Your knees are one of the most vulnerable parts of your bodies. In case of strenuous or vigorous activities, knees are more prone to damage and injury than the other parts. Several of the knee tissues are fairly delicate and often are easily impaired. Among the other knee tissue injuries, meniscus tears are perhaps the most frequent. Meniscus is essentially a cartilage that protects and stabilizes the knee joints. However, an untoward twist or a strain can lead to a tear in the meniscus. Meniscus tears are a common phenomenon among athletes and sportsmen. They have been noted to be more recurrent in older individuals. 

Some of the early symptoms that indicate the onset of a meniscus tear are swelling and difficulty in bending or straightening of the leg. Sometimes a" locking sensation" in the knees also forebodes a torn meniscus. The inflammation potentially causes a lot of pain and irritation. While, it is fairly easy to ignore a meniscus tear for a normal knee injury, prolonged overlooking may only aggravate the pain and worsen the condition. The process of diagnosing a meniscus tear usually involves an mri scan and an x-ray examination, over and above a detailed evaluation of the wound.

Treating meniscus tears vary according to the extent of the injury. Depending upon the location and the depth of the tear, various cures can be tried. The healing process, however, depends upon other allied factors such as age, level of physical activities and one's medical history. An external and minor injury is easily mendable. Whereas, graver injuries are resolved through surgical means. The other non-operative means include certain prescribed medicines and specific exercises. Some of the recommended ways of battling a meniscus tear can be enlisted as:

1. Resting the knee by limiting the activities that involve excessive use of the legs or they may potentially strain the leg muscles.
2. Applying ice pack can significantly bring relief to the swelling and the pain in the injured knee. Doctors advice regular use for a duration of at least 15 days.
3. Compressing the knee using an elastic bandage or neoprene sleeve reduces the swelling in the knee.
4. Prescribed medicines in the likes of non-steroidal anti-inflammatory drugs can be effective remedies for a meniscus tear. However, one must mandatorily consult a doctor before consuming such medicines.

All About Torn Meniscus

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!

If your kid is affected by Duchenne muscular dystrophy (DMD), it is important for you to know about the best ways of dealing with the condition. Muscular dystrophy consists of group of diseases, which result in the weakening of muscles along with reduced flexibility. DMD accounts for being the most common type of muscular dystrophy. It occurs because of flaws in the gene, which controls how your body keeps the muscles healthy. This disease affects boys and the symptoms start appearing from early childhood.

Treatment
There is no specific treatment for DMD. However, there are several ways, including medicines and therapy, to deal with the symptoms and to protect the muscles.

Several steroids such as prednisone help in slowing down muscle damage. Children taking this medicine are able to walk for two to five years longer than they would usually do. Lung and heart functions are also improved.
DMD leads to heart problems and hence, you should take your child to a heart doctor for regular checkups until the age of 10.
In some cases, a surgery may be required to fix their shortened muscles, for straightening the spine, or for treating a heart or lung problem.
Taking care of your child
If your child has DMD, it does not mean that he will have to refrain from activities such as school, sports and spending time with friends. By sticking to the right treatment plan, you will be able to make your child active.

Stand and walk: Being in an upright position will keep your child s bones strong and the spine straight. You can get your child braces or standing walkers, which will help him in terms of balance and mobility.
Eat right: Although there is no special diet for DMD, several food items should be taken for preventing problems related to weight. Your child should eat the proper amount of food with a proper balance of nutrients and calories regularly.
Stay active: You should ensure that your child exercises regularly. Regular stretching exercises help in keeping the muscles and joints limber, which makes him feel better. You can avail the help of a physical therapist for an exercise schedule.
You can look for and join local support groups associated with DMD, as other families living with DMD can be a source of good advice and understanding about life with DMD.

Muscular Dystrophy -  How To Deal With It?

Paralysis is a chronic medical disease characterized by a loss of muscle function in the body accompanied by sensory loss. The patient is unable to control the paralysed muscle consciously. Most common causes of injury are stroke, multiple sclerosis, spinal cord injury and head injury.  There are 4 types of paralysis and the effect may be complete or partial. The effect may be confined to only one space or multiple areas; and it may affect one or both sides of the body. Paralysis, on one hand, can be brief and may last for a short time; if not, it can be long term or permanent too. 

