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!

Hemorrhoids or piles are diagnosed by swelling of veins in the lower part of anus and rectum. Due to swelling, the walls of rectum and anus are stretched and thus become irritated. Hemorrhoids are of two types: Internal and External hemorrhoids.

Internal Haemorrhoids: As the name suggests, the piles are not visible from outside. These are present deep inside the rectum, located above the pectinate line and these are covered with the cells that are present through the rest of intestines. Internal hemorrhoids are normally painless. The first sign of internal hemorrhoids is rectal bleeding. However, straining can push internalhemorrhoid and it protrudes through the anus and this can be painful.

Causes of Haemorrhoids
The swelling of hemorrhoid occurs only when the pressure in the small vessels of rectum and anus is increased and is engorged with blood. The size of the hemorrhoids is also increased. The increased pressure may be due to various factors:

Consuming low fiber diet and pushing or straining while passing stools, thus blood vessel pressure is increased.
Pregnancy also is a cause of swelling as there is the increased pressure of the uterus on rectum and anus.
Sitting for long on toilet also increases pressure.
Obesity is also a cause of hemorrhoids.
People suffering from diarrhea, both acute and chronic.
A person having colon cancer might have hemorrhoids.
Signs and Symptoms of Haemorrhoids:

The most common symptoms of hemorrhoids are painless bleeding, itching in anal, swelling and feeling of the presence of lump at the anus.
All these symptoms are associated with inflamed hemorrhoid.
Inflamed internal hemorrhoid can cause swelling, but is painless as there are no fibers attached to veins above the pectinate line that cause pain. However, passing hard stools can scrape off the thin lining of hemorrhoid, which can cause the painless bleeding.
Spasms of the rectum and anal muscles caused by these swollen hemorrhoidscause pain, especially when they are protruded through the anus.
Internal hemorrhoids can form a clot or thrombose resulting in severe pain.
The presence of has inflammation, stool,and constant moisture and these can lead to itching and burning sensation in the anus among patient of internal hemorrhoid.
Treatment of Haemorrhoids

Diet: Haemorrhoids can be treated when individuals consume a fiber-rich diet in order to soften the stools and ease their bowel movements. Fiber-rich foods include fresh fruits, dry fruits, grains, vegetables, and cereals. About 20 to 30 grams per day of fibrous foods is recommended. Dietary fiber will help create bulk in the intestines which will help in softening of stools and ease bowel movement. Supplemental fiber available in the marketincludes psyllium husk, methylcellulose, and calcium polycarbophil. Other recommendations include increased intake of liquids and having stool softeners. Drinking enough water and liquids will prevent stool from hardening.
Over-the-counter topical treatment: There are various products available to treat hemorrhoids, such as gels, hydrocortisone creams, ointments, foams, pads, and suppositories.
Home remedies: Soaking anus in a warm sitz bath might also help in hemorrhoids for about 10 to 15 minutes per day. One should practice good hygiene and clean anus with warm water while showering. Avoid using soap and dry toilet paper. One can also use a cold compress on the anus.
Minimally Invasive Procedure for Hemorrhoids (MIPH)

Out of the various types of medical and surgical interventions available to treat Piles, Minimally Invasive Procedure for Hemorrhoids (MIPH) 0r painless stapler surgery is known to be very popular since it acts an alternative approach to surgical interventions made for piles.

MIPH is defined as a minimally invasive surgical technique in which a band of loose or prolapsed mucosa and sub mucosa in the rectum is excised, proximal to the piles and disrupted mucosa is fixed by  stapled end to end mucosal anastomosis.

This will ultimately occlude the blood supply to the superior hemorrhoidal artery above the hemorrhoidal tissue, resulting in the retraction of prolapsed mucosa back to its original anatomical position. A special circular stapler known as PPHO3 is used in the anastomosis and the whole maneuver will take around 30 45 minutes.

Internal Haemorrhoids - Best Ways They Can Be Treated!

The human body allows for movement through the complex system of bones, muscles and joints. A break in the bone is medically known as a fracture and can be caused by constant stress, pressure or impact. It is common knowledge that with age, the bone strength decreases and incidence of fractures (osteoporotic fracture) increases. Based on the affected bone and impact, different types of fractures are commonly identified as:

Complete: When the breakage of the bone is complete, producing two or more pieces, it is referred to as a complete fracture.
Incomplete: When the breakage is incomplete, where the bone has cracked, but does not break into pieces, it is known as an incomplete fracture.
Another type would be the open or closed fracture:
Open fracture: When the skin is exposed and the bone breaks through this exposed skin, it is known as compound or open fracture.
Simple or closed fracture: The bone breaks, but the skin continuity is maintained. Again, here are different types including hairline, greenstick, oblique, etc.
What is the reason behind a fracture?
A bone will fracture when force is applied to it that is stronger than the bone itself. A key factor in a bone s susceptibility to fracturing is age. Both children and older people are prone to bone fractures. Children s bones are constantly growing and have not reached their full strength. Elderly people have brittle bones with old age and are prone to develop bone diseases, making them susceptible to fractures.

How they are treated?
Splint and pain medications are commonly used. Closed reduction where the fracture is reduced without opening up the tissues and open reduction, where the tissues are opened up are common approaches to managing fractures.

Can they be prevented?
Especially with children and in the elderly, extra precaution should be taken to avoid any kind of injury and fracture.

Develop an exercise routine to strengthen the muscles
Manage weight
Use the right footwear and exercise gear
Watch your medications (avoid sleep inducing ones)
Increase lighting in the room/home to improve clarity of vision for elderly
Make the home/living area fall-proof by reducing clutter, using railing in the bathroom and bedroom, using rubber mat, etc.
While a fall may seem inevitable, taking the above steps can help reduce the incidence and severity of a fall, thereby minimizing damage.

Bone Fracture - Common Types and How They Can be Prevented?

Tennis elbow is a condition which is characterized by a sharp pain on the outer portion of the elbow. This condition is also called  lateral epicondylitis  and it occurs when the muscles of the elbow are overused. The symptoms of pain tend to occur near the forearm when you bend your elbow or try to grip an object.

Causes
The elbow joint comprises of muscles which facilitate movement of the wrist, elbows and the fingers. There are tendons present in the elbow which join the muscles and bones, thus regulating the forearm muscles. When the muscles of the elbow are overused, then it can lead to inflammation and tears in the muscles.

This condition is so called as it is usually caused by playing certain sports, primarily tennis. It may also be caused by activities that put repetitive stress on the elbow. If the same pain occurs around the inner portion of the elbow, it is called a  golfer s elbow .

Prevention
The best treatment method to prevent tennis elbow is to strengthen your elbow muscles. You need to follow a regulated strength and stretching program directed at strengthening the muscles of the body, including the elbows.

Here are some tips to prevent tennis elbow:

Try to stay in good shape physically.
Use proper technique when you are carrying out any activity that involves the elbow.
Avoid overstressing the elbow joint with repetitive movements as it can cause injury to the tendon.
The muscles of the shoulder, arm and the upper back should be strengthened to prevent tennis elbow.
For movements that require you to twist your arm or grasp things, you can use a counter force brace to protect your elbow. This brace is worn on the forearm which redistributes pressure on the muscle. A counter force brace is recommended for people who are at an increased risk of tennis elbow.

Tennis Elbow - Tips To Help You Prevent It!

A sprain refers to a break or a tear in any of the ligaments of your body. A ligament is a band consisting of tissues that connect the bones at any given joint in our body.

A strain on the other hand refers to a tear or a break in the entire muscle itself or a tendon (the band of tissues that connect the muscle to the bones).

Occurrence
Sprains usually take place due to unforeseen incidents like falls, accidents, and such other things that forces the body part to go out of its normal position. The most common types of sprains that people suffer from are ankle sprains which affect about 25,000 people every day on a worldwide basis.

Strains usually happen when you twist a whole muscle or a tendon. This condition most commonly occurs in cases of sportspersons who are engaged in contact sports like hockey, football, rugby, and such others.

Symptoms
The identification signs of sprains and strains are mostly very similar, which are listed below:
1. Pain and discomfort in the joints
2. Visible swelling or inflammation seen on the joints
3. Bruising of the affected area
4. Tenderness and softness of the affected joint

The overall intensity of the above mentioned symptoms might differ basis on the severity of the condition that is directly proportional to the nature of injury that you have faced. Some pains are so light that it may not affect your daily routine at all, whereas some pains are so intense, that you might not be able to move your affected joint at all.

Treatment
Some of the common methods to cure a sprain or a strain are listed below:
1. Rest the area which is affected
2. Apply ice bags or cold compress to soothe the pain
3. Compress the affected joint using a compression tape
4. Place the affected joint on an elevated area to speed up the healing process

Sprain Versus Strain

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