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!

Fibromyalgia is a condition characterised by extreme muscle pain that is followed by weakness, fatigue and issue with the state of mind. It is believed that fibromyalgia causes painful sensations by affecting the way your mind forms pain signals.

Indications now and then start after a physical injury, surgery, disease or critical mental anxiety. In different cases, side effects progressively show after some time with no single occasion that triggers it.

Here are some coping methods you can use to help yourself live well with fibromyalgia:

Minimize stress and tension in your life. Stress may play an essential part in activating fibromyalgia side effects and its symptoms. Many individuals with fibromyalgia tend to feel on the edge, anxious, and inactive around the time when the side effects fibromyalgia flare up.

Exclude yourself from unpleasant circumstances. People tend to amplify issues, making them appear to be far more prominent than they are. When you think of something to be a last chance situation, despite the fact that in reality, it is not, your body responds as though you are at risk. Work at treating your feelings as problems come by.

Make worksite adjustments. To continue working full-time, you should stay rationally and physically ready to handle your employment obligations. To keep away from stress and tension, you may need to give additional time during the day to complete your personal needs and sort out your problems. Converse with your manager and work out a timetable that allows you to manage your time.

Coordination. Coordination is important with an unending condition like fibromyalgia. Transparent conversations diminish the problems amongst you and your companion, family, friends and colleagues.

Figure out how to say no. Failing to say no to excessively numerous requests will make you overburdened. That will add to your anxiety level. To help yourself say  no  to a convincing companion, consider the circumstance before you reply and also think about the time you will be saving.

Keep a diary. Writing in a diary consistently can turn into a great channel for analyzing yourself and your situation. A few people can also figure out when their fibromyalgia symptoms started. That can help them see how and when the symptoms began.

Take a hot shower. Take a hot shower, a hot tub bath, or a steam bath. To begin with, it will help you to unwind the muscles that are tense. It will also decrease the pain and make your muscles more flexible and effortless to move.

Exercise frequently. As per physiotherapists, exercising routinely is vital to get rid of fibromyalgia. In light of the pain, delicate muscles, continuous weakness, and stiffness felt by individuals with fibromyalgia, many have turned out to be physically unfit. Hence, all of the above-mentioned treatments are very important in order to stay fit.

How To Deal With Fibromyalgia?

Causes and symptoms of Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease, which is characterized by the inflammation of the joint lining and gives rise to pain, stiffness, warmth and redness in the joints. The inflammation occurs in the tissue that normally produces lubricating fluids for the joint. This condition is progressive in nature, and can cause the destruction of joints, leading to functional and locomotive disability.

Though rheumatoid arthritis is a disease that can last for years, patients may not experience any symptoms for a long time. In some cases, the disease may affect other parts of the body like the eyes, lungs, and the heart.

The severity and duration of the symptoms are unpredictable, and the symptoms experienced are:

- At times, people experience increased disease conditions called flare-ups.

- They may also experience alternating periods when the symptoms fade or diminish, which is referred to as remission.

- Some of the common symptoms of the disease include lasting pain and stiffness for more than an hour in the morning, inflammation, fatigue, fever, and a general sense of discomfort.

- Inflammation in the joints close to the hands like wrists and fingers and other parts like neck, shoulders, elbows, knees and hips can also be affected.

- In some cases, both sides of the body are affected at the same time, which is known as inflammation in a symmetric pattern.

Rheumatoid arthritis is usually caused by the body's weakened immune system, which produces antigens to attack itself. The trigger to this reaction is not yet clearly deciphered.

It is diagnosed by clinical examination (American association of Rheumatology criterion) supported by relevant Investigations.

Management

Management for Arthritis includes the following aspects:

1) To control disease activity and control of symptoms of pain, stiffness.

2) Medical treatment to prevent system effects of the disease.

3) Nonmedical treatments comprise of dietary therapy, physiotherapy, immunomodulation therapy.

4) Minimal surgical therapy like arthroscopic synovectomy to confirm the diagnosis as well as reduce disease activity. At times, with the advanced decline of joints, a major surgery like replacement therapy may be required for specific cases.

What's more important is to know that at any stage of the disease patient can adopt and live an active life with appropriate treatment.



What Really Causes Rheumatoid Arthritis?

A Simple Guide to Arthritis

One of the most common ailments the elderly suffer from is arthritis. However, arthritis can affect people of all ages. It is a rheumatic disease as in, it affects joints and bones. It can be of many types and the term covers a number of inflammatory and non-inflammatory joint diseases. Some of the most well-known types of arthritis are rheumatoid arthritis, bone spurs, gout, and osteoarthritis.

The causes of arthritis have not been defined but there are a number of factors that increase a person's chances of getting it. Foremost amongst these is increasing age and excess weight. Arthritic conditions such as rheumatoid arthritis, ankylosing spondylitis, and lupus are said to be hereditary and linked to certain genes. Sometimes, injuries can also cause arthritic conditions. Misuse of steroids can also result in arthritis.

Here is a look at the most common symptoms of the disease :-

Pain around the joints is the most well-known symptom of arthritis. Along with pain, you may also notice swollen or stiff joints.
Increased body temperature around the affected joints and redness in the area is also a symptom of arthritis. These symptoms range from mild to severe, and can be constant or may come and go.
Everybody suffers from occasional joint pains but if any of the above symptoms persist for a long duration, it is best to consult a doctor. The sooner you seek treatment, the easier it becomes to deal with arthritis. If left untreated for too long, arthritis can result in permanent joint damage.

While there is no single cure for arthritis, it can be effectively controlled if treated in time. Since the type and severity of arthritis differ from person to person, treatment for the same must also be tailored to the needs of the individual.

Drugs for arthritis can be categorized as those that treat symptoms such as pain and stiffness, and those that suppress inflammatory conditions.

In some cases, surgery may be advisable. 

Physical therapy and regular exercise are very important when dealing with arthritis.

It is equally important to eat a healthy, nutritious and well-balanced diet. If you are overweight, try and lose the excess kilos.

You must also look after your joints to ensure that there is no further degradation of bone or muscle tissue. Avoid staying in one position for a long time, and try and maintain a good posture. These simple techniques can be very effective when dealing with all types of arthritis.

A Simple Guide to Arthritis

A stroke or paralysis can occur when the blood supply to that part of your brain is curtailed or drastically reduced. Due to this, the brain is deprived of the essential oxygen and the nutrients, and within a few minutes the brain cells can undergo severe damage and die. It is often treated as a medical emergency and can cause complications for life if left unattended.

Symptoms:
With regards to a stroke, a quick and an immediate treatment can be the difference between life and death. It is very much mandatory to note the symptoms of stroke and to impart the treatment accordingly. Some of them can include:

Trouble with speaking: Your speech pattern gets affected, and you may have trouble talking.
Paralysis: When the oxygen is cut off, a part of the body can become numb thus rendering it lifeless.
Headache: A severe headache may occur that can make the body go into spasm. Dizziness and unconsciousness can follow it.
Walking and mobility: You would be unable to walk on your own, or there can be a huge difference in your walk pattern. Most of the times, you might not be having any control over your legs.
Risk Factors
There are many risk factors associated with stroke and paralysis. The most common one is undoubtedly overweight. Physical inactivity, alcohol abuse, and drug abuse can contribute equally to the occurrence of stroke. Cholesterol levels, high blood pressure and old age may also be risk factors. Paralysis can be the biggest drawback of stroke where one part of your body can be lost to movements. You might also lose control of your face or arm, and this can affect your walking steps. This can be a life changing factor and more than medication sometimes physical therapy heals the person to an extent.

Physiotherapy for Paralysis:
You can feel helpless and frustrated, and this can lead to depression. There are many ways by which physiotherapy can help you. The therapies are made in such a way that you can try to lead a normal life without any hindrance, and this depends on the nature of the paralysis you are undergoing. In most of the cases, a person can get back at least 60% to 70% of his/her mobility back though not completely. Also, current medicines have advanced that there is a possibility to get back the movement in the paralyzed areas.

One of the major challenges you will face is to relax as the physical feeling of helplessness can hamper your thoughts in the long run. Stay relaxed and always remember that you are not alone. Take the help of a family member or a friend. Be relaxed all the time and make a determined effort with physiotherapy exercises. Avoid the lifestyle which you had before and embark on a healthier lifestyle and make sure you watch your diet at all times. Try to indulge in your favorite pass time and over a period start your daily chores without the help of an aid. You can undergo the physiotherapy exercises for life as they can be positive even after the condition subsidies.

Paralysis & Stroke - How Physiotherapy Can Help?

Gout: a brief idea

In the simplest of words gout can be defined as the inflammation of joints due to continuous accretion of urate crystals. An excess of uric acid can make a person suffer from gout. There could be a higher percentage of uric acid in a person's blood due to two chief reasons; an inept excretory system that fails to rid your body of surplus acid and also greater production of the acid. Arthritis is of three kinds; gout is one of those three. Homeopathy is known for its efficacy in treating gout. 
   
Homeopathic remedies for gout:
1. Urtica urens can cure gout: This homeopathic medicine is prescribed by a professional practitioner if the person is susceptible to cold. Urtica urens can work on a patient if he or she is allergic to snow,  air, touch and water. Hive like eruptions on your ankles, wrists, and shoulders can be treated through regular consumption of this medication.
   
2. Ledum can relieve you of pain: A painful, swollen area that develops on the small joints such as the joints of your toe fingers can be cured with the use of Ledum. The sensation of shooting pain in your limbs or feet can also be dealt with Ledum. Apart from that swollen small joints can be given momentary respite by falling back upon the cold compression therapy. Patients are advised to take this medicine if they exhibit intolerance to external warmth. 
 
3. Lycopodium is effective on sore joints: Chalky deposits of urate can be found in a person's knees. This results in chronic gout. Chronic gout has symptoms like limited urination. The urine may or may not have red sediments. People have also been reported with symptoms like extreme backache. Lycopodium successfully cures cases of unceasing gout.
     
4. Try out benzoic acid for a big toe: If your gout is accompanied by stinking yellow urine you probably need Benzoic acid. Gout could be so severe that it might result in a stiff limb. In certain cases it makes a person limp. The thumb of your feet might get swollen making you have a big toe. A big toe usually kills you with tearing pain.
    
5. Arnica deals with bruises: Arnica is your go to solution in case of a throbbing, stinging pain in any part of the body. This medication is a cherished answer to aches in every household. When gout is tender and it hinders free movement, this medicine comes to your aid. The medicine also heals bruised eruptions.

Homeopathy and Gout

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

Consult for Shoulder Surgeon - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES