs and it subsiding once you are on rest
Severe pain after the movement of joints for a long time
Pain that becomes worse in rainy days
Joints becoming stiff after waking up in the morning but they improve in the latter part of the day
Pain which also occurs in the thighs and the genital regions coupled with joints swelling and joints getting stiff after rest.
Rheumatoid arthritis

Rheumatoid arthritis is a chronic form of arthritis caused because of the knee joint inflammations. This form of arthritis can occur at any age. Being an auto-immune disease, its symptoms include, but are not limited to:

Severe pain in the morning
Mild fever accompanying the pain
Joints suddenly becoming swollen, red and warm causing, immense pain
Sudden stiffness of the joints
Pain that increases in cold weather
Mild fever, extreme tiredness and weakening of the muscles
Doctors are still doubtful about what exactly causes the disease; but the deformation of the immune system might cause the damage of the joints, causing people who are already suffering from obesity, smokers, and women, in general, more prone to this disease.

When the knee pain is diagnosed as a form of arthritis, the following treatments are suggested:

If you are overweight or obese, losing some of those extra pounds can go a long way in reducing the pain.
Muscle-stretching exercises are effective in keeping the knee joints flexible.
Dry needling, cupping, taping can help to control the pain and keep the joint supported.
Prescribed dosage of anti-inflammatory drugs such as Tylenol, Motrin, and Advil or injections of hyaluronic acid might relieve your pain.
If regular treatments do not work, you might opt for knee-replacement surgery and osteotomy (the process of cutting a bone with the help of surgery) which might better the alignment of the knee by transforming the bone shapes.

Physiotherapy for knee arthritis

Physiotherapy treatment is aimed at improving the symptoms of the disease (i.e. knee pain, swelling, stiffness), and you should begin to notice a positive difference within one or a few physiotherapy sessions. The main goals of physiotherapy for your knee arthritis are:

Reduce your knee pain and inflammation.
Normalise your knee joint range of motion.
Strengthen your knee: esp quadriceps (esp VMO) and hamstrings.
Strengthen your lower limb: calves, hip and pelvis muscles.
Improve your patellofemoral (knee cap) alignment and function.
Normalise your muscle lengths.
Improve your proprioception, agility and balance.
Improve your technique and function eg walking, squatting.

How Physiotherapy Helps To Manage Arthritis?

The carpal tunnel syndrome and peripheral neuropathy can be the two problems which cause numbness in the fingers. The median nerve at the base of the hand passes through the carpal tunnel. If the tunnel is pinched or narrow, the nerve may be tightened, which affects the functioning of the fingers. The numbness, pain, and sensations in the fingers can be due to the neurological disorder in the body.

How Can I Relieve Numbness in My Hands?

The numbness in the hands and fingers can be very uncomfortable, especially when you are writing or driving. Many medications will relieve your numbness, but you can also try effective home remedies which have no side effects.

  Apply ice on the numbness or just dip your hands in the ice-cold water for a few minutes.

  You can also try heat massage by heating a massage pad or salt bag and applying on your numbed fingers.

  Daily stretching and exercise of hands and fingers can also relieve you from finger pain.

  Regular meditation and walk can relieve you from pain and refresh your muscles from stress.

  Avoid lifting heavy weights because it may tighten your tunnel.

There are also various ways to relieve your numbness in the thumb and fingers of the hands by means of using acupressure and herbal tea.

What Causes Numbness in Fingers While Sleeping?

Many reasons cause numbness in the fingers. Waking up with numb fingers or hands is generally not worrisome, if you do not have any other nerve symptoms. Many times, the sleeping position puts extra pressure on your hands or fingers, which causes numbness.

The nerve compression is very common while sleeping. This happens due to the position of sleep or the sharing of the bed. If you are experiencing other symptoms like weakness in the hands and legs or pain, this may lead to some serious nerve damage disease.

What Causes Numbness in Tips of Fingers?

The main reason for numbness in the tips of the fingers is the ulnar nerve compression. The ulnar nerve is responsible for the pain and shock to the hand that gives grip to the fingers. If you sleep with folded arms or legs inwards, then it is possible that you might have numbness in the tips of the fingers. The ulnar nerve reacts when pressure is put on the elbows or knees. What Does it Mean When You Wake up, and Your Fingers are Numb? Many people think that numbness in the fingers and hands are caused due to some disorder or serious illness. But, it is very common. Numbness in the fingers happens when the nerve compression is applied for a longer time.

