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!

The spinal cord is indispensable to your body. It supports your head, keeps your posture erect, and helps you walk. Ailments of the spine are extremely painful to remedy and throw a lot of your other organs in trouble as well. Therefore, it follows that you should take the best care of your spine possible.

While there are a number of ways you can do that, some stand out from the rest. They are:

  Do your exercises properly: there are umpteen ways you can work out and get results that are harmful to your spine. You may easily lift something too heavy for your constitution, or the angle at which the object is placed may be too high for all your muscles to coordinate and work properly. Be aware, and avoid these mistakes. If you feel like the object is too heavy, refrain from lifting it. Even when lifting, make it such that the muscles of your lower body have to do the maximum work.

  Move on: Physical movement is the first commandment of having your spine fit and in a peak condition. This movement can be trivial and every day, like daily walks in the park or going to walk your pet. However, a sustained movement like that is very important, combined with stretching or aerobic exercises.

  Work smart: There are several ways you can avoid injuring your spine at the workplace. You should choose a chair that is adjusted according to your height and supports your lower back well. Your feet should be able to reach the floor properly and well. You should also avoid unhealthy conveniences like holding your phone between your ear and shoulders to keep your hands free.

  Go for daily checks: You should keep daily tabs on what is happening to your spine. Go for daily checks, and immediately check with your doctor if you experience symptoms like back pain without any evident disease, or if discomfort persists even after medication.

The spine is integral to the proper functioning of your whole body, and shouldn t be ignored even for a day. There are exercises you can do to keep it in good shape, and those that you can avoid. There are also triggers after which you should check with your doctor as well. Here s wishing you good spinal health.

The spine is an integral part!

Ways To Keep Your Spine Happy!

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!

The hand is one of the most commonly used parts of our body and is susceptible to damage, wear and tear as well as injury. Pain in the hand can be attributed to numerous causes, including damage and other conditions that can affect the joints, cartilage, nerves and other parts of the hand.

Causes

De Quervain's tendinitis: This is also known as de Quervain's tendinosis. It causes pain on the thumb side of the wrist. The pain may grow slowly or suddenly. It can also spread to every part of the thumb and up the lower arm. On the off chance that you have de Quervain's tendinitis, you may experience pain while performing the following actions:

- Clenching The fist

- Handling on or holding objects

- Turning the wrist

Treatment for this includes the following:

- Wearing a prop to rest the thumb and wrist

- Calming drugs

- Cortisone infusions

Carpal tunnel disorder: This is common amongst the well-known nerve issues. It can cause pain in the following parts of the hand:

- Palm and a few fingers

- Wrist

- Lower arm


The treatment methods includes the following:

- Resting the hand and wrist

- Painkillers

- Wrist support

- Steroid infusions

- Active recuperation

- Breaks

Fracture: It's a crack or break in a bone that can cause immense pain in the hand. Other than this, the hand may also experience the following:

- Stiffness

- Swelling

- Loss of proper motion and movement

The kind of treatment depends on the kind of fracture. Braces are usually used for small fractures. Sticks, wires, or plates might be used to treat severe fractures. Likewise, surgery may also be recommended to set the broken bone properly.

Arthritis: This is a disease causing joint inflammation and stiffness of the joints. It causes the joints to lose the ligament that permits them to move easily against each other. This tears the ligament, giving rise to crippling pain and swelling.

In the hand, the regions where this regularly happens are as follows:

- Base of the thumb

- Center joint of one or more fingers

- End joint, which is nearest to the fingertip

The treatment depends on the seriousness of the injury and the following may be used:

- Painkillers

- Props for the fingers or wrist

- Heat

- Non-intrusive treatment

Trigger finger: Also known as stenosing tenosynovitis, this defect causes the fingers or the thumb to bend. It can be difficult, particularly when bowing or fixing the influenced finger or thumb.

Knobs may form on the influenced ligaments. Also, the sheath itself may thicken. In the long run, the ligament may get to be adhered when you attempt to fix a twisted finger or thumb.

