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Contents

1 2012 5

1.1 April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

All That Tingles Is Not Carpal Tunnel! (2012-04-04 05:51) . . . . . . . . . . . . . . . . . . 5

Arthritis of the Elbow (2012-04-20 05:39) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1.2 May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

JOINT ARTHRITIS (2012-05-05 11:20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Arthritis (2012-05-16 11:02) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

1.3 June . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Plantar Fasciitis (2012-06-08 07:02) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Does Your Shoulder keep you awake at Night? (2012-06-13 06:04) . . . . . . . . . . . . . . 12

1.4 July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Tennis Elbow (2012-07-02 10:11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Knee Arthritis Treatment (2012-07-07 08:10) . . . . . . . . . . . . . . . . . . . . . . . . . . 16

1.5 August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

INJURIES OF THE CERVICAL SPINE (2012-08-16 08:53) . . . . . . . . . . . . . . . . . . 17

Osteomyelitis (Bone Infection Disease) (2012-08-27 08:26) . . . . . . . . . . . . . . . . . . . 20

1.6 September . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Treatment of Amputation (2012-09-07 11:22) . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Injury To The Coccyx (Tailbone) (2012-09-29 08:56) . . . . . . . . . . . . . . . . . . . . . . 28

1.7 October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Rickets (Deficiency of Vitamin D, Calcium and Phosphate) (2012-10-09 07:24) . . . . . . . 30

1.8 November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Meniscal (Cartilage) Tear (2012-11-03 12:07) . . . . . . . . . . . . . . . . . . . . . . . . . . 32

How to get relief from Pelvic Pain Injuries? (2012-11-20 12:14) . . . . . . . . . . . . . . . . 35

1.9 December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

How to treat Arthritis Disease? (2012-12-18 06:01) . . . . . . . . . . . . . . . . . . . . . . . 42

What will causes of Ankle Pain Injury? (2012-12-28 07:34) . . . . . . . . . . . . . . . . . . 49

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2 2013 55

2.1 January . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

To Know About Genu Valgum (Knock Knees) (2013-01-02 11:40) . . . . . . . . . . . . . . . 55

How can we prevent Medial Meniscus Injury? (2013-01-15 05:27) . . . . . . . . . . . . . . . 58

2.2 February . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

How to treat Hip Dislocation? (2013-02-05 10:26) . . . . . . . . . . . . . . . . . . . . . . . . 61

How to diagnose Knee Joint Injury? (2013-02-21 09:48) . . . . . . . . . . . . . . . . . . . . 65

2.3 March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

Obesity is emerging as a serious health threat among children (2013-03-06 07:05) . . . . . . 68

2.4 April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Carpal Tunnel Syndrome (2013-04-10 05:52) . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

2.5 June . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

How to Recover from Rheumatoid Arthritis? (2013-06-24 11:16) . . . . . . . . . . . . . . . 71

2.6 July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Diving and Swimming Tips (2013-07-29 03:35) . . . . . . . . . . . . . . . . . . . . . . . . . 73

2.7 August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Safety Tips for Young Drivers (2013-08-21 06:39) . . . . . . . . . . . . . . . . . . . . . . . . 74

2.8 October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Experts’ Advice to Avoid Medical Errors (2013-10-22 08:22) . . . . . . . . . . . . . . . . . . 75

Steroid Injection Therapy May Increase Risk of Spinal Fracture (2013-10-29 07:33) . . . . . 79

2.9 November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

Advantages of Computer Assisted Surgery (2013-11-20 10:14) . . . . . . . . . . . . . . . . . 80

2.10 December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Treatment for Achilles Tendon Injuries (2013-12-19 09:36) . . . . . . . . . . . . . . . . . . . 81

3 2014 85

3.1 January . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Post Knee Rehabilitation: Do’s and Don’ts (2014-01-15 12:14) . . . . . . . . . . . . . . . . 85

3.2 February . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Morton’s Neuroma (2014-02-14 05:38) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

3.3 March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

BONE & JOINT (2014-03-14 07:13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

3.4 April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Greenstick Fracture (2014-04-26 12:30) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

3.5 May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Legg- Calve Perthes Disease (2014-05-27 11:21) . . . . . . . . . . . . . . . . . . . . . . . . . 94

4

Chapter 1

2012

1.1 April

All That Tingles Is Not Carpal Tunnel! (2012-04-04 05:51)

In Reality, All Tinglings are not Carpal Tunnel Syndromes

Numbness of the hands and [1]carpal tunnel syndrome are synonymous for many patients. If hand or fingersexperience weakness or tingling sensation, there is an automatic assumption of [2]carpal tunnel syndrome.The term has gained familiarity in the work places where upper extremities are exposed to repetitive motion.Keyboards are gaining notoriety for contributing to the condition. The syndrome has become a commonhousehold term in the nineties

[3]Carpal Tunnel Syndrome Treatment

An assortment of factors produces [4]pain, numbness, and weakness in the upper extremities and closelymimics the picture of carpal tunnel syndrome. Numbness is not necessarily a result of nerve pinching either -this is a second common misconception.

Conditions affecting as remote areas as the shoulders may produce a heavy and numb sensation in the [5]upperextremity. None of this has to do with any nerves whatsoever. Conversely, a [6]carpal tunnel syndrome painmay extend as high as the shoulder and can be confused with a shoulder condition.

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Vascular conditions that compromise the circulation to the extremity are also accompanied by tinglingand numbness. Conditions of the heart have been known to produce extremity symptoms these include[7]symptoms oftingling and numbness.

Metabolic disorders are another culprit on the list mimicking carpal tunnel syndrome. On the top of the listare [8]Diabetes and thyroid disorders. These produce symptoms with or without nerve compression (nervepinching).

Conditions of the neck frequently produce numbness, pain, and weakness of the hands. Arthritic or discconditions of the neck may produce nerve compression in the neck which produce [9]symptoms in the upperextremities.

The term [10]carpal tunnel is derived from the tunnel shaped configuration of the tiny wrist bones. Thistunnel harbors tendons that flex our fingers. A nerve called the median nerve is packed along the tendons.The median nerve carries sensations to the thumb and the majority of the fingers. The space has very littletolerance to any swelling and the resulting pressure. A wide variety of [11]causes may produce pressure in thecarpal tunnel. One of the physiological causes is pregnancy. Pregnancy related symptoms usually disappearafter childbirth.

It is not uncommon to experience pain at night. Positions of wrist flexion such as driving and holding anewspaper [12]trigger pain andnumbness. Keyboards have a similar effect.

Treatments:

Examination usually requires a careful history and evaluation of the related symptoms. Blood tests and nerveconduction studies may be necessary to establish the diagnosis. Treatment usually consists of treating theunderlying causes if they are identifiable. Splinting, protection, and anti-inflammatory medications produceconsiderable relief for most cases. [13]Carpal tunnel injections may be useful for more [14]chronic cases.C decompression is indicated for advanced or truely refractory cases. This out-patient procedure can beperformed under a local or regional anesthesia.

1. http://centerforadvancedorthopedics.com/

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Arthritis of the Elbow (2012-04-20 05:39)

Arthritis of the Elbow: Causes, Types, Treatments, Procedure.

How many times a day do you bend your elbow? A person usually bends their [1]elbow hundreds of times aday. Now imagine if every time you bent your elbow, you [2]felt the pain of arthritis. For many Americans,

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this scenario is all too true. [3]Arthritis of the elbow can cause pain not only when they bend their elbow,but also when they straighten it.

Causes of Arthritis of the Elbow:

• [4]Rheumatoid Arthritis (RA).

• [5]Osteoarthritis (OA or ”wear-and-tear” arthritis)

• [6]Trauma

[7]RA is a disease of the joint linings, or synovia. As the joint lining swells, the joint space narrows. Thedisease gradually destroys the bones and soft tissues. Usually, [8]RA affects both elbows, as well as otherjoint s such as the hand, wrist and shoulder.

[9]OA affects the cushioning cartilage on the ends of the bones that enables them to move smoothly in the[10]joint. As the cartilage is destroyed, the bones begin to rub against each other. Loose fragments withinthe joint may accelerate degeneration.

[11]Trauma or injury to the elbow can also damage the articular cartilage. This eventually leads to thedevelopment of post [12]traumatic arthritis. Usually, this form of arthritis is confined to the injured joint.

In the early stages of RA, pain may be primarily on the outer side of the joint. Pain generally worse ns as youturn (rotate) your forearm. The pain of OA may intensify as you extend your arm. Pain that [13]continuesduring the night or when you are at rest indicates a more advanced stage of OA. In addition to pain, one mayexperience swelling, inability to perform daily activities because the elbow gives away, inability to straightenor [14]bend the elbow, [15]locking of the elbow, and [16]stiffness in the elbow. At times, both elbows areinvolved or pain can occur at the wrist, shoulders, and elbow; this is indicative of RA.

Treatment:

The initial treatment is non- surgical and depends on the [17]type of arthritis. Your physician will discussthe options with you and develop an individualized program of medical and physical activities. Among thetherapies that can be used are: activity modification; since, OA may be linked to repetitive overuse of thejoint, modifying job or sports activities can be helpful. Intermittent periods of rest can relieve[18] stress onthe elbow. Painkillers, such as acetaminophen or ibuprofen can provide short-term pain relief. More potentagents can be prescribed to treat RA. These include anti malarial agents, gold salts, immunosuppressivedrugs, and corticosteroids. An injection of a corticosteroid into the joint can often help. Physical therapy isanother treatment option; heat or cold applications and gentle exercises may be prescribed. A splint wornat night, or one that permits movement as it protects the elbow from stresses, may also be helpful. Otherassistive devices, such as handle extensions, can be used to maintain daily activities.

Surgical Treatment:

If your arthritis does not respond to the above [19]treatments, you and your physician may discuss surgicaloptions. Because several nerves are near the elbow, a skilled orthopedic surgeon should be consulted.[20]Surgery usually results in improved pain control and increased range of motion.

Procedure:

The exact procedure will depend on the [21]type of arthritis you have, the stage of the disease, your age,expectations, and activity requirements. Arthroscopy, a procedure involving pencil-sized instruments andtwo or three small incisions, allows the surgeon to remove bone spurs, loose fragments, or a portion of thediseased synovium. This procedure can be used to treat both RA and OA. Another procedure is called asynovectomy; here, the [22]surgeon removes the diseased synovium. Sometimes, a port ion of bone is alsoremoved to provide a greater range of motion. This procedure is often used in the early stages of RA. In

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an osteotomy, part of the bone is removed to relieve pressure on the joint. This procedure is often used totreat OA. In an arthroplasty, the surgeon creates an artificial joint using either an internal prosthesis or anexternal fixation device. A total [23]joint replacement is usually reserved for patients over 60 years old orpatients with RA in advanced stages.







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1.2 May

JOINT ARTHRITIS (2012-05-05 11:20)

Is [1]ARTHRITIS LIMITING YOU?

[2]Arthritis is a painful joint condition that affects a reported 32.9 million American adults. Though itcommonly occurs in adults however, children can also be affected. Arthritis can occur in an [3]injured or[4]diseased joint. A joint is where the ends of two or more bones meet. The bone ends of a joint are coveredwith cartilage, a smooth material that cushions the bone and allows the[5] joint to move smoothly withoutpain.

Types:

Though there are more than a hundred different types of[6] arthritis, the two most common typesare called [7]Osteoarthritis and [8]Rheumatoid Arthritis.

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[9]Osteoarthritis Arthritis:

[10]Osteoarthritis is found in the joints of older people and in injured or overused joints of youngerindividual. It is commonly found in the knee, hips, and spine. In this type of [11]arthritis, the cartilagecovering the joint begins to wear away. Occasionally, bone growths, called ”spurs”, can develop in the joint.The resulting inflammation in the[12] joint causes pain and swelling.

[13]Rheumatoid Arthritis:

[14]Rheumatoid arthritis, another common form of [15]arthritis, is a long lasting disease in whichthe joint lining swells. This swelling invades surrounding tissues and causes chemical substances to attackand destroy the joint surface. Though [16]rheumatoid arthritis is commonly found in the hands and feet, itcan also occur in the knees, hips, and elbows. [17]Swelling, pain, and stiffness are present even when the jointis not used. Though rheumatoid arthritis can affect anyone, more than seventy percent of those with thisdisease are above thirty. The main approach to treating arthritis centers on pain relief, increased motion, andincreased strength. Many over-the-counter medications, including aspirin, ibuprofen, and naproxen can beused to control pain and inflammation associated with arthritis. Prescription medications are also available ifover-the counter medications are not effective. People with [18]arthritic joints can use canes, crutches, andwalkers to help relieve the stress placed on arthritic joints.

[19]Treatment:

Exercising and physical therapy can also be helpful in decreasing stiffness and in strengtheningmuscles around the joints. If these methods of [20]treatment are not successful, surgery is recommended.The type of surgery depends on the extent of [21]arthritis in the joints, its type, and the physical condition ofthe patient. [22]Surgical procedures include removal of the diseased or damaged joint lining, realignment ofthe joints, [23]total joint replacement, and fusion of the bone ends of a joint to prevent joint motion andrelieve joint pam.

Though there is no present cure for arthritis, researchers continue to make progress in finding theunderlying causes for the major [24]types of arthritis.

Still, people with arthritis can continue to perform normal activities. Various exercise programs,anti inflammatory drugs, and [25]weight reduction programs for obese people are ways to reduce pain,stiffness, and improve function. In persons with severe cases of arthritis, [26]orthopedic surgery can oftenprovide dramatic pain relief and restore lost joint function. A total joint replacement, for example, canusually enable a person with severe arthritis in the hip or the knee to walk around without pain or stiffness.Consult your orthopedic doctor if you are having symptoms typical of arthritis.



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9. http://centerforadvancedorthopedics.com/Location-Of-Advaced-Orthopedics.aspx










19. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.








Arthritis (2012-05-16 11:02)

Managing Arthritis in Active Adults:

All painful knees are not necessarily [1]arthritic. The knee is a complex joint with several moving partswhich is frequently challenged during regular and recreational activities. It is not uncommon for one part oranother to start showing signs of strain or regular wear and tear of the[2] joint surface, which is also knownas articular cartilage. This surface has appearance of a resilient plastic that is well constructed to absorb therepetitive loads during walking and running. The joint surface may start to show signs of wear and tear withor without apparent injury. This wear and tear of the joint surface is also known as degenerative [3]arthritis.

If the pain is produced by strains of parts other than the joint surface, the condition is not [4]arthritic.Smoking, overweight, trauma, repetitive loading and misalignments of the joint contribute to the developmentand continuation of the [5]knee arthritis. The knee has three main compartments or moving sections, whichabsorb the body loads during physical activities. The arthritic condition may involve one, two or all threecompartments of the joint. It is important for the patients to have this knowledge, since the treatment maydiffer depending upon the involvement of a particular compartment. [6]Pain and stiffness are two of the mostcommon [7]symptoms of arthritis. At times, this may be accompanied by swelling, popping, clicking andsensations of giving out. It is important to know that non-[8]arthritic conditions of the knee can also producesimilar symptoms that closely mimic arthritis. A history of symptoms, clinical examination and standing X-rays are usually sufficient to make a correct diagnosis of degenerative arthritis. On rare occasions, additionaltesting such as CT scan or MRI scans may be necessary to arrive at a diagnosis. These additional tests areunnecessary and redundant in more than 90 % of patients. The X- rays might show joint space narrowing,small bone over growths such as bone spurs or deposits of calcium. At times the X- rays look completelynormal and further investigations become necessary in face of continuing symptoms.





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1.3 June

Plantar Fasciitis (2012-06-08 07:02)

Symptoms And Treatment Of Heel Spur Syndrome:

[1]Plantar Fasciitis is commonly known as ”[2]heel spur syndrome”. It is common among people whoare active in sports (i.e. running). This [3]pain generally begins as a dull pain in the heel that may comeand go. At times the pain may be sharp and persistent. The pain is usually worse after times of rest such assitting or sleeping; therefore, more pain is noticed in the mornings or at the start of physical activities. The[4]plantar fascia is a thick fibrous band on the bottom of the foot. This is attached from the heel bone to thetoes and acts as a bowstring to produce the arch of the foot.

Running and other activities may place tension on the [5]fascia. This prolonged tension causes the fas-cia to swell at the point where the fascia is attached to the [6]heel bone. Injury may also occur at the mid-soleor near the toes. It is difficult to rest the foot; therefore, it is important to seek treatment as soon as possibleso that the problem does not progress. The [7]swelling reaction of the heel bone may produce new bonecalled [8]heel spurs. They are not initially painful and do not cause the problem; however, walking on spursmay cause sharp pain. Some contributing factors include flat feet, high arched feet, poor shoe support, toerunning, soft terrain, increasing age, sudden increase in activity level, or family tendency. Keep in mind thatplantar fasciitis may be aggravated by weight bearing sports.

Treatment for Plantar Fasciitis

Improvement may take longer if the condition has existed for a long time. It is important to wear goodshoes and to lose excess weight. During the recovery period, it would be helpful to replace weight bearing[9]sports with non-weight bearing sports such as cycling or swimming. Weight training will help to maintainleg strength. A sport is considered weight-bearing if the foot is repeatedly landing on the ground such asrunning or jogging.

• [10]Treatment of plantar fasciitis includes rest. Pain will be the guide to let you know when you shouldrest your foot.

• Ice can be applied for 30 to 60 minutes several times a day to [11]reduce swelling. The ice can be placedin a plastic bag covered with a towel. Apply ice for “approximately 15 minutes after activity.

• Anti-inflammatory/analgesic medication may also be used to reduce swelling. If there is no help after2-3 weeks, the [12]physician may decide to inject the tender area with cortisone or a local anesthetic.

• A heel or felt sponge can help to spread, equalize, and absorb the shock as your heel lands. This wouldease the pressure on the [13]plantar fascia. You may need to cut a hole in the sponge over the painfularea to avoid irritation.

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• [14]Surgery is rarely required for plantar fasciitis . It would only be considered if all other forms ofconservative treatment fails.

• When necessary, surgery requires the removal of the [15]bone spur and release of the plantar fascia.

After recovery, return to sports activities slowly. Pain will indicate that you are doing too much. Yourphysician can give you the proper exercises to strengthen the small muscles of the foot and to support thedamaged areas. This will help prevent [16]re-injury.

1. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx

2. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedic

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Does Your Shoulder keep you awake at Night? (2012-06-13 06:04)

Shoulder Pain: Symptoms, Causes and Treatment.

[1]Shoulder pain is a relatively common condition. Ordinary [2]strains and sprains produce shoul-der discomfort. Most of the time the condition is self-limiting and resolves spontaneously.

Some shoulder pains are recalcitrant and progressive. [3]Pain may or may not follow any specificinjury; it may be spontaneous. Patients usually feel[4] stiffness and find themselves experiencing increasingdifficulty in performing day to day routine functions. Pain eventually starts to invade periods of rest.Patients wake up several times during the night and find themselves rubbing their shoulders or popping[5]pain medications. Some patients develop weakness and cannot raise their arms to the side or forward. Inmost cases there is no visible [6]swelling or lump.

It is not uncommon for some people to discount it as [7]arthritis. They think that since there isno lasting cure then they must suffer and learn to live with the problem. NOT TRUE! Most [8]chronicshoulder pains are not arthritic and are relatively easy to cure.