Takeaway

Numbness is not always a problem. However, if it occurs with other significant nerve symptoms, it is advisable to consult a doctor immediately.

Finger Numbness - What Should You Know?

Spinal fusion is a surgery in which two or more vertebrae in the vertebral column or back are fused or joined to treat a slew of spinal problems and diseases, which cause debilitating back pain. This surgery helps to remove bone and tissue that are narrowing the spinal canal, squeezing the spinal cord and nerves, reducing pain and improving function.

There are many different causes of back pain like injury, poor posture, age, osteoarthritis, herniation of disc between two vertebrae, degenerative disc disease, narrowing of spine called stenosis, and spondylosis or lessening of space between the vertebrae- most of these can be treated using spinal fusion.

All of these causes put tremendous pressure on the vertebrae and pinch spinal nerves that pass through the back and radiate out into the arms, legs and torso. Apart from the pain, patients experience nerve and muscle weakness and irreversible damage affecting normal life.

Spinal fusion started off as just a treatment for fractures but now it has become the surgery of choice for a number of spine problems. Though it can be done anywhere in the spine, it is very effective when done in the lower part of the spine called lumbar spinal fusion or arthrodesis.

Spinal fusion is done by forming a direct bony connection between the vertebrae surrounding the painful discs, the cushioning between the vertebrae. Pain is stopped by stopping the motion of the painful discs.

There are different methods of spinal fusion each with its own advantages and limitations.

Techniques include fusion approached from the front, the back, or both of the vertebral column. Sometimes surgeons decide to use intervertebral cages or metal screws to provide internal structural support while the bone fuses. These cages may be placed between the vertebrae and packed with bone graft material taken from the patient or constructed out of synthetic materials.

What to expect?
Spinal fusion is not a risk-free procedure. It is a major surgery lasting several hours and carrying a number of risks like-

Failure of the vertebral fusion and breaking of metal implants
The vertebrae above and below the fusion can wear away aggravating problems
Blood clots may be formed that can travel to lungs causing embolism
Injury to spinal nerves causing permanent weakness in legs and problem with bladder and bowel function
Infections and blood loss
Heart attack or stroke during surgery
The patient has to be kept in hospital for a couple of days for post-operative care after which he will have to undergo rehabilitation for months. Hence, one should really think before going for spinal fusion. And when it is recommended, seek a second opinion before making a decision. 

Spinal Fusion Surgery - What To Expect?

Phimosis, Paraphimosis are the two major issues which occur in males In Phimosis, the foreskin is not easily pulled back from the tip position of the penis. Normally, this problem takes place in younger children and this is not a serious condition. With spontaneous erections and natural manipulations, more than 90% of foreskin becomes retractable by age 3 to 4 years. Few require Preputioplasty and Circucision is reserved for Balanitis Xerotica Obliterans. Paraphimosis, is quite a painful condition which needs to be treated urgently. Paraphimosis is the condition in which the foreskin is pulled back or get stuck in the same position. Due to this the retracted foreskin, as well as the penis part, becomes swollen. 

In this condition, the fluid will build up, and thus the foreskin cannot be returned to its original position. If anyone ignores it then it can lead to major issues. This can have an effect on blood flow to the tip of a penis. And, if not treated on time then the tip of the penis can get damaged.

The insect bite is a condition which can cause swelling of the phallus and prepuce. This can be easily treated by medicine. Differential diagnosis Penile edema, which is related to insect bites, allergic reactions, and trauma. 

Causes of Phimosis and Paraphimosis: 

Scar tissue: Any kind of infections can create the scratch marks on the foreskin. This can also affect the penis. Thus because of tough tissues, it is somewhat difficult to pull it back.    Pull and stretch: It is important that one should not forcefully move the foreskin. Pulling it or stretching the tip of penis vigorously can cause inflammation. 
Medical conditions: If anyone is suffering from diabetes, then there are chances of having a infection known as balanitis. This is typically an infection which takes place at the tip of the penis. 
Thus, in this case, it is necessary to discuss the problem with your doctor. Therefore, after going through your complete medical history, he can suggest you the best treatment which can manage the swelling of the penis. 

Why Paraphimosis happens? 

