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!

The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.
Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in   Acute radicular pain due to irritation or inflammation.

Symptomatic herniated disc with failed conservative therapy
Acute exacerbation of discogenic pain or pain of spinal stenosis
Neoplastic infiltration of roots
Epidural fibrosis
Chronic LBP with acute radicular symptoms
Epidural- lumbar injection
ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

There is minimal or no radiological finding.
Multilevel imaging abnormalities
Equivocal neurological examination finding or discrepancy between clinical & radiological signs
Postop patient with unexplainable or recurrent pain
Combined canal & lateral recess stenosis.
To find out the pathological dermatome for more invasive procedures, if needed
Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Procedures That Can Help Treat Slip Disc & Sciatica!

Our bones and joints make us functional on a day to day basis. It is, therefore, imperative that we should take good care of them at all times. There are many conditions that can affect our skeletal system and one of them is, Gout. While the link between the two may not be that obvious, gout happens to be a condition, which is sometimes related to arthritis. Therefore, it is sometimes known by the name 'gouty arthritis'.

While the issue may be severely painful, it does not mean that it cannot be reduced. And of course, when a person has the option and cutting the pain caused by gout drastically, his or her natural response is likely to be 'why not?'

Why Does It Happen?

The main reason for the occurrence of gout is too much uric acid being present in the body. The limbs of the body swell up, especially the extremities and this is known to be very painful. In many cases of gout, the swelling is especially evident in the big toe. Flare ups can last hours on end and may even get longer.

The people who wish to get the gout that is putting him or her through so much pain treated, there are quite a few options at their disposal. There are pain relievers that can be consumed under the advice of a medically qualified professional. While these pain relievers do not treat gout, but can reduces the intensity of the symptoms. Daily doses can be recommended as per the requirement and severity of the situation.

How to Get Rid of Gout?

While some anti-inflammatory drugs may have their effect, but no matter how bad the pain, aspirin is a drug that needs to be avoided. Intake of aspirin can make the problem even worse, which is the last thing a person would want!

The severe problems of gout can be dealt with the chemicals known as corticosteroids. Now, while these can provide some very effective pain relief, using them can be tricky due to certain side effects. One of these side effects is that since these chemicals are injected into the joints, they can significantly weaken them. The other side effect is that they slow the healing process of the wound. Both of these side effects are highly undesirable for any patients. These chemicals are usually prescribed by the doctors after a thorough analysis of patient's condition and history.

A person who drinks alcohol and suffers from severe condition of gout should look to scale back the amount which is consumed by him or her. This is because alcohol increases the amount of uric acid which is present in the blood.

Gout and Its Treatments

Debilitating inflammation in the joints and its surrounding tissue usually characterize arthritis. This ailment can greatly weaken the body. At the point when joints are seriously influenced by joint pain, there are a number of treatment methods that may be available for the patient. Pain relievers, physiotherapy and other forms of treatment can help in offering relief. Yet, when these methods fail, one can go in for replacement surgery of the affected joint. This may not just lessen or eliminate the pain experienced but it can also it can reestablish better strength in the joint. Hip, knee, and shoulder joint substitutions are a portion of the more normal surgeries suggested when managing joint pain.

Joint Replacement Surgery for Various Joints: Arthritis can affect a variety of joints in various ways. In the shoulder, this can be found in the humerus (the upper arm bone) and a bit of the scapula (the shoulder bone). In the knee, it includes the finishes of the femur and tibia (the thigh bone and shin bone, separately) and the patella (the knee top). In the hip, the influenced zones are the femur and the attachment in the pelvic bones in which it rests (the hip bone socket). In simple words, an aggregate joint trade or replacement for joint pain includes replacing the harmed joint surfaces with simulated segments artificially.

Ideal Candidate: In the event that your joint pain is progressed yet you are generally healthy, joint substitution might be a choice. Notwithstanding, you should take the advice of an accomplished orthopedic pro who can give you moderate treatment choices and other negligibly intrusive ways to deal with the condition before resorting surgery.

As a rule, you may not be a decent candidate of the replacement if:

-You have inadequately controlled diabetes

-You are a chain smoker

-You are extremely chubby

-You have encountered contaminations in the influenced ligament joint before

The best contender for a ligament joint replacement surgery includes patients who:

-Have joint pain that is extreme

-Are encountering a debilitating effect in their personal life due to the painful symptoms

-Have discovered moderate medicines, for example, mitigating drugs and non-intrusive treatment to be ineffectual

-Are willing to effectively and regularly participate in a recovery program after surgery

The accomplishment of a joint substitution surgery relies on upon the stability of the remaining parts of the joint. In the event that the joint has endured a few diseases, or in the event that it has experienced a few surgeries, it may not be sufficiently solid to withstand a joint replacement procedure. What's more, if you there are immune system disorders or long ailments like diabetes at play, then there may be little chance of aligning with the new joint.

Should You Undergo a Total Joint Replacement for Arthritis?

Gout is a form of arthritis which leads to inflammation along with severe attacks of pain and redness in the joints. It typically affects a single joint at a time, however, in a few cases, the gout is affecting numerous joints at a time. The large toe is most affected, but gout can affect other joints at ankle, foot, knee and wrists and hands as well.

What causes gout?
Gouty arthritis arises by the disposition of uric acid crystals in the joints which is derived from purines. Some foods comprise of copious amounts of purines, particularly organ meats and red meats along with alcohol, shellfish, and anchovies. When the uric acid is within normal limits, they get easily passed through the kidneys in the form of urine. But when the uric acid is at high levels, it causes gout.

How can homeopathy help in the treatment of gout?
In homeopathy, the approach to treat gout is to treat the affected person as a whole in place of the signs and symptoms of gout. Therefore, it is important to know about the constitutional type of the individual rather than determining the disease therapeutically. Besides taking appropriate homeopathic medicine, it is advised to maintain a healthy diet for proper management of the condition.

The homeopathic experts choose the remedies according to the entire picture of the patient and not just on the basis of the physical symptoms. Therefore, factors like mental and emotional state, lifestyle, character, stress levels, family history and other general factors come to play. Here are some of the most effective homeopathic medicines that are able to cure gout symptoms effectively:

Urticaurens: This homeopathic medicine helps in the elimination of uric acid from the body. You can take this medicine for hives like eruptions, pain in ankles, wrists and acute gout deltoid.
Colchicum: When the gout attack is so severe that you are not able to touch or move the affected area, you can take Colchicum. It is suitable for the treatment of inflammation, oedematous swelling along with coldness of feet and legs. It can also be used when the symptoms tend to be worse during the night and in warm weather.
Ledum pal: When the gouty pains shoot all across the foot, joints, and limbs, Ledum pal can come to your rescue. It can also be used when the ball of the great toe is swollen and become hot and pale.
Benzoic acid: This can prevent and cure the symptoms of gout especially, dark-colored urine and pain in the great toe. Typically, when the uric acid levels are increased, benzoic acid is indicated.
The treatments mentioned above are some of the best homeopathic treatments for gout, yet, it is recommended to consult an expert before you decide to self-medicate.

Effective Homeopathy Remedies That Can Cure Gout!

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!

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