The movement between bones and muscles is possible due to the fluid filled sacs that enable smooth gliding of the bones. When there is an inflammation of these sacs, condition known as bursitis results, leading to friction, reduced movement, painful movement, discomfort, and irritation.

Some of the common causes of bursitis include age, which brings along reduced elasticity of the tendons and ligaments.  Additionally, sudden injury to the bursa area, repetitive stress, overuse of the ligaments or tendons, incorrect posture, and improper exercise can all lead to bursitis.

The most commonly affected parts are the elbows, shoulders, hips, knees, and ankles. The dull, aching pain that ensues is accompanied by stiffness. Movement can worsen this pain.  The area can be red, hot, and swollen indicating infection. Whatever the area affected, some of the common ways to manage bursitis pain are listed below.

1. Rest - As soon as bursitis is identified, the area must be rested. As noted, in most cases, repetitive stress and injury is the most common cause, and resting the area really helps.

2. Ice only - If bursitis is happening for the first time, then an ice pack alone should help reduce the pain in 1 to 2 days.

3. Ice and moist heat - If it is happening repeatedly, then alternating moist heat and ice for 15 minutes each will help.  This can be done two to three times a day. 

4. Anti-inflammatories: In most cases, if rest and topical therapy are not working, then the regular anti-inflammatory agents may be given. 

5. Physical Therapy - In some cases, mild exercises can help reduce inflammation and pain. 

6. DMSO (dimethyl sulfoxide) - This clear, colorless, oily liquid is made from wood pulp and helps in reducing the inflammation caused by bursitis. A 70% DMSO mixture can be applied with cotton on the affected area 3 times a day for 3 days, then 2 times a day for the next 3 days, and then 1 time a day for the next 3 days.  If there is no improvement in the first 3 days, it needs to be discontinued.

7. Foods to remove calcium deposits - In a number of cases, bursitis that is present for months or years is worsened due to the calcium deposits. Foods like apple cider vinegar can help dissolve the calcium deposits that could have formed in the bursa.

8. Steroids: Local injections of corticosteroids may be necessary in some cases. Though inflammation can be curtailed with this, there is always the fear of hampered immunity and altered sugar levels.

9. Surgical drainage - In very rare cases, the bursa may need to be surgically drained.
Bursitis is a very common issue and can be managed easily as well. Consult your doctor and avoid medicating on your own.

Ways to Treat Bursitis

If you have been facing back problems in the form of pain and discomfort for a long time despite undergoing treatment and medications, then you must be wondering whether you should go for a spine surgery. With the advancement in technology in the field of medical surgery, spine surgery has gained popularity owing to its effectiveness and high success rate. However, there are plenty of misconceptions regarding spine surgery, which need to be busted so that people do not make decisions based on these false beliefs.

Here are five myths about spine surgery debunked-

  Myth: Surgery is a must if you have damaged discs.
Fact: Many people live with a herniated disc. It is a fairly common spinal condition. The common belief is that you need to undergo a surgery to fix the problem. However, it is not true. In fact, many people have found relief from back pain following non-surgical methods such as physiotherapy and low-key exercises. These are the initial course of the treatment and usually, the patient sees positive results after the completion of the course.

  Myth: Surgery can relieve you from back pain completely.
Fact: Spine surgery is meant to correct spinal problems by restoring the functioning of your spine and reducing back pain. However, a surgery cannot relieve you from the pain completely. In other words, it cannot fix the problem entirely. There are certain parameters, which you need to correct on your own. These include maintaining a healthy body weight, living a healthy and active life, eating a balanced diet etc. Nevertheless, if the spine problem/injury is diagnosed early, the chances of a successful spine surgery increase.

  Myth: Spine surgery has serious repercussions, and it is not worth a try.
Fact: Like all other types of surgery, spine surgery too has a few risks or side effects associated with it. The most common types include blood clots, infection, weakness, and bleeding. However, these are not as serious as it sounds like. Since most of the surgeries are minimally invasive today, the minor side effects do not last more than a week and recovery takes place sooner. The side effects can also be managed with pain management medications well so the patient need not worry.

  Myth: Visiting a spine surgeon means you will definitely need a surgery.
Fact: Your orthopaedic may advise you to see a spine surgeon if the symptoms of your spine injury/problem become severe. This does not necessarily mean you will have to undergo a surgery. Sometimes, the doctor may schedule an appointment with the surgeon to have a unique perspective of the condition. Surgery is prescribed only as the last resort.

  Myth: Undergoing a surgery once means you will need another one soon.
Fact: If you have gone under the knife once, it does not necessarily mean you will need another surgery soon. Multiple surgical procedures are required only if the patient has sustained complex trauma to the spine. Such cases are rare. Usually, the patient undergoes spine surgery once, following which he/she is provided with a post-operative guideline. The guideline suggests engaging in mild exercises and making vital lifestyle changes to ensure fast recovery.

If you have been suffering from persistent, recurring pain in the back or neck that has altered or affected your quality of life in a negative way, its time you should consult a doctor. Do not hesitate if you need to undergo e a spine surgery urgently. The facts stated above will help clear your mind and eliminate any false belief that you had been holding in.

Spine Surgery - Busting The Myths Around It!

Myths about and treatments for arthritis

Arthritis is a medical condition which causes stiffness and inflammation in the joints. It can be extremely painful and should be cared for on daily basis.
 
