The deltoid muscle is situated around the shoulder joint that makes up the shoulder. It is classified into three parts - front, side and rear deltoids. It is one of the most frequently used muscles in the body, its major functions are abduction and forward elevation of the arm.

Causes
A deltoid strain is a condition where you experience pain and tenderness in the shoulder area due to various causes like overuse of the deltoid muscle. It is very common in weightlifting and various sports such as cricket. It may even lead to partial loss of function in the deltoid muscle. Deltoid strain may be caused due to overworking of the muscle without adequate rest. It may also be caused due to lengthening of the deltoid muscle under stress or direct trauma to the muscle.

There are three types of deltoid strains

Grade 1 deltoid strain: It is characterized by tight muscles with some possible swelling. There may be mild pain when you use your shoulders for any activity.
Grade 2 deltoid strain: This strain is a result of a major injury to the deltoid muscle; there may be visible swelling and pain while carrying out activities that require movement of the shoulder. Lifting your arm to the front or the sides becomes difficult and painful.
Grade 3 deltoid strain: This form of deltoid strain is the most severe of the three; it may cause the shoulders to become immobile. You usually will experience excessive pain and severe swelling. You might not be able to move your arm and carry out any activity that requires the shoulders.
Diagnosis
The diagnosis of a deltoid strain starts with a physical exam where the doctor will understand the symptoms of the deltoid strain. Various imaging tests such as x-rays may be required for the diagnosis. The basic treatment for shoulder strain comprises of the RICE protocol (rest, ice, compression and elevation) which is used to treat grade 1 and grade 2 strains. Grade 3 strains may require surgery in addition to the above treatment methods. In case of excess pain, the doctor may prescribe non-steroidal anti-inflammatory drugs to ease the pain.

All About Deltoid Strain!

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!

Muscle sprains and ligament tears are one of the most common injuries that medical practitioners encounter on a regular basis. These injuries are painful and can also limit one s movement, needless to say. However, there are simple things that can be done as soon as the injury happens so that the impact of the injury can be reduced, the symptoms minimised, and recovery improved.

A sprain is a tear of the ligament. The ligament is responsible for connecting the tissue strands that connect the bone to the muscle. When this sprain affects the muscle or even the tendon, it is known as a strain.
Sprains are very common and can occur due to a fall, twist, or impact. Most commonly affected areas are the ankles and wrists. Sprains happen when there is a pull or a twist of the ankle or the joint. This is very common in athletes and can be caused by repetitive motions in the knees, wrists, elbows, etc.

The most common symptom is pain, swelling, limited movement, and sometimes bruising. The degree of these injuries depends on its severity. The most common ways to treat such injuries are as follows.

RICE therapy: RICE is an acronym for rest, ice, compress, and elevate. Rest the affected area immediately by stopping any further activity. Ice the area using an ice wrap, with the ice cubes wrapped in a towel or a cotton cloth. Repeat this exercise if possible for every 20 minutes. This will reduce the swelling and pain. Compress the area using a sling or a wrap. This will help in reducing the swelling. Elevate the affected area if possible above the heart. This will help control the blood flow and thereby reduce the swelling and pain.
Pain control: If there is pain that needs medication, go for the non-steroidal drugs like ibuprofen or acetaminophen. If it is a child that is injured, it is advisable to give non-aspirin ones.
Seek professional help: Most sprains can be self-limiting over a couple of days. However, it is advisable to seek medical help if there is significant pain, swelling, or numbness, open wounds or bruises, or inability to move the joint.
The doctor may decide to do the following.

Scanning or imaging to rule out any internal hard/soft tissue injury like fracture or tear
Immobilise the joint with a splint or a cast
Start physical therapy if there is severe pain and immobility
Surgical repair if there is a ligament injury
A word of caution to athletes or people who are very active physically is to go easy on the joint. In an eagerness to quickly get back to their routine, more and severe damage may be caused. This can be avoided by allowing time for complete healing.

Muscle & Ligament Sprain - Tips To Help You Deal With It!

If you are an avid runner, then you might also be well aware of the type of running injuries one is prone to. It might be foolish to say that running injuries can be prevented. It is because these injuries do happen quite often. Though these cannot be prevented, these can definitely be treated. Furthermore, precautions from your side can always be taken to make sure that these injuries do not cause a major impact on your health and can be cured without much of a hassle. Here are some important points that you need to remember to avoid running injuries or to lessen their adverse impact on your body.


Flexible Body: Flexibility is an important part of a runner s body. You not only need to have the stamina to run, but also must possess flexible features to get you out swiftly from any serious damage. Flexibility is attained when you do regular exercises and stretching in particular. It makes your muscles resilient towards many injuries and provides your body a better shape and long lasting stamina as well.
Strengthen Your Body: Body strength is required if you want to avoid any sports injuries. Special strength training sessions are organised with the coaches of sportspersons. These sessions help in building up muscle strength. This would, in turn, lessen muscle fatigue and make you able enough to perform better.
Balanced Diet: It does not matter whether you are an athletic or not, a balanced diet is needed for everyone. Balanced diet does not mean picking and choosing of food. It means a proper diet chart, mapping everything that your body needs to stay fit. Furthermore, it should contain ample amount of water to keep you hydrated.
Take Rest When Required: It is often said by the elders that too much of work would ruin your health and body. Thus, even for the athletes, it is important to take rest in between periods of heavy training sessions. This would give you a chance to relax your body and relieve you of all the stress. Furthermore, if you are injured or hurt, it would give you ample time to recover from your injuries.
Wear Proper Shoes: As a runner, you need to take care of all parts of your body. This would also include your legs. To prevent any sprains or muscle injury in the leg and to practice for long hours, proper running shoes are needed.  