Physiotherapy is a health care profession wherein diseases are assessed, diagnosed and treated via exercise. It is also used to prevent a particular disability or disease. Science has yet to discover a cure for paralysis but the aim of physiotherapy is to make the patient as independent as possible. Depending on the affected area and the extent of paralysis, physiotherapy is started. Doctors recommend physiotherapy for paralysis for the following reasons

Physiotherapy should be started immediately because it improves blood circulation and relaxes the affected muscles. It can also inhibit the advancement of paralysis and develop muscle tone and the general well-being of the patient.
If the brain has suffered a severe external injury, physiotherapy assists in reducing the swelling and fastens the recovery process.
It aims at making the patient mobile and fully functioning.
Physiotherapy focuses on the maintenance of respiratory function.
Prevents pressure sores and contracture.
The physiotherapist sometimes works on unaffected muscles to compensate for the paralysed ones. Physiotherapy maintains and builds muscular strength in the affected areas. This action prevents deformation of limbs.
Physiotherapy training helps in managing paralyzed bladder and bowel movements.
Physiotherapy helps in building the morale of the patient and motivates the patient to be independent.
A side effect of Paralysis is post-traumatic depression that includes anxiety, denial hostility. The patient is often angry which may worsen his condition. Physiotherapy helps in controlling these feelings and gives the patient hope.
A physiotherapist suggests adaptive and modern equipment such as a splint, orthosis, braces as well as a cane for the disabled person depending on severity of the condition.

Paralysis - How Physiotherapy Can Be Helpful?

Knee is a hinge joint where the lower leg bone tibia meets the thigh bone femur. During osteoarthritis, cartilage or ligament defects and degenerative arthritis, knee replacement surgery is recommended world-wide to get relief from extreme pain. Knee replacement surgery, also known as knee arthroscopy, is a surgical procedure, in which the affected knee joint is replaced with synthetic material. The most likely candidates for total knee replacement are the patients with severe destruction of the knee joint coupled with progressive pain and impaired function.

Modern technological advances have made computer assisted knee replacement surgery extremely popular around the globe. In this surgery, the surgeon is assisted by a computer to remove the optimum amount and angle of the bone, which otherwise is done by inspecting manually. This is an excellent example of surgery through small incision and it eliminates the chances of human error. A perfect alignment and balance is achieved and hence longevity is also increased to 20 - 30 years. Knee replacement surgery is also specific to gender as the anatomy of male and female patients is different.

There are many types of knee replacements, most common being the total knee replacement or Total Knee Arthroplasty. In addition, there is partial knee replacement, bilateral knee replacement, revision knee replacement and knee arthroscopy.

In knee replacement surgery, the worn out surfaces of joints of knee are replaced with artificial implant of plastic and metal. The lower end of the femur bone is removed and replaced with a metal shell. The upper end of the lower leg bone (tibia) is also removed and replaced with a channelled plastic implant with a metal stem. A plastic ball is also added under the kneecap depending on its condition. These artificial components are commonly referred as prosthesis. The design of these highly flexible implants replicate knee, with the rotating knee replacement implants assist in backward and forward swing of the legs.

Patients whose knee joints have been damaged by either trauma or progressive arthritis should consider total knee replacement surgery. Post-surgical hospital stay after knee joint replacement is usually three to five days. The surgery has a very high success rate and shows dramatic improvement after a month. This improvement is most notable one month or more after surgery. The pain caused by the damaged joint is reduced significantly when the new gliding surface is constructed during surgery. Initially, patient will walk with the help of a walking aid until the knee is able to support full body weight. After six weeks, patient can walk comfortably with minimal assistance. Patients with artificial joints are prescribed to take antibiotics during the course of any elective invasive procedures including dental work. Physiotherapy is an essential part of rehabilitation and it will increase the muscle strength and patient can enjoy most activities, except running and jumping.

Knee Replacement

A slipped disc is a condition which is characterized by a damaged disc in your spinal cord. The disc is a soft substance present in the spinal cord that cushions the vertebra in the spine. A slipped disc occurs when the soft substance in the disk pops out causing pain in the area. 

There are various preventive measures that you can adopt to prevent a slipped disc from occurring; they are

Keep a check on weight: Being overweight increases the risk of a slipped disc as the pressure on the lower back will be immense. In order to reduce the pressure, maintain optimal levels of bodyweight.
Exercise regularly: Do strength training exercises such as the plank and squats to strengthen the core muscles. This helps in strengthening your lower back strong and prevents slipped disc from occurring.
Maintain a good form while exercising or lifting anything heavy: If you are exercising or simply lifting something heavy, make sure to keep your lower back straight. Lifting heavy weights without proper form may lead to slipped disc as the spine may not be able to bear the stress.
Quit smoking: It is advised to quit smoking as smoking impairs the ability of the disc to absorb nutrients and thus, prevents it from remaining healthy. It may also cause the discs to become brittle and dry.
Maintain a good posture: Remember to keep an uptight posture while walking; keep the spine straight to prevent slouching. Maintain a proper neutral posture while sitting as well. Hunching over your desk while working with your computer may also cause problems in your spine.
Do not sit for prolonged periods: Sitting for extended periods of time may cause problems in your lower back and posture. It may weaken the lower back muscles and lead to complications such as a slipped disc.

Slipped Disc - Things You Must Do To Prevent It!

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