Frozen shoulder is a condition where the patient encounters continuous shoulder stiffness and pain. It could last for several weeks. Inflammation around the shoulder increases the inability to move or stretch properly. This happens when somebody is recovering from an injury. Frozen shoulder can also occur when somebody is wearing a sling or a cast. It also occurs if someone is recovering from surgery or experiencing joint pain. It may also be experienced as a symptom of thyroid, joint disorders or diabetes.

Some of the causes and risk factors for creating a frozen shoulder are as follows:

    If you are 40 years or older, your chances of a frozen shoulder are higher than others
    Recovering from a damage or surgery
    Hormonal imbalance
    Ladies are more prone to a frozen shoulder
    Cervical disc infection that influences the nerves around the shoulder
    Not moving your arm because of other pain or wounds
    Having a previous medical condition like diabetes or other heart diseases
    Open-heart surgery or spinal surgeries
    Poor diet and unhealthy lifestyle

The most widely recognized symptoms of a frozen shoulder include:

    Stiffness around the shoulder usually happens in one shoulder at a time (not both) and will probably return in the same shoulder. Muscle, joint and bone agony in and around the shoulders or arms may be experienced.
    Restricted scope of movement
    Having difficulty moving and using the shoulders or arms ordinarily, (for example, experiencing difficulty in getting dressed, driving, holding objects before you, and gestures.)

Treatment:

    Stretch the Shoulder: Before beginning shoulder exercises for a frozen shoulder, try to warm up your shoulder by doing a few warm up exercises. This will improve the blood supply in the affected area and avoid future injuries by making your body more comfortable with the motion. The best approach is to extend and warm up the shoulder by applying heat for 10 to 15 minutes, scrubbing down or showering with Epsom salt.
    Non-intrusive treatment: While these activities mentioned above can be easily performed at home, if pain continues and makes it difficult to move around or work ordinarily, see a physiotherapist who can appoint particular activities and can enhance your scope of movement, flexibility and strength.
    Acupuncture: Acupuncture is considered one of the best treatment choices for any joint and nerve related problem. The treatment is based on focusing on the trigger points of the pain and putting pressure on them via needles. The treatment is not painful and is known to produce good results in the long run.
    Dietary Supplements: Various supplements can be taken with the recommendation of a doctor, in order to improve recovery. Alfalfa (horse feed) and turmeric are two of the most regularly recommended elements that relieve swelling and repair the tissue in the shoulder.

Best Remedies for a Frozen Shoulder

Spondylitis, or cervical spondylitis, is a common condition that affects a large section of the adult population. This most common disorder of the cervical spine is a degenerative condition. There are soft disks between the vertebral bones which shrink with age and gets stiff. This leads to formation of small bone spurs. This reduces the space available for the disk to move, causing nerve pinching.

Causes:

Ageing is the most common cause for spondylitis. Injury, incorrect sleeping posture, and heavy weight-lifting can also cause spondylitis. While earlier it was common in people who were 60-plus, with more people spending more time at their computers and workstations, the onset happens much earlier in 30s and sometimes even in 20s.

Symptoms:

Most symptoms related to spondylitis are centered on the neck and shoulder regions. There is pain and stiffness in the neck that can extend to the shoulders, nape of the neck, arms, and sometimes even the fingers. In rare cases, the pain can extend into the forehead and back of the head too. Associated symptoms include numbness, weakness, and a pricking sensation in the hands, arms, and sometimes fingers.

Homeopathy in cervical spondylitis:

Homeopathy treats the root of the issue after taking into account all symptoms. Listed below are some common homeopathic remedies for spondylitis.

Conium: there is neck pain along with vertigo when lying down or turning in bed. There is constant mild pain in the back of the head and a tight sensation in the forehead region.
Rhus tox: when the neck pain is worse in the morning and with rest, rhus is a good option. Moving the neck helps relieve this pain, which is often as a result of some injury.
Kalmia latifolia: when there is pain extending from the neck to the arm and hand and fingers, kalmia works wonders. There may also be pain from the nape of the neck to the shoulder blades. The pain is increased with leaning forwards or looking down. The patient may also have nausea with the pain.
Gelsemium: when there is pain extending from the neck to the back of the head, centering in the occipital region. The patient also feels weak, dull, and dizzy. The pain is triggered by emotional excitement.
Silicea: when there is pain extending from the neck to the eyes and forehead, silicea provides good relief. The patient will have intolerance to cold and feels chilly. The pain is improved by heat pads and lying down.
Calcarea phos: if the radiographs show bony changes in the cervical spine with the spondylitis, this is very useful. The bony spurs that form can be painful and cause nerve pinching leading to vertigo.