How To Avoid Running Injuries?

Avascular Necrosis, also termed as Ischemic Bone Necrosis or Osteonecrosis is a medical condition characterized by the bone death on being deprived of blood. The condition is known to occur in the shoulder, ankles, and knees. However, the part of the body most affected by Avascular Necrosis is the hip. In this article, we will describe the conditions that contribute towards Avascular Necrosis of the hip along with the associated symptoms.

Factors that lead to Avascular Necrosis of the hip
The supply of blood to the bones may be interrupted by a myriad of factors some of which include

1. Certain medical conditions and health disorders such as

Gaucher's disease: A genetic disorder resulting from glucocerebrosidase enzyme deficiency. As a result, glucocerebroside gets deposited in the cells of the macrophage-monocyte system.
Sickle cell anemia: A genetic disorder which results in the RBC's appearing like a sickle cell instead of being round shaped.
Both of these conditions bring about a significant reduction in the supply of blood to the bones resulting in Avascular Necrosis.

Certain inflammatory conditions that may damage the arteries and trigger Avascular Necrosis of the hip include autoimmune diseases, pancreatitis or HIV infection.

2. Extensive and prolonged use of corticosteroids: Often used as non-inflammatory drugs, corticosteroids can play a contributing role, resulting in Avascular Necrosis (non-traumatic). The fatty substances are usually broken down by the body. However, the use of corticosteroids may affect this breakdown as a result of which the fatty substances start piling up in the blood vessels, constricting their size. The constricted blood vessels, in turn, reduces the supply of blood to the bones to a great extent.

3. An injury or a fracture affecting the femur: A hip fracture or a dislocation that affects the upper half of the thigh bone or the femur acts as a potential threat, triggering a traumatic Avascular Necrosis (AVN) of the hip.

In some case, radiation therapy or chemotherapy for cancer can go a long way in interfering with the ability of the bone (weakens the bone) to receive blood, causing bone death.

People who are into heavy drinking stand a greater risk of suffering from AVN. An increased consumption of alcohol causing constriction and narrowing of the blood vessels interfering with the flow of blood to the bones.

Symptoms characteristic of AVN of the hip

Unfortunately, the initial stages of AVN are asymptomatic. However, as the condition progresses into later stages, a person may experience pain and discomfort, particularly while exerting pressure on the bone affected by the condition.
As the bone and the adjacent joints deteriorate and collapse further, a person may experience great difficulty in using the joint altogether.
In some cases, the condition may progress and affect both the hips (Avascular Necrosis Bilateral).

Causes and Symptoms of Avascular Necrosis of the Hip

In the recent years, with the building work pressure and the increasing stress in our everyday activities, our regular lives have become choc-a-bloc with all sorts of engagements. This often renders our bodies prone to fatigue and listlessness. This phenomenon can often be observed in an intensified form by way of a disorder called Fibromyalgia or as it is deemed in common parlance, "rheumatism". 

Fibromyalgia is an ailment, which causes pain in the body tissues. The tender and fibrous tissues like muscles, ligaments and tendons are often affected by this disease. As a consequence of Fibromyalgia, one feels incapacitated to work or perform any physical activity. Sometimes Fibromyalgia is accompanied by extreme headaches, sleep disturbances, muscle pain and consistent dizziness. 

The degree of chronicity of the disease may vary but the underlying cause remains the same. Given the high incidence of the disease, the treatment for the same is also widely available. However, for a more effective and lasting cure, many resort to homeopathy. Homeopathy offers several remedies to Fibromyalgia, classified on the basis of the discrete symptoms of the disease. 

1. Rhus Tox: Rhus Tox is an excellent antidote for rheumatism induced stillness and muscle pain. When paired with suitable exercises, it can afford a lot of relief. 

2. Ruta Grav: Ruta Grav aids in relieving tendon pains and sustained usage helps in restoring muscle strength in case of Fibromyalgia.

3. Rhododendron: Often the Fibromyalgia pain gets aggravated with a marked change in the season. Rhododendron mitigates the intensity of the pain. 

4. Arnica: For any injury induced body ache, Arnica is an extremely effective cure. It also functions as the foremost option, when the precise causes or the symptoms are unknown. 

5. Causticum: Certain forms of Fibromyalgia are accompanied with soreness, weakness and a feeling of stillness. Causticum soothes such ailments.

6. Bryonia: Bryonia alleviates chronic pain in the soft tissues of the body. Exposure to heat needs to be avoided mandatorily in order to optimize the effect of Bryonia. 

7. Kalmia Latifolia: When besides the obverse symptoms of Fibromyalgia, the pain in the muscle is accompanied with a feeling of cold and numbness, one of the best homeopathic cures is Kalmia Latifolia. 

Fibryomalgia is an ailment, which not only manifests physical troubles but also affects one's emotional status adversely. Therefore, to mete out the best remedy, homeopathy carefully assess both the physical and the psychosocial bearing of the patient before recommending a particular cure.

Homeopathy and Fibromyalgia

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