The carpal tunnel is the passageway for the median nerve to pass through on the inner side of your hand, when your palms are facing down. For example, while typing, there is a lot of movement of the fingers and this puts a lot of pressure on this tunnel. In fact, people who are involved in a lot of typing are one of the most prone people for carpal tunnel syndrome (CTS). Other causes would include trauma, fractures, etc., where the tunnel is injured.

Conventional measures to treat CTS included a combination of exercise and pain killers in mild to moderate cases. In moderate (sometimes) to severe cases, surgery was also done. However, with advancements in medical technology, endoscopic surgical procedure is gaining popularity.

What is done?
In endoscopic surgery, a small incision is made in the wrist or one each in the palm and the wrist. Through this, a flexible tube with a camera and minute cutting tools are inserted into the wrist. Another ligament known as transverse carpal ligament is cut. This reduces the pressure on the median nerve, which provides relief from the CTS symptoms.

What to expect as benefits?
The intention behind the surgery remains the same in both traditional and endoscopic procedures. The pressure on the median nerve is released, restoring movement and reducing pain in the joints. In addition, the endoscopic procedure has the following benefits.

Less invasive: Needless to say, there are only one or two small incisions done for this procedure, so less surrounding tissue is damaged.
Same day surgery: No hospitalization is required, and unless required, the patient can return home on the same day of surgery.
Reduced recovery time: The recovery period is usually substantially less compared to the traditional surgical approach.
Back to work: Depending on which is your dominant hand, you would be able to return to your regular work earlier than with regular surgery. If your non-dominant hand is involved, a day or two of rest is required. If your dominant hand was involved, give it up to four weeks for complete recovery.
Reduced chances of nerve injury: The area of operation has many nerves and blood vessels, and endoscopic surgery reduces the chances of damaging adjacent nerves.
Anesthesia: This is done under local anesthesia. Therefore, complications arising out of general anesthesia are completely avoided.
Indications
While these sound promising, your doctor will decide if you are a candidate for endoscopic procedure depending on the following:

Nonsurgical treatment including exercise and pain killers have not provided relief, even after several months.
Severe symptoms including those of nerve damage, like loss of sensation, altered coordination, etc., is affecting your normal daily routine.
Person requiring bilateral surgery like severe trauma, wheelchair dependent, etc.

Carpal Tunnel - How Endoscopic Surgery is Beneficial?

Rheumatoid Arthritis is a chronic progressive auto immune disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles. This makes it one of the most dreaded types of Arthritis. Such symptoms are not observed in Osteoarthritis, the most common arthritic condition.

The difference between Osteoarthritis and Rheumatoid Arthritis can be put simply. In Osteoarthritis, degeneration of tissue leads to bone erosion and that precipitates the condition. In Rheumatoid Arthritis, the disease condition precipitates cartilage degradation, which abates Bone Erosion. The problem is aggravated by the obvious absence of effective medicines and treatment options.

However, one can take the help of Homeopathy to alleviate the conditions to a large extent. Homeopathy can help in all round management of the disease condition.

Causes of Rheumatoid Arthritis

The cause of Rheumatoid Arthritis is radically different from degenerative Arthritic conditions.

In Rheumatoid Arthritis, the immune system attacks the lining of the joints, the Synovium. This results in inflammation of the tissue leading to its thickening. Over time, the thickened Synovium has the effect of degrading the joints and cartilages in a joint.

Gradually, even the Ligaments and Tendons weaken resulting in the joint losing its alignment and shape. This results in deformities which are not curable so far.

Symptoms of Rheumatoid Arthritis

Symptoms include:

Tender, swollen and worn joints

Joint stiffness. This is one of the most common symptoms of Rheumatoid Arthritis. It is usually worse after a period of inactivity, as well as in the mornings.

Fever, Fatigue and Weight loss

Smaller joints like fingers, wrists etc. are usually affected first unlike Osteoarthritis. In Osteoarthritis, the big joints like knee, shoulder, ankle etc. are mostly affected.