Mishandled foreskin 
Piercing 
Treatment and cure for Paraphimosis: 
The manual reduction is the first treatment which is suggested by your doctor. In this procedure, analgesic is given as a pain killer through the mouth. Other than this local anesthetic block is applied to your penis. Or applying anesthetic jelly in a local area is quite helpful during manual reduction. Injections of hyaluronidase are also effective to decrease the swelling.

How Surgery Can Help Manage Swelling Of Penis?

Myths about Total Knee Replacement

Myth#1 - Knee replacement is a surgery for old people. “I’m too young for a knee replacement.”
Fact - Candidacy for a knee replacement is not based on age, but on the person’s level of pain and immobility. Living with a painful joint that prohibits you from working or participating in normal life activities is an outdated way of thinking. Age is not necessarily a limiting factor. Often times, a patient is actually fearful about the uncertainty of surgery. Once they are able to resume many of the activities they enjoyed before the surgery, with increased mobility and with less pain, they are very happy they had the surgery. The quality of life one achieves by living without knee pain is priceless.

Myth#2 - “I should wait as long as possible to undergo knee replacement surgery” 
Fact - You don't need to suffer by waiting until the pain is intolerable. The longer life of joint replacements enables people to consider surgery earlier and at a younger age. Osteoarthritis is a degenerative disease that continues to damage the joint and delaying surgery makes both surgery and return to activity more difficult. Delaying surgery lowers a patients’ quality of life not only before the operation, but even for up to two years following surgery.

Myth#3 - “I should continue with medications as long as possible”
Fact - Medicines including painkillers just give symptomatic relief for a temporary duration and prolonged usage is riddled with serious side effects such as renal failure, peptic ulceration  etc. All these medicines are NOT curable.

Myth#4 - Alternative therapies such as acupressure, ozone treatment, massage beds, oils, laser therapy, magnetic therapy; braces will cure my advanced arthritis and knee pain.
Fact - Till date there is NO cure for advanced knee arthritis and these alternate therapies are not backed by established scientific data. All these modalities give temporary pain relief in early to moderate arthritis for some duration only and are NOT curative. Often times, a patient who is actually fearful about the uncertainty of surgery lands up trying these in order to avoid surgery. 

Myth#5 - After a knee replacement, it takes months to recover.
Fact - Depending on the activity, most patients who undergo knee replacement are able to perform routine tasks within a few weeks. A return to rigorous activity takes only a few months. One becomes independent for himself before discharge from hospital. There’s no prolonged best rest required after the surgery.


Myth#6 - After knee replacement, I’ll have to give up some activities and sports.
Fact - You have a high probability of getting back to activities like brisk walking or cycling in 6 to 12 weeks. It will take a bit longer to return to more rigorous activities and contact sports. Squatting and sitting cross legged though possible but at best should be kept to minimal.

Myth#7 - Knee replacement surgery leaves a large scar that is noticeable.
Fact - Scarring is minimal compared to traditional surgery. In fact, the scar is typically only 3 to 5 inches long. As time passes, the scar will fade and become less noticeable.

Myth#8 - Knee replacement is a very painful surgery. There is lots of pain in post operative period.
Fact - With modern day pain management such as in a multimodal approach, ensures that the patient does not feel any pain in post op period and has a smooth recovery.

Myth#9 - Knee replacement is done one at a time.
Fact - Both the knees can be operated at the same time if the patient does not have significant co morbidities and is deemed fit to undergo the procedure by the doctor.

Myth#10 - The new knee lasts for 5-6 yrs. only.
Fact - With modern day precision including computer assisted knee replacement and advancement in biomaterials, the survivorship has increased considerably. Today's joint replacements last 25 years or longer and, for most people, will last a lifetime.

Myth#11 - Knee replacement cannot be done a second time.
Fact - Knee replacement can be done multiple times what is called as a revision joint replacement surgery with good survivorship.

Myth#12 - “I am obese, I cannot undergo Knee replacement surgery.”
Fact - Knee replacement can be successfully done in an obese patient though the recovery is somewhat prolonged and might require additional implants. However, patients who are morbidly obese and have restricted mobility primarily due to obesity are better off after a bariatric procedure.

Myth#13 “I have diabetes or hypertension or heart ailment, so  I cannot undergo Knee replacement surgery.”
Fact  - diabetes hypertension or heart.



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