Wounds and bruises are both injuries. However, they differ widely in terms of the causing factors, the nature of the injury, the pain they cause and the kind of treatment they require. The following are a few of the myriad ways in which the two injuries differ from each other:

1. A wound causes quick damage - the skin tissue is cut or punctured while a bruise (also called a closed wound) is where the skin is not torn. 

2. A wound is usually caused by a sharp object but bruises are the results of blunt force or trauma.

3. A wound almost certainly bleeds due to ruptured tissue and blood vessels. Blunt injury also damages the blood capillaries of the skin and causes blood to accumulate under the skin tissue, creating a dark patch of skin. Blood vessels can also break due to lifting of heavy objects or overexertion of muscles.

4. A wound carries the risk of infection because the skin is open but a bruise does not get infected.

5. A wound has a burning or stinging sensation but a bruise is characterized by swelling and a blunt throbbing pain.

6. A wound can be healed by antiseptic and antibiotic medication. Large wounds need to be closed by stitching them up to avoid severe infection. On the other hand, a bruise usually heals by itself. A cold compress and pain killers may be used to ease discomfort. Heat can be applied to the injured spot to normalize the blood flow and dissolve the blood clot.

7. A wound can lead to complications like bacterial infections or the healing might be delayed by chronic diseases like diabetes. In case of a bruise, it usually does not cause complications but if there's a blunt injury to sensitive areas like the head, the tailbone or the eyes, medical attention is advised.

8. Wounds and bruises can also be differentiated on the basis of their subtypes. The different types of wounds are:

a. Incision (sharp objects cutting the dermis layer of skin)
b. Abrasion (the epithelial tissue is scraped off)
c. Avulsion (a body structure is torn off)
d. Penetration (a sharp object causes an entry and an exit wound)
e. Puncture (only an entry wound caused by a sharp object)

The different types of bruises are:
a. Hematoma (blood pools under the skin)
b. Purpura (tiny spots of blood on the inside of the mouth)
c. Contusion (similar to hematoma and caused by external trauma)
d. Crush injury (caused due to a large amount of force on the body part for a long time)

Wounds VS Bruises

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!

Knee pain is one of the most common and painful ailments that can limit mobility. Injuries can result in cartilage or meniscal tears or sprains too. Obesity is another reason because of which knee pain is on the rise. Also, regular wear and tear of ligaments and tendons around the knees due to old age is another cause. These days, with reduced physical activities and sedentary lifestyles, the rate at which knees are wearing out has also become accelerated. Whatever the reason, a correct diagnosis followed by prompt treatment can help. Over the years, physiotherapy has been playing an important role in treating knee injuries. Whether to supplement the various drugs to reduce pain and inflammation or to avoid surgery, physiotherapy has helped many and its popularity is growing every day. Here are some ways that physiotherapy can help reduce pain.

Improve flexibility of tendons: The knee cap is an area where there are lot of tendons and ligaments, coordinating to enable movement. Careful exercising can ensure that the flexibility of tendons and ligaments is improved, thereby making your knee movement easier and less painful.
Improves blood supply: As we all know, proper movement requires good blood supply. Exercising with special focus on the knee ensures that blood supply is improved, and thereby the supporting ligaments and tendons function optimally.
Enhances the knee cap function: The knee cap is that portion which joins your thigh bone to your calf bones. This is prone to slip out of place, especially with arthritis and injuries. This can be painful and limit movement to a great degree. Focused exercises aimed at improving knee cap function will ensure that the knee cap has a wider range of function, and does not slip out of its socket easily.
Reduce rigidity: Once you start physiotherapy, you will feel your knees getting more flexible. The rigidity that had set in as a result of injuries and/or old age will also reduce over a period of time.
Slow down the wear and tear: When you start physiotherapy after knee damage, continuing the exercise routine, of course with expert guidance, can reduce the pace at which further damage might happen. A word of caution though. Be sure to consult an experienced physiotherapist before you begin. Exercising in a bad manner can do equal or more harm than the original injury or old age itself.

Knee Pain and Physiotherapy

The human hand has multiple bones, tendons, ligaments and muscles which in unison help us to grip things and manipulate other objects to do our work. Within the wrist lies a narrow passageway on the palm side which houses the main nerve for movement of the nine tendons. These tendons help us to move our fingers individually and grip things or accomplish any task we want with our hands.

What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition where this nerve gets pinched due to variety of factors and may have adverse affects. Some of the symptoms include tingling, numbness and pain with movements of the arm.&nbsp;

Causes of carpal tunnel syndrome-
The nerve within the wrist which is known as the median nerve can be pinched due to a variety of factors:

Movements where the wrists are always higher and in an angle - repetitive movements of the wrists where the hands are always at a lower angle can increase the chances of carpal tunnel syndrome. This is usually a workplace related problem and thus be caused by bad hand posture.
Medical conditions - there are certain medical conditions that may also trigger the onset of carpal tunnel syndrome such as diabetes, thyroid, menopause and other problems.
Pregnancy - pregnancy has also known to cause carpal tunnel disorder as it can alter the balance of fluids within your body. However, other factors could also put your fluids in imbalance and cause problems with the median nerve.
Conditions that may cause inflammation - certain conditions such as rheumatoid arthritis can cause the inflammation within the joints which might lead to the median nerve being pinched which in turn might lead to carpal tunnel syndrome.
Some preventive measures from carpal tunnel syndrome-

Breaks from repetitive work - it is important for your wrists to have a break when you are doing repetitive tasks that might cause carpal tunnel syndrome. Relax and stretch your muscles within the break time
Wear wrist splints - these are support devices which can help correct problems for repetitive actions throughout the day while you are sleeping.
Take pain reliever if you start having chronic pains - if your wrist pain is not letting you functions normally, take a pain reliever such as ibuprofen or aspirin and go to a doctor as soon as possible for a more thorough treatment.

Carpal Tunnel Syndrome - An Overview

In most cases, pain anywhere in the body can be explained as a symptom of some other problem, but sometimes, there is no reason for abdominal pain. This type of pain is known as chronic functional abdominal pain. This is a gastrointestinal disorder that cannot be explained through X-ray or laboratory findings. It can be triggered by altered sensitivity to nerve impulses in the brain and gut. People suffering from this condition are often so debilitated by the pain that it becomes the central focus of their life.

This condition cannot be cured, but with proper treatment, it can be managed so that it does not affect the quality of your life. The aim of treatment for this condition is to control the symptoms and improve functioning. When it comes to treating this condition, the patient s relationship with his or her doctor plays an important role as the condition cannot be proven through any form of testing and it has a great psychological effect on the person. Regular checkups are also a key to managing this condition effectively.

The first step towards achieving this is to identify possible emotional and situational triggers. Maintaining a journal that records these experiences can help with this. Further treatment is usually either through psychological treatment or antidepressants.

Psychological treatment is based on the understanding that the brain can block pain by diverting attention elsewhere. Nerve impulses that travel from the abdomen to the brain must pass through a type of  gate  that is controlled by nerve impulses generated by the brain. When these impulses close the gates, pain is blocked while when these gates are open, the pain can be magnified. Psychological treatment for chronic functional abdominal pain can be in the form of relaxation techniques, imagery, hypnosis and cognitive behavioral therapy. While relaxation techniques such as meditation and hypnosis help a person shift focus from the pain, cognitive behavioral therapy teaches a person how to change thoughts and perceptions in order to control the pain.

Antidepressants can also act as pain relievers. This form of medication stimulates the production of brain signals that close the  gates  of nerve transmissions. This blocks the pain but can take several weeks to be effective. Some people may experience side effects such as drowsiness and nausea and hence should never be taken without a doctor s supervision. In some cases, antidepressants may also be combined with cognitive behavioral therapy or medication to regulate bowels.

Ways to Treat Chronic Functional Abdominal Pain!

Hip replacement surgery is a method wherein a defective hip joint is removed and replaced with an artificial hip joint. This procedure is only opted for after all the other treatments have failed to yield the desired effects. Hip replacement surgery removes damaged or diseased parts of a hip joint and replaces them with new, man-made parts. The goals of this surgery are to:
Relieve pain
Help the hip joint work better
Improve walking and other movements.
Who Should Have Hip Replacement Surgery?
The most common reason for hip replacement is osteoarthritis in the hip joint. Your doctor might also suggest this surgery if you have:
Rheumatoid arthritis (a disease that causes joint pain, stiffness, and swelling)
Osteonecrosis (a disease that causes the bone in joints to die)
Injury of the hip joint
Bone tumors that break down the hip joint.
Your doctor will likely suggest other treatments first, including:
Walking aids, such as a cane
An exercise program
Physical therapy
Medications.
These treatments may decrease hip pain and improve function. Sometimes the pain remains and makes daily activities hard to do. In this case, your doctor may order an x ray to look at the damage to the joint. If the x ray shows damage and your hip joint hurts, you may need a hip replacement.
The Procedure-
Hip replacement surgery is a procedure that can either be performed by traditional means or a minimally invasive procedure. The primary difference between the two procedures is the size of the incision. The procedure begins with the doctor administering local anesthesia, though in certain cases, general anesthesia is also administered.
An incision is then made along the hip and the muscles that are connected to the thigh bone are shifted, so that the hip joint is exposed.
An equipment is then used to remove the ball socket of the joint by cutting the thighbone.
The artificial joint is then fixed to the thighbone and it is allowed to adhere properly.
Once the joint is fixed, the ball of the thighbone is then put in the hip socket.
The fluids from the incision area are then allowed to drain.
The hip muscles are then put in place and the incision is closed.
Post -surgery-
After the surgery, the recovery stage begins. The period of hospital stay post-surgery usually lasts for 4-6 days. A drainage tube is attached to the bladder to get rid of waste products from the body. Physical therapy begins immediately after the surgery and you will be able to walk after a few days with walking aids. The physical therapy continues for a few months after the surgery.
After care-
It is advised to avoid activities that involve twisting your leg for at least half a year. You should also avoid crossing the leg along the mid portion of your body. Your physiotherapist will provide you with exercises that aid to help you recover. Avoid climbing stairs and sit on chairs that have strong back support. 

All About Hip Replacement

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