You may also suffer from problems not related to joints at all. You may suffer from problems with lungs, heart, eyes, skin, nerve tissue, kidneys, blood vessels, bone marrow etc. However, these are the fallouts of long-standing suffering from Rheumatoid Arthritis, and not any initial symptom.

Homeopathic Cure of Rheumatoid Arthritis

A study published in the British Journal of Clinical Pharmacology has shown that there is a significant improvement in Joint articular index, Pain, Grip strength and Stiffness in patients administered with homoeopathic medicines over a fixed period. Moreover, no side effect was observed in the patients who were given Homeopathic medicines.

The Unique Aspects Of Homeopathy in Treatment of Rheumatoid Arthritis

What is important in Homeopathy is to get complete history of the patient. The patient needs to talk to the doctor in detail starting with the onset of symptoms. The doctor may also ask questions about the social and family backgrounds. They ask such questions to make sure that they can establish some kind of a link between the onset of Rheumatoid Arthritis and patient s habits, social interactions, family interactions etc.

Based on these details, the doctors choose a medical course for the patient. Homeopathic may not provide instant relief, but will work in the long run, as it cures the root of the disease along with curing the disease.

Consulting an experienced Homeopathic Doctor with specialization in Arthritis is suggested for treatment of Rheumatoid Arthritis.

Rheumatoid Arthritis - Causes, Symptoms And Homeopathic Cure!

Back pain is something that affects many people all over the world. Persistent and chronic pain seems to be one of the most common complaints. Middle back pain is back pain that is felt in the thoracic vertebrae region, which is located between the base of the neck and top of the lumbar spine. The ribs attach to a long, flat bone in the middle of the chest called the sternum and wrap around the back. In case, there is a nerve around there is squeezed, disturbed, or injured, you are likely to feel pain in different spots where the nerve goes through, for example, your arms, legs, chest and the stomach.

Some of the most common causes of middle back pain are as follows:

Middle back pain can happen as a consequence of injury or sudden damage or it can happen through strain or poor stance after some time.
The most widely recognized reason for middle back pain seems to begin from soft tissue problems or muscular irritation. These can emerge from poor stance, lack of strength, prolonged sitting in front of a computer, utilizing a heavy backpack, overuse injuries, (for example, repetitive movement), or injury, (like a whiplash damage brought about by an auto crash or as a consequence of a sports injuries).
The middle back is a moderately normal site for inflammatory, degenerative, metabolic, infective and neoplastic conditions.
Middle back pain and its dysfunctions are connected with various conditions, for example, essential and optional osteoporosis (particularly vertebral cracks and hyperkyphosis emerging from vertebral bone loss), ankylosing spondylitis, osteoarthritis and Scheuermann's infection.
Muscle strain, overuse or damage to the muscles, tendons, and discs that are backing your spine can also cause middle back pain.
Weight on the spinal nerves from specific issues, for example, a herniated disc.
A fracture in one of the vertebrae can also cause pain in this region.
Osteoarthritis created by the breakdown of ligament or cartilage that cushions the little joints in the spine.
Myofascial pain that influences the connective tissue of a muscle or gathering of muscles.
In uncommon cases, pain might be brought about by different issues, for example, gall bladder disease, cancer or an infection.
Getting hit hard in the back can also cause chronic pain.
Lift something too heavy may cause pain and a sudden pressure in this area.
A compression fracture of the vertebra can also bring about intense or chronic pain in the middle back. The injury may bring about a fracture, however in ladies over age 50 without critical injury or somebody known to have osteoporosis, an unconstrained vertebral fracture is possible.
Other contributing factors to injury include lack of strength which can be treated by a Pain Management Specialist using non-surgical methods.

Common Causes of Middle Back Pain

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!

Osteoporosis is a condition wherein the bones become brittle and weak; so much so that even mildly stressful activities such as coughing, bending over or even a slight fall (such as the one from a high rise chair) can result in fractures. Osteoporosis-related fractures commonly occur in the spine, hip or the wrist. The human body has a continuous mechanism of bone absorption and removal. In case of osteoporosis, the creation of new bones doesn t happen in accordance with the removal of old bones.

Spinal Fractures:

The bones of the spine get extremely vulnerable to breakage and even cracking open. The fractures in the spine, also known as vertebral compression fractures can cause a sharp stinging pain in the back that may make sitting, standing, or even walking a very tardy task.

Risk Factors:

Increasing age

Abnormally less or high body weight

Smoking

Menopause or low levels of sex hormones

Gender: This disorder is more likely to affect women as compared to men. Also women, who are above 50 are more likely to suffer from this debilitating disorder.

Race is a significant risk factor of osteoporosis. If you are of Asian descent, you are more likely to be affected by it.

Having a family history of osteoporosis will put you at a greater risk of this disorder.

Symptoms:

Fractured or collapsed vertebra causing back pain

A stooped posture

A shrunken appearance (as if one has had loss of height)

Very fragile bones, thus increasing risks of fractures

Severe and sudden pain in the back

Difficulty in twisting or bending the body

Lower spine fractures are way more troublesome as compared to fractures in the upper spine. Fracturing more than a bone in the spine also remains a huge possibility.

Diagnosis and Treatment:

Firstly, an X-ray or a computerized tomography (CT scan) will be done to have a closer look at the bones. A bone density test is another commonly used method of diagnosing osteoporosis. 

Steroids and medications: Some medications may be used to prevent or combat osteoporosis. These include alendronate, ibandronate, risedronate and zoledronic acid.

Physical therapy: Just like muscles, bones get stronger too when you exercise. Weight-bearing and muscle- strengthening exercises are the most helpful in this regard and are considered best for the treatment of osteoporosis. Cardiovascular exercises such as walking, jogging or even swimming can prove to be immensely beneficial.

Diet: Make a diet chart that includes high-calcium food items, dairy products such as yogurt, cheese, and low-fat milk, tofu, green vegetables such as collard greens and broccoli, sea fish such as salmon and sardines.

Salt: Limit salt intake

Therapy: Hormone replacement therapy (treatment method consisting of estrogens to alleviate and treat symptoms of osteoporosis) is another method of treatment that can be recommended by the doctor.

Osteoporosis Spine Fractures: Risks, Symptoms and Treatments

Arthritis is a disease in which the joints in your body swell. Inflammation or swelling can be caused due to body's natural response to injury or disease. It can cause discomfort in the form of pain, stiffness as well as difficulty in movement. Major types of arthritis are osteoarthritis, rheumatoid arthritis, psoriatic arthritis, and gout.

Causes of arthritis

Arthritis is generally caused by a combination of factors. It can happen due to genetic factors in case the disease runs in the family. Sometimes it can be caused due to injuries of the past; it can also be a by-product of your lifestyle. Some of the common causes of arthritis are:

1. Genetic makeup in which arthritis can be a hereditary trait
2. Physically taxing work life or injuries caused in an accident
3. Imbalance in the immunity system
4. Infections in the joint.

Risk Factors associated with arthritis

1. Family history - You can be prone to develop arthritis if it runs in the family. It can occur due to its hereditary trait hence making you more vulnerable to the environmental factors which contribute to developing arthritis.

2. Age - The risk of arthritis can increase with age. Types like osteoarthritis, rheumatoid arthritis and gout are more common in the old age.

3. Gender - Your sex is an important factor as women are more likely to develop rheumatoid arthritis while men are prone to suffer from gout.

4. Joint injury - Joint injury caused due to accidents or due to sports activities can trigger arthritis. People with previous joint injuries can develop arthritis in that joint.

5. Obesity - Excess weight can put a lot of pressure on the joints, on the knees and hips in particular. Hence, obese people have more chances of developing arthritis than fitter people.

Causes and Risk Factors Associated with Arthritis

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