However there are many myths surrounding arthritis that need to be busted.

1. Myth: every knee pain is arthritis.
Truth: the condition in which joints pain a lot, it is assumed that every type of knee pain is arthritis and there is only one type of arthritis. From gout to virus caused arthritis, to autoimmune arthritis, there are numerous different types of arthritis.

2. Myth: stop exercising to avoid straining your knee.
Truth: with the joints paining a lot, a lot of patients believe that they cannot exercise any more. The truth is that there are specific low-impact workouts designed for people with arthritis so that staying fit is never a problem.

3. Myth: arthritis makes you immobile.
Truth: arthritis does change your life since it affects your joints. But remember, it doesn't make you a handicap. It is false to believe that nothing can be done about the disease.

4. Myth: diet has no impact on the disease.
Truth: since it is a joints related problem, many people believe that dietary changes are not required if you are suffering from arthritis. It is in fact crucial since those suffering from arthritis are at higher risk of being obese, and in turn getting heart diseases and type2 diabetes.

If you would like to consult with me privately, please click on consult.


Busting The Myths Surrounding Arthritis

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!

Natural Ways To Manage Arthritis

You might be aware that there is no way that you can prevent arthritis to happen except for being car. But what you can do is delay and reduce the risk of its potential onset. If your joints are healthy now, there is no guarantee that they will always be, unless, you take good care. 

Do you know a few kinds of arthritis can be modified. They are:

1. Gout - Have a healthy, balanced diet which is low in cholesterol, alcohol and sugar. This will help you fight against the onset of gout.

2. Osteoarthritis - To modify the risk factor of osteoarthritis, it is important to maintain a healthy weight.

How to defeat arthritis?

1. Keep a check on your weight: If you are obese, you are putting more pressure on your joints and as a result, they wear out soon. By losing weight, you can make a lot of difference in your joint health.

2. Ensure good water intake: Our body is 70% water. And water is one of those things which is the most important for us. Staying hydrated is very important, even for your joints. Because when the body is dehydrated, and the body needs water, it uses the water stored in our bodies, incl the water in the cartilage.

3. Try to avoid any injury: No one really wants to get injured but it is important to be careful and cautious against injuries of any kind. The more injured your joints are, the more susceptible they are to wear and tear now, and arthritis later in life.

4. Don’t stress with physical tasks: There is a way and correct posture to do them, but many people ignore those and perform the tasks clumsily. This puts additional pressure on your joints.

5. Get Your share of Vitamin D: Vitamin D is very important for us. If your body has adequate amount of vitamin D, then you are less susceptible to arthritis. It is wise to get the levels tested and if low, a doctor consulted for proper medication.

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Pain- free Arthritis? Here’s How To Make It Happen!

Total Hip Replacement is also known as Total Hip Arthroplasty, in which the damaged cartilage and bones in the hip area are removed and replaced with prosthetic components. On the other hand, Total Knee Replacement, also known as Total Knee Arthroplasty or resurfacing, involves replacing the bone surface of the knee area. 

Causes of Hip and Knee Pain 

Arthritis is the most common cause of chronic hip and knee pain or disability. Other causes include: 

  Avascular necrosis or Osteonecrosis is a condition where there is an inadequate supply of blood to the femoral head due to a hip injury. The inadequate supply of blood may cause the bone surface to collapse and this can result in arthritis. 

  Rheumatoid Arthritis is the most common inflammatory Arthritis. In this condition, the synovial membrane surrounding the joint begins to thicken and become inflamed. This results in cartilage loss, stiffness, and pain. 

  Osteoarthritis is the type of arthritis, usually related to old age but can occur among young people too. The cartilage cushioning the hip and knee bones becomes soft and gradually wears off. The bones eventually start rubbing against each other which causes stiffness and pain in the knee and hip area. 

  Post-Traumatic Arthritis can follow a severe hip and knee fracture or injury. 

  Some children with hip disease or problem, even after treatment, can develop into arthritis later. This may be caused by uneven or unusual growth of hip which affects the joint surfaces. 

Knee Replacement Procedure 

  Bone Preparation: The surface of impaired cartilage at the end of the tibia and femur are separated besides a small extent of the underlying bone. 

  Locating the Metal Implants: The removed bone and cartilage are substituted by metal implants creating the joint surface. These metal pieces may either be press-fit or cemented into the bone. 

  Resurfacing the Patella: The undersurface of the kneecap or Patella is cropped and reformed with a plastic button. This process is variable depending upon the condition. 

  Inserting a Spacer: To form a smooth gliding surface, a plastic spacer of medical-grade is positioned between the metal components. 

Hip Replacement Procedure 

  Metal stem replaces the damaged femoral head and positioned into the femur s hollow center. 

  On the upper portion of the stem, a ceramic or metal ball is planted. This ball acts as a substitute for the damaged/detached femoral head. 

  The damaged Acetabulum or cartilage surface of the socket is discarded and supplanted by a metal socket. Cement or screws are used to sustain the socket in place. 

  A spacer, either metallic, plastic or ceramic is placed between the socket and the new ball for a smooth gliding surface. 

Take Away 

Knee and Hip Replacement are taken as the last option for the patient. The surgery and its outcome vary depending upon various factors. One should consult the doctor before undergoing for the Hip and Knee Replacement Surgery.

Primary Knee & Hip Replacement - Know More About Them!

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