Spondylitis - Causes and Symptoms

Shoulder pain can be a persistent dull and nagging sensation in the upper arm or shoulder area. It can be easily differentiated from neck pain as it is related to the movement of shoulders i.e. it will increase and decrease with shoulder movements, especially overhead activities. The other signs to identify shoulder pain is if your shoulder movements are reduced.

If you find it difficult to scratch / wash your back, comb your hair or reach your back pocket, it clearly shows you are suffering from shoulder pain. Shoulder pain can happen due to various reasons, it varies from person to person depending on the activities he/she is involved in, for e.g. sports, manual job etc. It can be a single major injury or multiple small injuries due to repetitive usage patterns. Also, degenerative changes in various parts of the shoulder can lead to shoulder pain.

In case of middle to old age, injuries that can cause shoulder pain are:

    Biceps Tendonitis
    Acromio-clavicular Joint arthritis
    Scapular Dyskinesia
    Trapezitis
    Suprascapular nerve entrapment In young age, injury due to sports or gym activity can cause shoulder pain
    Superior labral anterior/posterior (SLAP tear)lesion

Also, traumatic or repeated dislocations of shoulder can cause shoulder pain due to:

    Bankart lesion

Diagnose Shoulder Pain

Shoulder pain can be diagnosed only after thorough history taking and clinical examination. However, some imaging studies can be very helpful like:

    X-rays: Through an x-ray one can view the shoulder in many different views.
    Ultrasound: With an ultrasound, you can also check the damaged caused to the tendons and muscles of the shoulder but the quality of reporting depends upon the expertise of the doctor.
    MRI: MRI gives a clear picture of the shoulder as it shows everything related to a shoulder joint that is joints, vessels, tendons and muscles that too from different angles.
    Diagnostic Arthroscopy: A surgical procedure often used by orthopaedic surgeons to diagnose and treat issues inside a joint. Arthroscopy has the big advantage that one can use it to diagnose as well as treat at the same time.

Treatment for Various Types of Shoulder Pain

    For Shoulder Impingement or Rotator Cuff tear: Give rest to the shoulder for a few days only Dedicated Physiotherapy Protocol Bursal injections If these fail then, (Surgery)Arthroscopic sub-acromial decompression If Cuff tear is found, then one can go for Arthroscopic/Mini-open repair
    Labral Lesions: For anterior Labral lesions (Bankart's) following anterior shoulder dislocation then surgery in the form of Arthroscopic Bankart's repair is the only option to reduce risk of recurrence and degeneration.

SLAP Lesions

    Pain relief and physiotherapy as first step If this fails then following surgical options are available
    Arthroscopic debridement or repair of labrum
    Biceps tenotomy or tenodesis

Arthritis

In this case, the joint is already destroyed and has to be resurfaced for pain relief and to maintain ROM. If Rotator cuff muscles are working, then Shoulder resurfacing hemiarthroplasty (preferred in young people), that has a life of 10 to 15 years, Total shoulder replacement (preferred in middle aged to old people) has a life of 10 to 15 years. But, if rotator cuff muscle are not working then Reverse Geometry Shoulder replacement is recommended, that has a life of 10 years.

It is always advisable to get yourself diagnosed properly in case of shoulder pain as management changes depending on clinical situations. Neglecting shoulder conditions can lead to bigger problems later on.

Always remember 'a stitch in time saves nine'

Shoulder Pain: Causes, Diagnoses & Treatment

Cosmetic surgery is not restricted to the top half of your body. Today along with facelifts and breast implants, butt implants are also gaining popularity. This procedure is also known as gluteal augmentation. Butt implants are usually made of silicone. These soft, solid structures are implants under the gluteus maximus muscles and above the pelvic bone through an incision. The incision is typically made in the butt crease so that it is less noticeable. Here are a few others things you should know about butt implants:

It is performed under anaesthesia: Butt implant surgery may be performed under local or general anaesthesia and usually takes anywhere between 2 to 7 hours. However, this procedure is usually an outpatient procedure and no hospitalisation is required.
It takes time to recover: After the procedure, you will probably notice swelling and tenderness in the area. In most cases, the patient is advised to wear a compression garment for a few days after the surgery. This should resolve itself in about 4-6 weeks but complete recovery can take up to 8 months. This is because the tailbone muscles are cut during the procedure.
The effects are permanent: Silicone implants can last a lifetime and hence the results of this surgery are permanent. With time the body s natural tissues merge with the implant. However, in some cases, the implant may slip with time causing an asymmetrical appearance. This can be corrected through a follow-up surgery.
Anyone can get a butt implant: Butt implants are typically used for people with a flat posterior, but you don t necessarily need to have a skinny frame to undergo this procedure. Also, there are no size or weight limitations to getting the procedure.
It is customisable: Butt implants can be customised to suit the person s size and frame. A surgeon will typically take into account the shape of the patient s pelvic bone and natural butt contours to create a butt implant that enhances the patient s frame and does not look unnatural.
There are risks: Complications are rare but possible with this surgery. Making an incision under the butt crease reduces its visibility but increases the risk of infections. There is also a risk of allergic reactions to anaesthesia. Other possible side effects include pain, discomfort, nerve damage and reduced sensitivity.
They do not feel completely natural: Silicone butt implants may feel harder than normal tissue and at some angles may not look very natural remove these and post more of positive aspects.

Butt Implants - Things You Must Know!

Spinal fractures are extremely painful and usually happen when an external force applied to the spine exceeds the vertebral column s ability to bear the load. Many times, the bone fragments pinch and damage the spinal cord, which leads to an injury or dislocation of the bony vertebra. Although spinal fractures can develop anywhere along the spine, the most common site is the lower back.

What causes spinal fractures?

Spinal fractures can occur due to both minor trauma/falls and major accidents. The following are the probable causes of such fractures-

  Injuries sustained while playing a sport
  A traumatic injury
  Spinal instability
  Injuries sustained after falling from a height
  A whiplash
  Injuries sustained in an accident
  An underlying condition such as Osteoporosis, which causes the spinal bones to weaken

Symptoms observed:

Spinal fractures are characterized by the following symptoms-

  Muscle spasm and swelling
  Numbness
  Acute pain that worsens when you walk or stand for a long time
  A tingling sensation
  Restricted mobility of the spinal column
  Spinal deformity/disability
  Sudden onset of pain in the lower back region

What are the various types of spinal fractures?

Spinal fractures primarily fall into four categories, namely the following-

  Compression - Compression fractures are quite common in people with osteoporosis or bone cancer. The bones become fragile and brittle. If sudden force is applied with extreme pressure, the vertebra may not be able to support the load and that may result in a fracture.

  Burst - Severe trauma, such as a car accident can cause burst fractures. The external pressure is so much that the vertebra gets crushed. As a result, the bony fragments spread out and cause spinal cord injury. Unlike a compression fracture, where only a part of the vertebra is damaged, a burst fracture leads to multiple fractures in the vertebra.

  Flexion-distraction - This type of fracture is likely to happen if you are involved in a car accident. Normally, the spine is made to flex forward. However, a sudden jerk that pushes your body forward can put a lot of pressure on the spine and cause the vertebrae to break.

  Fracture-dislocation - This debilitating condition results from a torn ligament and broken bone.

What is the treatment for spinal fractures?

Treatment options for spinal fractures include both non-surgical and surgical methods.

  Non-surgical treatment - Most cases of spinal fractures can be treated with immobilization in a corset or brace for up to 10-12 weeks. Bracing will help prevent deformity and reduce pain.

  Surgical treatment - The doctor may recommend surgery in severe cases. The two standard surgical procedures are-

Vertebroplasty - The surgeon will insert a tube, known as a catheter, into the compressed vertebra. Through the catheter, he/she will inject bone cement into the fracture site. This will harden and stabilize the vertebral column. Vertebroplasty has proved to be an effective procedure to reduce pain. The surgery restores mobility and prevents loss of bone due to bed rest.

Kyphoplasty - During this procedure, the surgeon inserts a catheter into the spinal column under the guidance of an X-ray. Next, he/she makes small incisions along the back and inserts an inflatable bone stamp. The tamp, once inflated, bring back the vertebral body to its original height. It also creates a cavity to be filled with bone cement, which seals the cracks. The bone cement stops the vertebra from collapsing again. After the whole procedure, the surgeon will remove the catheter and stitch the incisions.

Following surgery, you will need to wear a brace for about 6-12 weeks. Physical therapy is strongly recommended initially to help you get back to your daily activities in a week or two.

Spinal Fractures - All You Should Know!

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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