Inguino-scrotal and Inguino-labial swellings are common in children during infancy. A common cause of an Inguino-scrotal swelling in children is the presence of a patent processus vaginalis. It presents in the form of an inguinal hernia or hydrocele. Male infants are often affected 3 to 6 times more than the female ones. Processus vaginalis is the outpouching of peritoneum that extends through the inguinal canal. It is first seen during the 3rd month of intrauterine life. It follows the gubernaculum and testes through the inguinal canal and reaches the scrotum by the 7th month of gestation. 

Differential diagnosis of inguino-scrotal swelling in children: 

Inguinal hernia and hydrocele 
Torsion testes, epididymorchitis 
Undescended testes 
Varicocele 
Enlarged inguinal lymph node 
Abscess or lipoma 
Normally after the testicular descent, the portion of processus vaginalis surrounding the testis becomes tunica vaginalis. The processus vaginalis gets obliterated, eliminating the communication between peritoneal cavity and scrotum. A patent processus vaginalis is seen up to 20% in adulthood. 

Hernia and Hydrocele: The testicles or ovaries form in the abdomen near the kidneys, between 3 to 4 months of fetal development. Further, they gradually move down into the lower part of the abdomen as the fetus continues to develop. On descending downwards, small part of the peritoneum (a layer of tissue lining the abdomen from inside) that attaches to the testicle is drawn with it into the scrotum. This forms a pouch or sac. A similar process occurs in females as the round ligament of the uterus descends into the groin at the labia. The sac formed is processus vaginalis. Any connection between the abdominal cavity and the scrotum or groin is eliminated. When closure of the processus vaginalis is delayed or incomplete, it may stretch and eventually become a hernia. Stretching of processus vaginalis creates the inguinal sac that allows organs an extension from abdomen and entry into the sac. If fluid, rather than organs, builds up and remains in the sac, the child has a hydrocele. Approximately 80 percent to 90 percent of inguinal hernias appear in boys. They are more common on the right side, but in about 10 percent of cases, they occur on both sides (bilaterally). 

Epididymorchitis: Epididymitis is the pain and swelling of the tube that attaches to each testicle called as the epididymis. Orchitis is pain and swelling of the testicle. Since epididymis and testis lie next to each other, differentiation of the inflamed part is difficult. Hence, the term epididymo-orchitis is often used. Infection with bacteria often causes these problems. Other causes are infections from surgery or from a catheter that drains urine. The mumps virus also can cause orchitis. Analgesics or anti-inflammatory medicines can reduce the pain. Antibiotics are used if the problem is caused by bacteria. 

Torsion testis: It is a painful condition that occurs in the boys. It is a twisting of the testicles and the spermatic cord (the structure extending from the groin to the testes that contains nerves, ducts, and blood vessels). A decreased blood flow to the testes is caused by torsion of the testes. This torsion essentially strangles them of oxygen and nutrients. While it generally occurs in adolescent boys, it may also occur during fetal development or shortly after a baby is born. Urgent surgical procedure is undertaken if testicular torsion is confirmed in a child. The chance of survival for the testicle is best if surgery is completed within six hours of symptom onset.

Know The Types Of Inguinoscrotal Swelling In Children!

From marathon runners to footballers, amongst athletes, 'pulling a hamstring' is the most common type of injury. The hamstring is a group of four muscles at the back of your thigh. When one of these muscles gets overloaded or begins to tear, it is known as a hamstring injury. While a hamstring injury is painful, it does not indicate the end of an athlete's career.

Minor hamstring injuries may heal by themselves. In cases where one of the muscles is torn, surgery is required to repair and reattach the muscles. Recovery time depends on the severity of the injury. Stretching and exercising the muscles of the leg are the most important parts of rehabilitation. The healing of a hamstring injury can be divided into four stages.

1. Acute phase: The first five days after a hamstring injury is known as the acute phase of rehabilitation. The aim of treatment at this phase is to reduce inflammation and keep the other muscles from atrophy. For minor hamstring injuries resting the leg, using ice packs and keeping the leg elevated can accelerate the healing process. Once the pain and swelling has decreased, patients can use a cane or crutch to exercise the leg.

2. Subacute phase: From the fifth day to the 3rd week after the injury, the focus of the treatment shifts from minimizing swelling to strengthening the leg and increasing the range of possible motions. At this time, an athlete can resume cardiovascular training. Swimming and other forms of aquatic training are said to be especially beneficial to the treatment of hamstring injuries.

3. Remodeling phase: The remodeling phase continues upto 6 weeks after the injury. Strengthening the leg is the focus of this stage of treatment. Using ankle weights can be beneficial towards strengthening the leg muscles. It is important to be careful about the weight being used and to gradually increase this weight to avoid an added injury.

4. Functional stage: This stage can last upto 6 months until the athlete can regain full function of his or her leg. As the athlete's gait gets back to normal, they may start jogging and short sprints. Gradually, more sport specific exercises may be added to the workout.

There is no fixed time when an athlete can return to active sports after a hamstring injury. While players with minor injuries may return to the field after 3 weeks, athletes with muscles tears may take upto 6 months to recover completely. Hamstring injuries tend to reoccur and hence before they can get back to active sports, an athlete must pass an isometric strength test and flexibility test. This ensures that there are no subtle after effects of the injury that can increase the risk of a repeat injury.

Hamstring Injury Recovery and Return to Sports

Are you suffering with pins and needles in your hand? You may be suffering with carpal tunnel syndrome. Carpal tunnel is a tunnel made of bones in the wrist. Roof of the the tunnel is made of a ligament. This tunnel contains a nerve and some tendons which help in bending of fingers.

This nerve is called median nerve and it acts as a electrical wire carrying sensation from certain parts of hand. It also functions as a wire carrying power signals from brain to hand. Increased pressure of the tunnel causes compression of the nerve and this condition is called as carpal tunnel syndrome. This syndrome gives symptoms of pins and needles in part of hand and weakness in grip. (Pins and needles in Hindi is commonly known as झुनझुनाहट or झुनझुनी or सुन्न पन). Often patient will wake up in night because of pins and needles and shake their hand to relieve the symptoms. It can also manifest as burning sensation or pain in hand.

Carpal tunnel can be caused due to multiple factors. It is commonly seen in pregnant females. Repeated use of hand in certain postures can also lead to carpal tunnel syndrome. Other causes are thyroid problems, diabetes, rheumatoid arthritis and injury to wrist.

Diagnosis of carpal tunnel is mainly clinical and nerve conduction study is a useful tool in confirming the diagnosis. Special (Neuropathic ) pain killers can help with the symptoms. Physiotherapy and posture training can also reduce pins and needles. Night splints are often helpful. If symptoms fail to improve with non operating measures, surgical decompression of carpal tunnel is indicated. Carpal tunnel surgery is performed as a day case procedure under local anaesthetic. It has very satisfying results and a quick recovery.

This article is for information purpose only and not a substitute for proper medical advise.

Pins & Needles In Hand - Carpal Tunnel Syndrome!

Rotator Cuff Tear is one of the most common disabilities observed amongst adults above 40 years of age. Rotator Cuff is a group of four muscles that keep the Humerus (arm bone) attached to the socket of the Shoulder. The Rotator Cuff keeps the Shoulder Blade attached to the arm, and when there s a damage (tear) in one of these muscles, excruciating pain is felt by the patient.

Kinds of Rotator Cuff Tear-

  Partial Tear: This happens when one of the Tendons amongst the four Tendons is damaged or torn.
  Full Tear: This occurs when all the Tendons are torn; this is also called Complete Tear. Severe pain is experienced in this type of tear and surgery might be required.

Symptoms-

  A person may experience excruciating pain while performing daily tasks like Combing hair, Picking up Laundry, etc.
  Muscle weakness and stiffness on Shoulder.

Diagnosis of Rotator Cuff Tear-

  Ultrasound is used to check the internal structure of the shoulder and the damaged muscle pattern. The waves directed into the shoulder create images of the Tendons and ligaments of the shoulder. This allows the doctor to access the severity of the damage on the shoulder.
  MRI: When the doctor needs a better look at the Tendon damage, radio waves provide a better imagery than Ultrasound.

Treatment of Rotator Cuff Tear-

  RICE (Rest Ice Compression Elevation): In Case of partial rotator cuff injuries with very little damage, RICE is a good treatment option to treat temporary partial damage in the shoulder. Applying cold water and moving the hands slowly helps the muscles to get into shape.

  Injections: Non-inflammatory drugs are prescribed to the patient suffering from Full Rotator Cuff injury to deal with the pain. A Tendon tear can cause extreme pain, which might give the patient some sleepless nights. Non-inflammatory painkillers temporarily numb the shoulder, allowing the patient to sleep.

  Physical Therapies: Physical therapy is one of the most sought out treatment option. Physical therapy allows a person to recover from a rotator cuff injury through exercises and mild movements of the arms and shoulders.

  Surgery: When the injury is too severe for conventional treatment and medication, a patient might have to go through some complex surgeries.

A) Arthroscopic Tendon Repair: In this surgery, the doctor makes a small incision on the shoulders and then inserts a Laparoscope type instrument (Arthroscope) into the muscles, with a camera attached on the top. This instrument allows the surgeon to see the muscle structure and also helps in re-joining the tendons.

B) Open Tendon Repair: Arthroscopic Tendon Repair can be a bit complex, that s why an open tendon repair is preferred by most doctors. In this surgery, the surgeon makes a bigger incision and attaches the Tendons surgically. 

Conclusion-
Rotator Cuff Tears is a severe problem for the locomotion of body, but it is treatable, as long as one doesn t delay going to an experienced doctor.

Rotator Cuff Tear - Know The Treatment Options!

Cervical spondylosis is fast becoming the bane of modern life. An age-related wear and tear problem affecting the spinal discs in your neck, cervical spondylosis is increasingly affecting the young because of the use of cell phones, laptops and the like.

Cervical spondylosis is a general term used to define shrinkage of discs in between vertebrae in the neck region. Along with disc degeneration, bony projections also form in the area and are called bone spurs.
Other causes of cervical spondylosis are dehydrated discs. Discs are thick, pad-like cushions in between vertebrae that act as shock absorbers. They are made of a gel- like material that can dry over time. This causes the spinal vertebrae to rub together causing pain. The discs also crack which allows the internal gel-like material to spill out and impinge on spinal nerves causing symptoms.

There is a narrowing of the space required by the spinal cord and nerves that emanate in the upper spine to go to various parts of the body. Pinching of these nerves can cause alarming symptoms like

Numbness and weakness in your arms, hands, legs and feet
Lack of coordination and difficulty in walking
Loss of bladder or bowel movement
Stiffness and pain in neck
Treatment and management
Usually, cervical spondylosis doesn t cause any symptoms. But when you start experiencing pain, stiffness and weakness of muscles, it s best to go to a doctor who will diagnose the problem and then treat it.
Treatment for cervical spondylosis depends on the severity of your symptoms. Its goal is to get rid of pain, allow you to carry on your daily activities and prevent any permanent damage to your spinal cord and nerves.

Medicines

Anti-inflammatory drugs are prescribed to reduce pain and inflammation. Example Ibuprofen.
Corticosteroids are oral medications to get rid of the severe pain. If these don t work, your doctor can suggest steroid injections.
Muscle relaxants medicines relax the muscles in the upper part of the spine and help in curing neck pain and stiffness
Anti-seizure medications are also prescribed to dull the pain of damaged nerves in the spine. These include epilepsy medications, such as gabapentin and pregabalin.
Physiotherapy

Non surgical treatments are usually very effective in treating cervical spondylosis and surgery is usually not required. Physiotherapy is a bulwark for patients as it helps manage the condition very well.
Neck exercises that help stretch and strengthen muscles in your neck and shoulders can help manage debilitating symptoms of cervical spondylosis.
Few patients also benefit from traction, which can help provide more space for nerve roots within the spine.
Surgery

Surgery is the last resort for treating cervical spondylosis.
It is suggested when non-surgical treatments fail and the pain and neurological signs such as weakness in your arms or legs get worse.
It is done to create more room for your spinal cord and nerve roots.
Cervical spondylosis surgery typically involves removing:

Herniated disk
Bone spurs
Part of a vertebra

Cervical Spondylosis - How to Treat It?

The problem of morning back and neck pain may be due to the position of sleeping or it may be related to inflammatory arthritis which can be familial. Morning back pain is largely related to wrong sleeping posture and less commonly due to arthritic conditions like Ankylosing Spondylitis or Rheumatoid Arthritis. Whatever be the cause- this condition requires attention by an Orthopedic doctor as it may worsen in due course of time and should not be taken lightly.

Some common factors causing this are:

Mattress: Too soft or too hard a mattress might induce back ache after sleep. For people with waist and hips of equal proportion, a firmer mattress would do well. For those with narrower waist than their hips, a flexible and softer mattress that can move with the pelvic weight would be a perfect choice. Refrain from using old hardened mattresses.

Pillow: The pillow you use must be able to render support to your neck naturally. Instead of using excessively firm or soft pillow, try substituting it with memory foam pillows, refillable water pillows or cervical support pillows.

Posture: Not changing your position while sleeping or sleeping on the belly exerts strain on the back muscles, causing pain. On the other hand, sleeping on the back or on the sides causes comparatively less strain on the spine.

Other causes such as strenuous workouts or physical activities or sitting at a stretch during the day might cause pain while sleeping or after getting up from bed.

Remedies for Morning Back Pain:

Fortunately, there are some home remedies to cure the morning back pain.

Switching your mattress is a more expensive remedy for back pain, but may often be the ultimate cure. Most people sleep the best on medium-firm mattresses. Be sure to try out the mattress before you buy it.

For occasional back pain after sleeping, apply heat to your back to relax your muscles before you go to bed and when you get up in the morning.

Massage your back with pain relieving creams and apply heat on it with a heating pad for quick relief.

Specific spinal stretching exercises and Planks (a type of exercise) can greatly help in easing back pain, if done on a regular basis.

It is always recommended to CONSULT an Orthopaedic doctor if you suffer from morning back pain.



What Should You Know About Morning Back Pain And Neck Pain?

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