Resting now and again while wearing a support may help resolve the issue. Over-the-counter torment pharmaceuticals can facilitate the agony. Corticosteroid infusions can mitigate side effects. Surgery might be recommended for extreme cases.

Causes of Common Hand Pain and How to Find Relief

Foods to eat/ avoid for arthritis and inflammatory pain

Different foods have different properties. Here are some foods to have and a few you must refrain from if you are suffering from arthritis and inflammatory pain:

Include these foods in your diet.
1) cherries - these contain anthocyanocides which assist in lowering uric acids, thus reducing the level of pain.
2) ginger - eating fresh ginger of drinking ginger root tea is advisable if suffering from arthritis and inflammatory pain. The gingerols present in it include anti-inflammatory compounds which are extremely helpful.
3) pineapple - there exists in pineapples, an element called bromelain which is a very effective anti-inflammatory.
4) raw apple cider vinegar - anti-inflammatory properties of raw apple cider vinegar are also very beneficial. It can be consumed by drinking a tablespoon of the vinegar mixed in about 250ml water or as salad dressing.
5) turmeric - turmeric or as we call it haldi, has anti-oxidant as well as anti-inflammatory properties.
6) omega 3 fatty acids - omega 3 fatty acids also have anthocyanocides. Which lower the levels of uric acids. Eating more of chia seeds, flax seeds and fish is also encouraged.

And the foods to avoid are,
1) sugary foods - sugary foods are like toxins which cause inflammations and lead to more pains in the body. Hence, avoid foods with excessive sugar when suffering from arthritis and inflammatory pain.
2) omega 6 oils - these oils, if consumed in high amounts, cause inflammations. It is advisable to replace these foods with healthier foods.
3) fried foods: deep fried foods are cooked at high temperatures and thus induce inflammation.
4) salt - this happens to some people where excess intake of sodium increases the pain in the joints. Hence, lowering consumption is not a bad idea.



Living With Arthritis - Foods To Pick OR Kick

Uncontrollable division of cells present in the tissue leads to the formation of a lump or mass of tissue. This mass of tissue is known as a tumor and when this condition is diagnosed in the bones of a human body, it is known as bone tumor. Most bone tumors are non-cancerous (benign) and cannot grow. However, it is still possible that the bones could be weakened and the condition could result in fractures and other such problems. The tumor replaces the normal and healthy tissue.

It is observed that cases of malignant bone tumors are much less as compared to benign tumors. Some examples of benign bone tumours include:
1. Giant Cell tumor: In this condition, the tumor affects the legs
2. Osteochondroma: This form is most common among teenagers
3. Osteoblastoma: A tumor which develops in young adults and affects the spine
4. Osteoid osteoma: A tumor that affects long bones
5. Enchondroma: Usually found in hand and feet.

As stated earlier, metastatic cancer is a form of cancer that spreads to the bone from other spots in the body. Cancers from other parts that commonly spread to the bones include breast cancer, prostate cancer and lung cancer.

It is common for bone tumors to bear no symptoms and they can only be diagnosed using an x-ray. However, a typical symptom of bone tumor is pain which:
1. Starts in the region of the bone tumor
2. Often feels achy
3. Worsens with activity

Other symptoms that might be related to bone tumors are:
1. Abnormal swelling around the bone
2. Fever
3. Limping, in rare cases

Treatment
1. Benign bone tumors can be treated by just using medications. However, the tumours might relapse even after treatment.
2. Treatment of malignant tumor might require a number of specialists. The stage of cancer plays a vital role in the treatment.

Common treatments for bone tumor are:
1. Amputation: It is the surgical removal of all or a part of the limb and is conducted only if the tumor is large.
2. Radiation therapy: High intensity X-rays are used to kill cancer cells and treat the tumors.
3. Chemotherapy: Tumor cells which have infiltrated the bloodstream are eliminated using cancer drugs.

Abnormal Swelling - Can it be a Sign of Bone Tumor

Don't wait any longer, manage your Shoulder Specialist online with a Lybrate doctor today

Consult for Shoulder Specialist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES