Avascular Necrosis, also termed as Ischemic Bone Necrosis or Osteonecrosis is a medical condition characterized by the bone death on being deprived of blood. The condition is known to occur in the shoulder, ankles, and knees. However, the part of the body most affected by Avascular Necrosis is the hip. In this article, we will describe the conditions that contribute towards Avascular Necrosis of the hip along with the associated symptoms.

Factors that lead to Avascular Necrosis of the hip
The supply of blood to the bones may be interrupted by a myriad of factors some of which include

1. Certain medical conditions and health disorders such as

Gaucher's disease: A genetic disorder resulting from glucocerebrosidase enzyme deficiency. As a result, glucocerebroside gets deposited in the cells of the macrophage-monocyte system.
Sickle cell anemia: A genetic disorder which results in the RBC's appearing like a sickle cell instead of being round shaped.
Both of these conditions bring about a significant reduction in the supply of blood to the bones resulting in Avascular Necrosis.

Certain inflammatory conditions that may damage the arteries and trigger Avascular Necrosis of the hip include autoimmune diseases, pancreatitis or HIV infection.

2. Extensive and prolonged use of corticosteroids: Often used as non-inflammatory drugs, corticosteroids can play a contributing role, resulting in Avascular Necrosis (non-traumatic). The fatty substances are usually broken down by the body. However, the use of corticosteroids may affect this breakdown as a result of which the fatty substances start piling up in the blood vessels, constricting their size. The constricted blood vessels, in turn, reduces the supply of blood to the bones to a great extent.

3. An injury or a fracture affecting the femur: A hip fracture or a dislocation that affects the upper half of the thigh bone or the femur acts as a potential threat, triggering a traumatic Avascular Necrosis (AVN) of the hip.

In some case, radiation therapy or chemotherapy for cancer can go a long way in interfering with the ability of the bone (weakens the bone) to receive blood, causing bone death.

People who are into heavy drinking stand a greater risk of suffering from AVN. An increased consumption of alcohol causing constriction and narrowing of the blood vessels interfering with the flow of blood to the bones.

Symptoms characteristic of AVN of the hip

Unfortunately, the initial stages of AVN are asymptomatic. However, as the condition progresses into later stages, a person may experience pain and discomfort, particularly while exerting pressure on the bone affected by the condition.
As the bone and the adjacent joints deteriorate and collapse further, a person may experience great difficulty in using the joint altogether.
In some cases, the condition may progress and affect both the hips (Avascular Necrosis Bilateral).

Causes and Symptoms of Avascular Necrosis of the Hip

Foot pain contributes around 3-5 % of patients visiting Orthopedic OPD, with heel pain being predominant complaint. Heel pain commonly involves the underside or back of your heel. Although not a symptom of a serious condition, it s disabling as it can interfere with your routine activities.

Plantar fasciitis, Achilles tendinitis, Heel spur, Retrocalcaneal bursitis are few common conditions causing heel pain.

The below few conditions which are prone to developing heel pain like:

Abnormal walking style (gait)/altered alignment of the foot
Obesity
Ill-fitting shoes/ badly-worn shoes
Standing, running or jumping on hard surfaces
Injury to the heel, such as stress fractures
diabetes and arthritis
The most common causes of heel pain are plantar fasciitis (bottom of the heel) and Achilles tendinitis (back of the heel).

Presenting complaints:

Pain which is usually intense in the mornings or after a long period of res,
Discomfort or swelling in the back of your heel
Skin on your heel overly warm to the touch
Burning sensation over heel
Numbness or tingling in your heel
Swelling around ankle etc
Remedies you can try:

Avoid activities that aggravate your heels, such as running, standing for long periods or walking on hard surfaces.
Ice application on your heel for 10-15 minutes at least three times a day.
Well fitting shoes.
Non-steroidal antinflammatory drugs can reduce inflammation and pain
A splint is worn at night
Flexibility exercises
Prevention of heel pain:

Wear a well-fitting & comfortable shoe
Always warm up and cool down when exercising or playing
Silicone insoles
Consult your doctor immediately if, Heel pain persists in spite of home remedies. Try these tips to put Heel pain at rest!

Heel Pain - Effective Ways To Put It At Rest!

Hot and Cold therapy is one of the most popular home remedies for any kind of joint pain or muscle sprain. In some cases applying heat therapy and cold therapy alternatively, can help relieve the pain while for others only one form of therapy is necessary. To understand what to use when, one should first understand the effect of heat and cooling on the body.

Applying a heat pack or immersing the affected limb in hot water improves blood circulation and makes the muscles more flexible. Thus, it can help relax a muscle and fasten the healing of damaged tissues. On the other hand, cold therapy or cryotherapy reduces blood flow to the affected site. This helps relieve inflammation and pain caused by it. It can also make the area feel numb by reducing nerve activity temporarily.

Types of Heat Therapy
Heat therapy can be categorized as dry heat and moist heat. Dry heat involves using saunas or dry heating packs to relieve pain. This is also known as conducted heat therapy. As the name suggests, moist heat involves the use of steamed towels, hot baths and moist heating packs. This is also known as convection heat therapy. Moist heat is usually considered more effective than dry heat.

Types of Cold Therapy
Cold therapy may be applied to a part of the body or to the entire body. This includes ice packs, coolant sprays, ice baths, ice massages and whole body, cold therapy chambers.

How to use heat and cold therapy?
The sooner heat and cold therapy is given to a person, the faster they will recover from their pains. Heat therapy can be given to a person for extended periods of time but when giving cold therapy, a person should not be exposed to a cold pack or ice bath for more than 10-15 minutes. Care should also be taken no to apply ice or a frozen pack directly on the skin as it can damage the skin and nerves.

When not to use Heat Therapy?
If the injury site is swollen or bruised, cold therapy is better than heat therapy. Heat therapy should also not be applied to an open wound. People suffering from conditions such as diabetes, dermatitis, deep vein thrombosis, vascular diseases and multiple sclerosis should also avoid heat therapy as these conditions can increase the risk of burns and other such complications. Pregnant women should also consult a doctor before using a hot tub or sauna.

When not to use Cold Therapy?
Cold therapy is avoidable for treating stiff joints and muscles. People suffering from poor circulation and sensory disorders should also avoid using cold therapy without a doctor s supervision. 

Hot & Cold Therapy - How It Can Treat Pain?

Lower abdomen pain can originate from a range of medical issues. In some cases, the pain disappears just like the way it came, in some cases, it takes longer medical treatment to cure the pain. Once the origin and the root cause of the pain are diagnosed, there are plenty of medical options to cure the pain. In this piece, we will briefly touch upon the causes of lower abdomen pain:

Appendicitis: This is one of the most common causes of lower abdomen pain. It typically originates from the right side of the stomach and soon diverges into the other side as well. The pain can become unbearable in a matter of hours.
Pelvic inflammatory disease: This is an infection that is caused in the reproductive system of a woman. This is often characterized by vaginal discharge, fever, weakness, intercourse related pain and pain in the lower abdomen.
Miscarriage: In case there is a loss of fetus on or before the twentieth week, the mishap is termed as miscarriage. It results in acute pain in the lower abdomen pain, vaginal bleeding, back pain, fluid expulsion from the vagina etc.
Fibroids: This is a growth in the uterus that is often non-cancerous and is commonly characterized by symptoms such as heavy periods, constipation, pain in the legs and back area, pain in the lower abdomen area, frequent urination etc.
Cancer: A cancerous growth in the lower abdomen area can lead to very sharp pain in the back and surrounding area. The pain is dull in nature and slowly spreads to other areas in a short interval of time.
Cholecystitis: This is a disorder that results in swelling of the gallbladder area. It results in a sharp pain in the lower abdomen area. A doctor needs to be immediately consulted if a person is suffering from this disease.
Intestinal obstruction: When the lower bowl gets blocked due to the contents of the lower intestine, a person can feel a sharp pain in the lower abdomen area.
Salpingitis: When a woman faces stiff pain in the lower abdomen area due to an inflammation of the fallopian tube, Salpingitis is the culprit behind it. This is a sexual disease and needs a doctor s consultation to get rid of it.
PMS: A woman can face throbbing pain in the lower abdomen area during her monthly periods. Other symptoms include cramps, weakness, fatigue etc.
Endometriosis: When there is an extension of the uterus tissue just outside the wall of the uterus, it leads to symptoms such as lower abdomen pain, cramps etc.
Polycystic ovarian syndrome: This is a disorder of the hormone and can lead to symptoms such as heavy periods, a growth of facial hair accompanied with sharp pain the lower abdomen area.

Pain In Lower Abdomen - What Could Be The Causes?

Why does PAIN occur? Understand the Mechanism of Pain

Pain is an unpleasant and distressing physical sensation caused by disease or injury, which induces hurt and anxiety in those suffering from it.
There are many different manifestations of pain, ranging from short term (acute pain) to long term (chronic pain). Other classifications include pain in the internal organs (visceral pain), injured tissue (inflammatory pain), nerves (neuropathic pain), etc.

The reason for the occurrence of pain depends on the cause and kind of pain being experienced. In most cases, pain acts as a warning sign that the body has been afflicted by a disorder of some sort, which may have arisen due to internal sickness or external wounding. Acute pains are generally cured on their own through rest or simple medication. Chronic pains, on the other hand, are more complicated in nature and the treatment requires more elaborate diagnosis.

The mechanism of pain

Pain is an extremely personal and subjective experience and affects each individual to varying degrees. The pain signals, which can arise in any part of the body, travel through the spinal cord to the brain along thousands of specialized nerves and nerve fibres. In the brain, it is processed in the centres associated with anxiety, emotions, memory, appetite, etc. Signals and pain inputs are then returned from the brain to the spinal cord, which may heighten or diminish pain.

In some cases, pain may also be induced by damage to the brain and spinal cord, which happens after a stroke.
A constant barrage of pain signals may cause the cells at the end of nerve fibres to become over-sensitized. This is known as 'wind-up' and is one of the most common causes of chronic pain that occurs even though the root of the problem has been identified and treated.

The causes and effects of pain differ from case to case depending on the signals received by the brain and its interpretation. It affects the individual's day to day activities and if persistent, can also have a harmful impact on mental health and psychosis. Pain is always handled, diagnosed and treated differently in all patients by drawing out the best possible solution to the problem.





Why does PAIN occur? Understand the Mechanism of Pain

Hemorrhoids or piles are diagnosed by swelling of veins in the lower part of anus and rectum. Due to swelling, the walls of rectum and anus are stretched and thus become irritated. Hemorrhoids are of two types: Internal and External hemorrhoids.

Internal Haemorrhoids: As the name suggests, the piles are not visible from outside. These are present deep inside the rectum, located above the pectinate line and these are covered with the cells that are present through the rest of intestines. Internal hemorrhoids are normally painless. The first sign of internal hemorrhoids is rectal bleeding. However, straining can push internalhemorrhoid and it protrudes through the anus and this can be painful.

Causes of Haemorrhoids
The swelling of hemorrhoid occurs only when the pressure in the small vessels of rectum and anus is increased and is engorged with blood. The size of the hemorrhoids is also increased. The increased pressure may be due to various factors:

Consuming low fiber diet and pushing or straining while passing stools, thus blood vessel pressure is increased.
Pregnancy also is a cause of swelling as there is the increased pressure of the uterus on rectum and anus.
Sitting for long on toilet also increases pressure.
Obesity is also a cause of hemorrhoids.
People suffering from diarrhea, both acute and chronic.
A person having colon cancer might have hemorrhoids.
Signs and Symptoms of Haemorrhoids:

The most common symptoms of hemorrhoids are painless bleeding, itching in anal, swelling and feeling of the presence of lump at the anus.
All these symptoms are associated with inflamed hemorrhoid.
Inflamed internal hemorrhoid can cause swelling, but is painless as there are no fibers attached to veins above the pectinate line that cause pain. However, passing hard stools can scrape off the thin lining of hemorrhoid, which can cause the painless bleeding.
Spasms of the rectum and anal muscles caused by these swollen hemorrhoidscause pain, especially when they are protruded through the anus.
Internal hemorrhoids can form a clot or thrombose resulting in severe pain.
The presence of has inflammation, stool,and constant moisture and these can lead to itching and burning sensation in the anus among patient of internal hemorrhoid.
Treatment of Haemorrhoids

Diet: Haemorrhoids can be treated when individuals consume a fiber-rich diet in order to soften the stools and ease their bowel movements. Fiber-rich foods include fresh fruits, dry fruits, grains, vegetables, and cereals. About 20 to 30 grams per day of fibrous foods is recommended. Dietary fiber will help create bulk in the intestines which will help in softening of stools and ease bowel movement. Supplemental fiber available in the marketincludes psyllium husk, methylcellulose, and calcium polycarbophil. Other recommendations include increased intake of liquids and having stool softeners. Drinking enough water and liquids will prevent stool from hardening.
Over-the-counter topical treatment: There are various products available to treat hemorrhoids, such as gels, hydrocortisone creams, ointments, foams, pads, and suppositories.
Home remedies: Soaking anus in a warm sitz bath might also help in hemorrhoids for about 10 to 15 minutes per day. One should practice good hygiene and clean anus with warm water while showering. Avoid using soap and dry toilet paper. One can also use a cold compress on the anus.
Minimally Invasive Procedure for Hemorrhoids (MIPH)

Out of the various types of medical and surgical interventions available to treat Piles, Minimally Invasive Procedure for Hemorrhoids (MIPH) 0r painless stapler surgery is known to be very popular since it acts an alternative approach to surgical interventions made for piles.

MIPH is defined as a minimally invasive surgical technique in which a band of loose or prolapsed mucosa and sub mucosa in the rectum is excised, proximal to the piles and disrupted mucosa is fixed by  stapled end to end mucosal anastomosis.

This will ultimately occlude the blood supply to the superior hemorrhoidal artery above the hemorrhoidal tissue, resulting in the retraction of prolapsed mucosa back to its original anatomical position. A special circular stapler known as PPHO3 is used in the anastomosis and the whole maneuver will take around 30 45 minutes.

Internal Haemorrhoids - Best Ways They Can Be Treated!

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