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!

Tennis Elbow is involved with the muscles and tendons of one s forearm. It leads to inflammation of the tendons which join the forearm muscles on the outside of the elbow.

Physiotherapy treatment can be of great help. The primary goal of this treatment is to improve the strength as well as the flexibility of one&#39;s forearm muscles. Now, before we take a look at the tips regarding physiotherapy treatment, let us briefly discuss its symptoms and causes.

Symptoms

If a person suffers from the problem of tennis elbow, then it s sure to cause pain and tenderness on the outside of one s elbow. The pain is at its peak when the elbow is kept still, while there might be variations in the pain when it is in use.

There are other symptoms, which include:

Trying to lift the arm can cause discomfort as it results in pain.
One can also feel the pain while writing or even when anyone tries to grip small objects.
People can even encounter stiffness accompanied by pain when they try to extend his or her arm at full length.

Causes

There are a number of causes behind the occurrence of Tennis Elbow. They include:

Incorrect movements of the arm on a repeated basis, which can result in the tendons getting torn.
Those who play sports like badminton, tennis and squash that require excessive movement of racquets.
Any manual work that requires regular lifting of the wrist.
Sports activities that involve an extensive amount of throwing.

Tips Regarding Physiotherapy Treatment For Tennis Elbow


Consult a physiotherapist to undergo physiotherapy treatment for tennis elbow, the therapist would help to provide strength and flexibility of forearm muscles. The following are some of the tips regarding Physiotherapy treatment to treat tennis elbow:

A physiotherapist can offer the modern technique of dry needling the wrist extensions in order to improve the range of motion among patients.
Modern physiotherapy treatment for tennis elbow also includes the use of Kinesiology Tape, which can relieve pressure, relax associated muscles and also increase blood circulation.
Cupping is another mode of physiotherapy treatment, which can help increase blood flow to the affected tissue and improve the length to rest muscles
Physiotherapy can include a patient wearing an elbow strap, which wraps around his or her upper forearm in such a way that the pressure gets relieved on the tendon attachment.
A physical therapist might even apply ice and electrical stimulation to ease out the pain and improve the healing process of the tendon.
Physical Therapy sessions can also include iontophoresis, which makes use of mild electric current to insert anti-inflammatory medicine.
Once the pain subsides, a physical therapist provides inputs on different exercises like Wrist Extensor Flex, Elbow Bend, Wrist Turn, Wrist Lift and Palm Up, Towel Twist etc.

Physiotherapy Treatment In Tennis Elbow!

Human bones are continuously being removed and formed, which is necessary for its proper maintenance. However, in certain cases, especially with aging, some bones and joints will be worn down to an extent where the body will not be able to reform them. This is especially true in the case of hips, which may become worn due to age or other problems within the body. 

Hip replacement surgery 
When this happens, a hip replacement surgery can be performed to replace the original joints with a prosthesis or artificial hip, which is usually made out of metal or a specially formed composite material or even a combination of the two. Along with other parts, it replaces the natural hip with an artificial hip to restore mobility and other related functions.

Benefits of hip replacement surgery:
1. Lessening hip pain: This is one of the major factors as well as symptoms of requiring hip replacement surgery. Due to the grinding down of the bones, even the slightest movement causes pain and after the surgery and the recovery period, the pain is lessened.

2. Correction of bone deformity: When the bones grind down and are abnormally reformed, deformities may occur reducing mobility. Artificial hips will ensure that deformities are corrected and resulting problems are thus eliminated.

3. Return to normal activities: This is possibly one of the primary advantages of this surgery, although it entails a long recovery period. However, most patients can get back to their normal activities and are able to resume a pain free life.

4. Ability to have painless sleep: Many people who suffer from hip displacements or bone deformities are not able to sleep properly due to pain. After the surgery and the recovery period, they can return to normal functions and habits, thus are able to sleep properly.

5.  Leg strength increase: Many patients tend to have an increase in their leg strength as one side of the hip tends to become very weak due to bone problems before surgery. After surgery and recovery, the same side tends to have an increased strength due to the implant.

6. In most cases a lifelong solution to hip problems: As the hip replacement prosthesis is made out of metal and if the operation is successful, it usually tends to last till the end of a person's life and this area usually doesn't tend to have problems again.

Benefits of Hip Replacement Surgery

Why does PAIN occur? Understand the Mechanism of Pain

Pain is an unpleasant and distressing physical sensation caused by disease or injury, which induces hurt and anxiety in those suffering from it.
There are many different manifestations of pain, ranging from short term (acute pain) to long term (chronic pain). Other classifications include pain in the internal organs (visceral pain), injured tissue (inflammatory pain), nerves (neuropathic pain), etc.

The reason for the occurrence of pain depends on the cause and kind of pain being experienced. In most cases, pain acts as a warning sign that the body has been afflicted by a disorder of some sort, which may have arisen due to internal sickness or external wounding. Acute pains are generally cured on their own through rest or simple medication. Chronic pains, on the other hand, are more complicated in nature and the treatment requires more elaborate diagnosis.

The mechanism of pain

Pain is an extremely personal and subjective experience and affects each individual to varying degrees. The pain signals, which can arise in any part of the body, travel through the spinal cord to the brain along thousands of specialized nerves and nerve fibres. In the brain, it is processed in the centres associated with anxiety, emotions, memory, appetite, etc. Signals and pain inputs are then returned from the brain to the spinal cord, which may heighten or diminish pain.

In some cases, pain may also be induced by damage to the brain and spinal cord, which happens after a stroke.
A constant barrage of pain signals may cause the cells at the end of nerve fibres to become over-sensitized. This is known as 'wind-up' and is one of the most common causes of chronic pain that occurs even though the root of the problem has been identified and treated.

The causes and effects of pain differ from case to case depending on the signals received by the brain and its interpretation. It affects the individual's day to day activities and if persistent, can also have a harmful impact on mental health and psychosis. Pain is always handled, diagnosed and treated differently in all patients by drawing out the best possible solution to the problem.





Why does PAIN occur? Understand the Mechanism of Pain

Facial paralysis can happen due to many factors. Sometimes inflammation develops around the facial nerve as it passes through the skull from the brain. This presses on the nerve and makes it stop functioning. As the nerve stops functioning, so does the muscle it controls.


This is what happens in Bell s palsy, the most common cause of facial paralysis.


Bell s palsy can happen to anyone and its cause is, hold your breath, a viral infection. Herpes zoster, Varicella zoster and HIV viruses can cause Bell s palsy.


Bell's palsy is a common cause of a facial paralysis but there are many others too that affect or damage facial nerve. These include head injury, sarcoidosis, lyme disease, growths in the ear, tumours in the parotid gland, brain tumours and stroke.


The weakness of the face usually one-sided is a symptom of Bell s palsy. The face may droop to one side, chewing food is also tough, drooling, dry eyes and difficulty wrinkling forehead and speech are other symptoms of Bell s palsy, the most common reason for facial paralysis.


Treatment:
The type of therapy you receive for facial paralysis will depend on its cause. It will also develop on how long you ve suffered from facial paralysis and the extent of damage to the facial nerve.


Your physiotherapist can help and so can speech and language therapists to deal with the issue.


In physiotherapy, a treatment called 'facial retraining' with facial exercises helps with facial palsy. It is important that you seek help from a therapist who specialises in facial rehabilitation only.


This is what you can expect from facial rehabilitation therapy-
Exercises for eye care
Exercises for dry mouth management
Exercises to make drinking and eating easier
Speech therapy
Your physiotherapist will educate you on how the facial nerve works and how it recovers. This is important to make you recover. A home therapy programme plays an important role too. It includes massages to keep face muscles mobile and healthy, stretches to lengthen muscles, exercises to help re-learn balanced facial movements and relaxation of your facial nerve and muscles.


The physiotherapist will work on your facial movement to make muscles fit. The basic idea is to slowly rewire the brain-to-nerve-to-muscle pathway. The physiotherapist s first step is to retrain you to do correct movements voluntarily, while mentally focusing on the movement.


Physiotherapy may take months but keep at it to recover completely, especially the home exercises.


Injections of botulinum toxin or Botox also help especially if you suffer from spasms in facial muscles. Surgery is also an option for chronic cases.


Remember that exercises should be done gently as well as daily to reap benefits. Always do these exercises with the help of a therapist only. Doing exercises by yourself can be counter- productive.


Facial Paralysis - How Can Physiotherapy Help You Get Better?

Arthritis is defined as a disease that causes painful inflammation and stiffness in joints. There are some food items, which you should avoid if you are suffering from arthritis since they can worsen your condition and lead to inflammation and joint pain. Stick to a smart, nutritious diet that doesn't make you gain weight. The following food items should be struck off your daily meals:
 
1. Red meat: red meat has high levels of saturated fat. Patients of arthritis must avoid consuming foods containing saturated fat because they contribute to obesity. They also contain omega-6 fatty acids, which lead to inflammation if the intake is high. Red meat contributes to higher overall fat and calorie intake.
 
2. Sugar and refined flour: sugar and refined flour may cause an upsurge in blood sugar levels. When there is a spike in your blood sugar levels, the body produces a pro-inflammatory chemical called cytokines to break down the carbohydrates. This results in inflammation, worsening your arthritis symptoms. They also increase your weight, putting more and more pressure on the joints.
 
3. Fried foods: eliminating fried foods from your diet helps in reducing the levels of inflammation. Fried foods increase oxidation in the body's cells due to toxins called advanced glycation endproducts or age. They are high in fat and lead to obesity. Moreover, most restaurants use hydrogenated oils which are rich in trans fats. Trans fats are even more harmful than saturated fats when it comes to inflammation, chronic heart diseases and other health problems.
 
4. Alcohol and tobacco: high intake of alcohol causes a surge in the body levels of crp or c - reactive protein which is a powerful agent of inflammation. The risk of developing rheumatoid arthritis is higher among smokers.
 
5. Processed foods: foods that are ready to eat and require minimal cooking contain several ingredients that cause inflammation. They are loaded with saturated fats, refined flour and sugar and are extremely unhealthy and worsen arthritic pain. 
 
6. Corn oil: many foods, especially baked foods, are cooked in corn oil or other oils which are rich in omega 6 fatty acids and trigger inflammation. Corn oil can be replaced with olive oil that is rich in omega 3 fatty acids which is anti-inflammatory.

Foods To Avoid In Arthritis!

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