The shoulder is a ball and socket kind of [9]joint. It is surrounded by an envelope of deep muscles

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called [10]rotator muscles or commonly known as ”rotator cuff”. The cuff symbolizes an envelope likeconfiguration. The [11]cuff is further covered by a [12]bony arch which provides shape and an outerconfiguration to the shoulder. The actual joint sits deeper, right below the bridge.

Causes:

Due to several reasons, the [13]muscles start to rub against the bony arch. This rubbing starts toproduce irritation of the rotator cuff. If the rubbing continues for a period of time, the cuff starts to erode.The final outcome may be a good size tear in the cuff. The pressure and rubbing is the cause of pain.[14]Night pain indicates probable erosion of the cuff although this is not necessarily the case in each andevery patient. This condition is also called ”[15]Impingement Syndrome”.

A simple office examination usually reveals the problem. X-rays are usually performed to obtainfurther information. In some patients, special investigations are indicated to verify tears of the cuff. Local[16]anesthetic injection, at times, is applied to confirm the diagnosis of impingement.

Another common cause of shoulder pain is degeneration of a tiny joint above the shoulder, the ACor acromioclavicular joint. Pain from this condition is usually on the top of the shoulder. One can usually feela tender spot right over the shoulder. True arthritis of the [17]shoulder joint is rather an uncommon cause.

One should always remember certain serious causes of shoulder pain. Fortunately these causes arerare. [18]Bone tumors, serious conditions in the chest or the abdomen can produce vague shoulder pain.Nerves pinching in the neck or TMJ conditions are also relatively common but non-serious causes of shoulderpain.

Treatment:

[19]Treatment of the problem is based upon the cause.

• Most cases are mild and relatively easily manageable.

• Medications, simple exercises, and physical therapy are the usual treatments.

• Most patients benefit from this plan. Some patients require injections, arthroscopy or [20]surgicalcorrection to get rid of the problem.

• For specific information on this condition, consult your[21] physician.





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1.4 July

Tennis Elbow (2012-07-02 10:11)

Lateral Epicondylitis: Symptoms And Treatment

[1]Tennis Elbow is an inflammation around the [2]bony knob of the outer side of the elbow. It oc-curs when the tissue that attaches [3]muscle to the bone becomes irritated. The bony knob is called the[4]lateral epicondyle; therefore, Tennis Elbow is also called lateral epicondylitis.

The muscles that allow you to straighten your [5]fingers and rotate your [6]lower arm and wrist arecalled [7]extensor muscles. These muscles extend from the outer side of your elbow to your wrist and fingers.A cord like fiber called a [8]tendon attaches the extensor muscles to the elbow. Overuse or an accident cancause tissue in the tendon to become inflamed or [9]injured.

Tennis elbow can be caused by playing a racket sport or doing anything that involves extendingyour [10]wrist or rotating your forearm such as twisting a screwdriver or lifting heavy objects with your palmdown. It is common for the [11]tissue to become inflamed more easily as you get older.

When the tendon is inflamed, the [12]nerves around the tendon become irritated. Then movingyour elbow is painful. Turning your hand or grasping objects can also be painful. The most commonsymptom of tennis elbow is pain on the outer side of the elbow and down the [13]forearm. You may havepain all the time or only when you lift things. The elbow may also swell, get red, or feel warm to the touch.It may also hurt to grip, turn your hand or swing your [14]arm.

Tennis elbow can be diagnosed from hearing symptoms and from the look and feel of your elbow.

Treatment for Tennis Elbow

[15]Treatment will depend how inflamed the tendon is. The goal of treatment will be to relieve thesymptoms and regain full use of your elbow.

Rest and Medication: The doctor may prescribe a tennis elbow splint to rest the [16]inflamed ten-don and allow it to heal. You may wish to use the other hand or change grips to reduce the amount of stresson the tendon. Oral anti-inflammatory medications may be used to reduce [17]swelling. Heat or ice may also

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be used to reduce swelling and relieve [18]pain.

Exercise and therapy: Exercises and [19]therapy may be prescribed to gently stretch and strengthen themuscles around your [20]elbow.

Anti-Inflammatory Injections: An injection may be given with an [21]anti-inflammatory such as cor-tisone to help reduce the swelling. You may have more pain at first; but, within a few days, your elbowshould feel better.

Surgery: [22]Surgery may be an option if no other treatments relieve the [23]pain or if the symp-toms persist for a long period of time. Surgery would be used to repair the inflamed tendon.

PREVENTION

It is important to try to prevent a flare-up of [24]tennis elbow. You may wish to make a fewchanges in the way you do certain things. You should grip with the palm up and lift heavy objects with bothhands. If you play racket [25]sports or golf, it is important to condition your [26]muscles, do warm-up andcool down exercises and use the correct strokes.

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Knee Arthritis Treatment (2012-07-07 08:10)

Pain Relief Treatment for Knee Arthritis:

In the [1]knee, [2]arthritis treatment can take several forms. Selection of [3]treatment takes several fac-tors into consideration and these may include but are not limited to, severity of [4]pain and disability,response to previous treatments, number and extent of the compartments that are involved in the [5]diseaseprocess, general health of the patient and circulation of the extremity.

Treatment:

• [6]Treatment could be as simple as modification of the physical activities and periodic utilization ofordinary pain medications.

• Non-impact activities such as cycling and swimming can provide excellent [7]cardiovascular and aerobicadvantage while the [8]joint is undergoing other medical treatments.

• For mild misalignments, [9]heel wedges and balancing shoe inserts come in handy to alleviate [10]painand improve function.

• Non-steroidal anti-inflammatory medications do provide symptomatic relief without reversing the[11]arthritis.

• Food supplements such as Glucosamine and Chondriotin sulfate also provides symptomatic relief anddo not delay the progression of the arthritis.

• These products are still under active research and their mode of action remains unknown.

Myriad of [12]injections are also utilized to provide symptomatic [13]relief. Among these injectable steroidsand lubricating type of injections are most popular. These injections if effective may provide relief for severalmonths. Injectable steroids are safe and effective for nasty and painful flares; however, their utilization shouldbe limited and never applied as a long-term [14]management strategy.

Choice of Surgery:

• [15]Surgical alternatives may be explored for resilient arthritic knees.

• [16]Surgery is an elective choice and never an absolute necessity.

• For arthritis induced loose bodies and related mechanical problems a relatively simple outpatientprocedure of [17]arthroscopy can alleviate the immediate problem without reversing the arthritis itself.

• Removal of loose bodies can extend the life of the joint and postpone the need for major invasiveprocedures.

In relatively younger adults, a portion of the joint can be replaced if the disease is localized to a singlecompartment. Such a procedure is known as uni-compartmental [18]knee replacement. If more than onecompartment is involved, it may become necessary to replace the entire joint through a standard total kneereplacement. Contrary to common misconception, a total knee replacement doesn’t entail removal of theentire knee; instead the procedure replaces the uneven arthritic surface with synthetic materials and preservesthe bulk of the original [19]bones that produce the natural shape of the [20]knee joint.

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Before any surgical procedures patients must familiarize themselves with the exact nature of [21]surgery,alternate approaches and risks that may accompany such procedures. No one should jump into surgicaloptions without acquiring sufficient knowledge about the operation.






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1.5 August

INJURIES OF THE CERVICAL SPINE (2012-08-16 08:53)

Cervical Spine Injury : Causes, Symptoms and Treatment

[1]Injuries of the [2]cervical spine are dangerous; and if associated with neurological damage, the results canbe devastating. Though diagnostic and [3]treatment methods have vastly improved over years, [4]still injuriesof the cervical spine pose the greatest challenge to the skill and acumen of [5]orthopedic and neurosurgeons.

Jefferson pointed out two areas commonly involved in [6]cervical spine injuries, C1-2 and C5-7. According toMeyer, C2 and C5 are commonly involved. Neurological damage is seen in 40 percent of cases. In 10 percentof cases, radiographs are normal.

Causes

• Fall from Height: It is the most common cause in developing countries.

• Diving Injuries: Diving into water with insufficient depth or in an inebriated condition.

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• Road Traffic Accidents (RTAs): Common cause in developed countries, e.g. [7]whiplash injury

• Gunshot Injuries: These injury the [8]cervical spine and the cord directly.

Mechanism of Injury

• Pure Flexion Force: For Example, compression [9]fracture of vertebral body, e.g. fall from height.

• Flexion Rotation: For Example, fall on one side of the [10]shoulder, disruption of facet capsule is seen.

• Axial Compression: For Example, fall of an object on the head results in load compression, e.g. explosivecomminuted fracture of C5 body.

• Extension Force: For Example, avulsion fracture of superior margin of [11]vertebral body, e.g. whiplashinjury.

• Lateral Flexion: For Example, fracture pedicle, fracture transverse process and [12]facet joints, etc.

• Direct Injuries: For example, fracture spinous process and body. Due to assault, [13]gunshot injury, etc.

WHIPLASH INJURY (SYN: Acceleration injury,[14] cervical sprain syndrome, soft tissue neck injury)

Definition

It is an unconventional and inconsequential ligamentous [15]injury of the cervical spine allegedly due to anextension injury following a rear-end collision in an RTA.

Incidence

• It is seen in about 25 percent of rear-end collision of RTAs.

• Seventy percent of those affected are women.

• It is common in the 3rd or 4th decades.

Clinical Features

Symptoms

• [16]Upper neck pain that becomes worse with movement.

• Occipital headache.

• [17]Neck stiffness.

• Rarely vertigo, auditory or visual disturbances, etc.

Signs

• Decreased range of neck movements.

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• Neck muscle spasm is seen.

• [18]Symptoms appear within 48 hours of injury and 57 percent recover within three months. Final stateis reached by one year.

Investigations

X-rays are usually normal. MRI helps to make a diagnosis.

Treatment

It is mainly conservative and consists of the following:

• Drugs: NSAIDs, [19]muscle relaxants, etc. are given.

• Collars: These are recommended for the first three days.

• Short [20]arc active movements are slowly begun.

• Active ROM exercises are slowly commenced.

• After the [21]pain subsides, isometric strengthening exercises are slowly commenced.

• Other modalities take ultrasound, traction, manipulation, [22]massage, etc. also helps.



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Osteomyelitis (Bone Infection Disease) (2012-08-27 08:26)

Signs, Symptoms And Treatment of Bone Disease:

[1]Osteomyelitis is one of the most difficult and challenging problems encountered in [2]orthopedics.From the life-threatening [3]acute osteomyelitis to the disabling [4]chronic osteomyelitis, it frustrates andthwarts the best efforts of orthopedic surgeons. The ravaging effects of osteomyelitis on a [5]bone and itsneighboring joints are a tale of dismay and gloom.

Definition

Osteomyelitis is defined as a suppurative process of the bone caused by [6]pyogenic organisms orsimply a pyogenic infection of the cancellous portion of the [7]bone.

Classification

Three types are described based on duration of [8]symptoms, route of spread of infection and hostresponse.

Hematogenous spread with primary infection being elsewhere like [9]tonsillitis, ASOM, pyoderma,etc. is the common mode of spread. Spread from neighboring infective sites like septic [10]arthritis and directinoculation of infecting organisms by way of penetrating wounds, punctured wounds, [11]trauma, etc. comesecond.

Clinical Features

[12]Acute osteomyelitis is a clinical catastrophe. It presents in the following manner:

Fever

This is the most common presenting symptom. The child usually has very high [13]fever and is as-sociated with profuse sweating, chills and rigors. Sometimes, the presentation is so acute that the child maybe in shock and [14]unconscious.

Swelling

This usually follows the fever and may affect the ends of long [15]bones. The swelling may beacutely [16]painful and the [17]skin may appear red.

Limitation of Movement

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The child may not move the [18]joint near the affected bone due to [19]pain and swelling. In fact,the child may lie still without moving the joint and this is sometimes called a state of pseudoparalysis.

Clinical Signs

This consists of general and local signs are :

1. General Features

2. Local Features

General Features

Symptoms:

• Fever

• Sweating

• Chills and Rigors

• Patient is usually in shock

Signs

• Increased Temperature

• Increased Pulse Rate

• Anemia

• Signs of dehydration and shock

General features of anemia, [20]dehydration, pyrexia, pulse rate, shock and toxicity may be present.

Local Features

Symptoms

• Local Swelling (80 %)

• Limitation of movement (50 %)

Signs

• Tenderness (80 %)

• Local Erthema (50 %)

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• Raised Temperature (50 %)

• Fluctuation Present (20 %)

• Effusion (10 %)

• Decreased Movements (50 %)

The local [21]swelling may show increased temperature may be tender to touch, and the [22]skin is stretched.Movements of the neighboring [23]joints are decreased and there may be effusion in them too.

Investigations

The investigations of [24]acute and chronic osteomyelitis is compared for easy remembrance and under-standing. In general, in acute osteomyelitis, laboratory investigations and [25]bone scan are more useful whileradiology is of much help in chronic osteomyelitis.

Management

Acute osteomyelitis is an [26]orthopedic emergency, which needs in patient admission.

Treatment

• Rest in Bed: Protect affected part with splints to alleviate [27]pain and spasm.

• Elevation of the part: Warm and moist packs to reduce the [28]swelling.

• Systematic Treatment: Blood transfusions, intravenous fluids to correct shock and hypovolemia.

• [29]Orthopedic Treatment

• [30]Physical Therapy Treatment

Principles of Antibiotics Therapy

• Appropriate drug: Usually the drug chosen is a broad spectrum bactericidal agent.

• Appropriate Route: Intravenous for the first 2 weeks and oral for the next 4 weeks.

• Appropriate Dose: The [31]drug depending on the body weight of the patient.

• Appropriate time to stop: When the [32]disease is eradicated, controlled or resistance or side effects tothe drugs develops.

• Appropriate adjunctive measures: a combination of ampicillin and cloxacillin are found to be veryeffective though pencillin G still the drug of first choice in our country.

Surgical Methods:

Depending upon the situation anyone of the following [33]surgical methods could be employed:

22

• Aspiration: It helps in decompression and the material so obtained may be used to identify the organismand check for [34]antibiotic sensitivity.

• Incision and Drainage: Helps to drain the subcutaneous abscess.

• Multiple drill holes: If the abscess is subperiosteal, this technique helps to drain the [35]pus by makingmultiple holes in the cortex.

• Small bone window: If the multiple drill holes do not drain the pus, a small window of [36]bone isremoved from the cortex and the pus is evacuated.





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1.6 September

Treatment of Amputation (2012-09-07 11:22)

Upper And Lower Limb Amputation Treatment:

[1]Amputation is a procedure that removes a [2]limb, partly or totally, through the level of one or more[3]bones, whereas disarticulation is a procedure that removes a limb through the level of a [4]joint.

Amputation is one of the oldest [5]surgical procedures. Refinements in amputation surgeries and advancesin prosthetic designs occurred mainly during the two World Wars. This advancement is progressive andessential as the number of [6]amputations performed is increasing each year. This is due to an increasingaging population with greater incidences of [7]diabetes and [8]peripheral vascular diseases as well as due toan ever increasing incidence of accidents. Amputations are more common in men and more often in the lowerlimbs.

Types of Amputation

There are two types of amputation:

(i) Open Amputation

(ii) Closed Amputation

Open Amputation

In open amputation, also called [9]guillotine amputation, the skin is not closed over the amputation stump.Open amputation is indicated in cases where the wound is grossly contaminated or in cases of severe [10]in-fections. After amputation the stump is left open and dressed regularly till the infection subsides and thestump wound becomes healthy. The stump can then be covered by any of following methods:

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• Skin grafting

• Secondary closure

• Revision of amputation: The amputation is done at a higher level, [11]skin flaps are designed and thestump wound is closed

Closed Amputation

In this type of amputation, the stump is closed primarily. All elective amputations are closed amputa-tions.

Surgical Principles

Meticulous attention to details and gentle handling of [12]tissues are essentl.al for a good outcome fol-lowing amputations. Important principles to be followed during amputation are:

Levels of Amputation

For an amputation in a [13]limb, ideal levels were suggested which gave the stump an optimum lengthto facilitate subsequent prosthetic fitting. For example, for an above-[14]knee amputation the optimumlength of the stump was taken as 25-30 cm as measured from the tip of the greater trochanter. Similarly,for a below-knee stump the optimum length suggested was 15 cm as measured from the [15]tibial tubercle.However, with the recent developments in the fabrication and fitting of [16]prosthesis, it is not necessary tostick to these stump lengths. These days the prosthesis (artificial limb) can be custom-made to fit at differentstump lengths. The viability of the tissue is the main criteria for determining the level of [17]amputation.

The stump should, however, have a well-healed, non-tender, supple scar. The stump should be in propershape and not bulky. Availability of total contact prosthesis has further increased the option in deciding thelevel of amputations. However, a joint must always be preserved, whenever possible.

In Upper Limb an Amputation could be:

• Shortening of the [18]phalanges.

• Ray Amputation of the Fingers: The whole digit is removed from the base of the correspondingmetacarpal.

• Below-Elbow Amputation: Amputation through [19]forearm bones.

• Through-elbow disarticulation.

• Above-Elbow Amputation: Amputation through the arm.

• Through-[20]shoulder disarticulation.

• Forequarter Amputation: It is carried out proximal to the [21]shoulder joint in which scapula and partof the clavicle are removed along with the shoulder girdle muscles.

• Krukenberg Operation: This operation is usually performed in patients with bilateral below-elbowamputations, who have sufficiently long stumps. The forearm is split between the radius and [22]ulnato provide the pincer grip. The patient can hold a spoon or such lighter objects with this ”fork”.

25

Lower Limb: The amputation may involve a toe or it may be:

• Mid tarsal amputation.

• Through -[23]ankle disarticulation.

• Syme’s Amputation: The tibia and [24]fibula are divided just above the ankle joint. The intact skinover the [25]heel is attached back to the end of the stump with or without a part of the calcaneum.Because of the intact heel, it becomes an end-bearing stump and the patients generally manage verywell walking even bare [26]foot after this type of amputation.

• Below Knee Amputation: Amputation through the [27]leg bones.

• Through knee disarticulation.

• Above Knee Amputation: Amputation through the femur.

• [28]Hip disarticulation.

• Hind Quarter Amputation with excision of the hemi pelvis.

Post-Operative Treatment

The follow-up is as important in amputation surgery as the procedure itself. The aim of this [29]exer-cise is to provide a pliable, functional non-deformed stump, which can fit prosthesis as well.

The Treatment Involves:

• Rigid Dressing: We use a plaster of Paris(PoP) stump cast at the conclusion of the [30]surgery withcare taken to pad all the bony prominences, avoid proximal constrictions and prevent postoperativecontractures.

• Soft Dressing or conventional dressing with sterile snugly fitting pads and elastic bandages can also beused, alternatively.

• Limb Positioning: The limb should be positioned properly to prevent contractures and [31]oedema.

• Exercises: Stump [32]exercises are necessary and should be encouraged after the wound heals up. Theseexercises help in reducing the oedema, preventing joint contractures and developing muscle strength.

• Crepe Bandage: The use of a crepe bandage over the stump is continued for 3-4 weeks. It helps inshaping the stump well which is conducive for the subsequent prosthetic fitting.

• Prosthetic Fitting: The prosthetic fitting can be:

• Immediate post-surgical.

• Definitive

• Immediate post-surgical fitting: A plaster of Paris mould is applied over the amputation stumpimmediately after surgery to which a temporary prosthesis-pilon is attached the next day. The patientis then allowed partial weight bearing as early as the [33]pain permits.

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• Definitive Prosthesis: This is usually given 3 months after the [34]surgery, when the stump has matured.

• Ambulation: This may be initiated:

(i) Immediately after [35]surgery.

(ii) Promptly when good stump healing is noticed.

(iii) Early: after stump has healed.

(iv) Late: after the stump has matured.









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Injury To The Coccyx (Tailbone) (2012-09-29 08:56)

Causes And Treatment of Tailbone Pain:

These are relatively rare [1]injuries, but could be quite troublesome to the patients. This can leadto the development of [2]coccydynia, which is described as a [3]chronic pain in the coccyx.

Mechanism of Injury

It is due to a direct fall on the [4]buttocks. It can also result from seat injuries while driving twowheelers or four wheelers. Of late constant pressure due to prolonged sitting as in the case of computerprofessionals can give rise to [5]coccydynia.

Clinical Features

The patient usually complains of pain in the buttocks and is unable to sit comfortably. Due to thedevelopment of coccydynia the pain may become [6]chronic. The patient also complains of difficulty intraveling and altered sitting postures due to the [7]pain.

Investigations

Plain X-ray of the [8]coccyx especially the lateral view helps to make the diagnosis. However, it isdifficult to position the patient for the X-rays. MRI of the sacrococcygeal region is a better option.

Treatment

1. Conservation Measures

The [9]treatment is essentially conservative in nature with periods of bed rest and symptomatictreatment for [10]pain and inflammation.

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2. Physiotherapy Management

Consists of the following steps:

• To [11]relieve pain, thermotherapy likes ultrasound and TENS.

• To relieve prolonged pressure on the buttocks, sitting on a ring cushion and sitting on alternate buttocksis adviced.

• Isometric exercises to the glutei maximus [12]muscle in sitting lying and prone positions are advisable.

• Sitz bath helps to relieve pain.

3. Injection Therapy

If the pain is unrelieved by the usual conservative and [13]physiotherapy measures, injection therapy consistingof a mixture of local steroids(Depomedorol, Kenacort, etc.) and xylocaine gives excellent [14]relief of pain.

4. Surgical Excision of the Coccyx

In extreme situations if all the above measures fail then [15]surgical removal of the coccyx may be con-sidered.







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1.7 October

Rickets (Deficiency of Vitamin D, Calcium and Phosphate) (2012-10-09 07:24)

Symptoms, Types and Treatment of Rickets Disease:

[1]Rickets is a metabolic disorder of childhood where the osteoid formation in the [2]bones is normal but itsmineralization is defective. This results in softening of bones and deformities.

Nutritional Rickets:

[3]Nutritional rickets is the most common type of rickets seen in the developing countries. It is causedby deficiency of vitamin D in the diet and by inadequate exposure of the body to sunlight. Sunlight promotesthe synthesis of vitamin D in the body. Nutritional rickets occur in children below 4 years of age.

Path Physiology:

The absorption of [4]calcium and phosphate from the intestine is reduced due to the deficiency of vita-min D. The subsequent fall in the serum calcium level stimulates hyper secretion of [5]parathyroid hormone.this, in turn, mobilizes calcium from the bone, making then soft and easily malleable to the pressure ofweight bearing and other stresses. It also results in the formation of uncalcified bone matrix. The disorderlyproliferation of the cartilage cells in the zone of proliferation, in the region of [6]metaphysis, results in”cupping” of the metaphysis and widening of the epiphyseal plates.

Signs and Symptoms:

In the florid stage, the general health is affected; the child is irritable and stunted in growth. The fol-lowing features may be seen:

1. Skull

• Craniotabes: The [7]fontanelle remains open even after 2 years of age.

• Frontal bossing: bossing (prominence) of the frontal and parietal bones.

1. Chest

• Pigeon Chest: The [8]sternum is prominent and thrusted forwards.

• Rickery Rosary: Prominence (beading) at the junction of [9]ribs with cartilages anteriorly gives anappearance of a “rosary.”

• Harrison’s Sulcus: It is a transverse groove in the anterior part of the lower chest; due to the [10]muscularpull of the diaphragm.

1. Abdomen: The abdomen is protuberant and gives a ”pot-belly” appearance. This is largely due tomuscular hypotonia.

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2. Extremities: There is widening at the epiphyseal regions of the [11]wrist, knee and [12]ankle. Deformitieslike coxa vara, genu valgum or varum, deformity of the [13]tibia due to compressive forces of the bodyweight on the soft decalcified bones. Occasionally a peculiar deformity called wind- swept deformitymay be seen.

Types of Rickets:

• Vitamin D -Resistant Rickets (familial hypophasphataemia): There is inability of the renal tubules toreabsorb phosphate from the glomerular filtrate, leading to hypophasphataemia.

• Fanconi Syndrome: This is due to the inability of the proximal tubules to reabsorb phosphates, glucoseand amino acids.

• Renal Rickets (renal osteodystrophy): The skeletal changes are associated with [14]chronic impairmentand manifest between 5 and 10 years of age.

• Coeliac Rickets: Diminished absorption of calcium from the intestines in steatorrhoea, sprue and[15]coeliac disease results in skeletal changes like those of nutritional rickets

Investigations:

[16]Serum calcium level may be normal or low but the serum phosphate is low. Serum alkaline phos-phatase is markedly raised during the active stage of the [17]disease.

Radiographs:

In a suspected case of nutritional rickets, radiographs of both wrists and both [18]knees (AP view only)should be done. The width of the [19]epiphyseal plate is increased markedly with fluffy and irregular edges.There is ”cupping” of the metaphysis. There may be bending of the long bones. The bones show generalizedrarefaction with thinning of the cortices.

Treatment:

1. Drug Treatment: Administration of high doses of vitamin D with calcium supplements is the mainstayof the [20]treatment. Six lac units of vitamin D is given as a single dose initially; which may be repeatedweekly for 3 weeks. After a favorable response, a maintenance dose of 400 units of vitamin D withcalcium is given.

2. Orthopaedic Treatment: Mild deformities of the [21]limbs should be treated by the use of splints(mermaid Splint). Weight bearing should be avoided till there is evidence of calcification in the bonesfollowing vitamin D and calcium [22]therapy. Marked deformities need [23]surgical correction bycorrective osteotomy.







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1.8 November

Meniscal (Cartilage) Tear (2012-11-03 12:07)

Symptoms and Treatment of Meniscal Tear:

What is a Meniscal (cartilage) Tear?

The [1]meniscus is a piece of cartilage in the middle of your [2]knee. [3]Cartilage is tough, smooth,rubbery tissue that lines and cushion the surface of the joints. There is a meniscus on the inner side of yourknee (the medial meniscus) and a meniscus on the outer side (the lateral meniscus). They attach to the topof the [4]shin bone ([5]tibia), make contact with the thigh bone (femur), and act as shock absorbers duringweight-bearing activities.

How does it occur?

A meniscal tear can occur when the knee is forcefully twisted or occasionally with minimal or no[6]trauma, such as when you are squatting.

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What are the symptoms?

You may have [7]pain in your knee joint. You may have immediate swelling with fluid in the joint,called an effusion. You may be unable to fully bend or straighten your [8]leg. Your knee may lock or getstuck in one place. You may hear a snap or pop at the time of the [9]injury. A chronic (old) meniscal tearmay give you pain on and off during activities, with or without swelling. Your knee may occasionally lockand you may have [10]stiffness in the knee.

How is it diagnosed?

Your [11]doctor will examine your knee and find that you have [12]tenderness along the joint line.Your doctor will move your knee in several ways that may cause pain along the injured meniscal surface.Your doctor may order X-rays to see if there are injuries to the bones in your knee but [13]meniscal tear willnot show up on a x-ray. An MRI (magnetic resonance imaging) is sometimes useful in diagnosing a meniscaltear.

How is it treated?

Treatment may include:

• Applying ice to your knee for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days or until the pain and[14]swelling are gone.

• Elevating your knee by placing a pillow underneath your leg.

• Wrapping an elastic bandage around your knee to keep the swelling from getting worse.

• Wearing a [15]knee immobilizer or other brace to prevent further injury.

• Using crutches

• Taking anti-inflammatory or [16]pain medication prescribed by your doctor.

[17]Surgery is needed to repair or remove large torn pieces of cartilage.While you are recovering from your[18]injury, you will need to change your sport or activity to one that does not make your condition worse.For example, you may need to swim instead of run.

When can I return to my sport or activity?

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you returntoo soon you may worsen your injury, which could lead to permanent [19]damage. Everyone recovers frominjury at a different rate. Return to your sport or activity will be determined by how soon your knee recovers,not by how many days or weeks it has been since your injury occured. In general, the longer you have[20]symptoms before you start [21]treatment, the longer it will take to get better. You may safely return toyour sport or activity when, starting from the top of the list and progressing to the end, each of the followingis true:

• Your injured knee can be fully straightened and bent without pain.

• Your knee and leg have regained normal strength compared to the uninjured [22]knee and leg.

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• Your knee is not swollen.

• You are able to jog straight ahead without [23]limping.

• You are able to sprint straight ahead without limping.

• You are able to do 45-degree cuts.

• You are able to do 90-degree cuts.

• You are able to do 20-yard figure-of-eight runs.

• You are able to do 10-yard figure-of-eight runs.

• You are able to jump on both legs without pain and jump on the injured leg without pain.

If you feel that your knee is giving way or if you develop pain or have swelling in your knee, you should seeyour [24]doctor.

How can a Meniscal Tear be prevented?

Unfortunately, most injuries to knee [25]cartilage occur during accidents that are not preventable. However,you may be able to avoid these injuries by having strong thigh and hamstring [26]muscles, as well as bymaintaining a good leg- stretching routine. When skiing, be sure that your ski bindings are set correctly by atrained professional so that your skin will release when you fall.







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How to get relief from Pelvic Pain Injuries? (2012-11-20 12:14)

Classification, Symptoms and Treatment of Pelvic Fracture:

[1] Stability of the Pelvis

Stability of the pelvis depends on both [2]bony and ligamentous structures. Anterior portion of the[3]pelvic ring neither participates in normal weight bearing nor is it essential for maintenance of pelvicstability. The posterior arch is formed by the sacrum, SI joints and ilia and is the weight-bearing portion ofthe pelvis. The posterosuperior SI ligaments provide most of the ligamentous stability of the SI [4]joints.

Stable Pelvic Fracture

These [5]fractures do not involve the pelvic ring and they are minimally displaced.

Unstable Pelvic Fracture

They involve the [6]pelvic ring and are widely displaced. Pelvic fractures pose a problem differentfrom others. Here the emphasis is on recognition of potential complications associated with these fractures,the notable ones being [7]injuries to the major vessels and nerves of the pelvis and major viscera likeintestines, bladder and the [8]urethra, severe intrapelvic hemorrhage from fracture of pelvic ring.

Mortality from pelvic fracture varies from 10-50 percent. Proper fracture [9]management decreasesthe blood loss and controls the hemorrhage. A to F management as proposed by Mac Murthy in multiple

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[10]trauma patients is important in management of the pelvic fractures.

History

Pelvic fractures usually occur due to high-velocity trauma following a road traffic accident (RTA)or due to fall from a height.

The relative incidences are as follows;

• RTA-80.7 percent.

• Fall-16.1 percent.

• [11]Compression fracture-rest.

Mechanism of injury

There are four mechanisms by which pelvic ring fractures are produced:

• Lateral compression.

• Anteroposterior compression.

• Vertical shears forces.

• Inferior forces (e.g. fall on [12]buttocks).

The first two mechanisms are common in RTA and may cause stable or unstable fractures. Vertical shearforces are due to fall from a height and will cause grossly unstable fractures. Fortunately, most pelvic fracturesare stable and respond to non operative [13]treatment. Unstable [14]fractures need manipulative reductionand stabilization by external fixators and sometimes by internal fixation. A proper evaluation of the fractureby radio-graph and CT scan helps to determine the best course of management.

Classification

Broadly speaking, the pelvic fractures can be placed under two categories.

Fractures not Affecting the Integrity of the Pelvic Ring

Direct blow fractures, which are commonly seen in iliac bone and avulsion fractures frequently encoun-tered in the young, come under this group. Avulsion fractures are commonly seen in antero-superior andinferior iliac [15]spines and ischial tuberosity .

Fractures Affecting the Integrity of the Pelvic Ring

These are single or double break fractures in the pelvic ring and could be stable or unstable. A stablefracture is one, which resists displacing forces. Obviously, fractures, which cannot resist usual forces, arecalled unstable fractures and these pose a major [16]therapeutic challenge.

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Many classifications have been proposed for pelvic fractures. Key and Conwell’s classification is by farthe simplest and commonly used classification. It has prognostic importance too.

Key and Conwell Classification

Fracture of Individual Bones without a Break in the Pelvic Ring.

• Avulsion fracture of the: Anterosuperior iliac spine, Antero inferior iliac spine, Ischial tuberosity.

• [17]Fracture of pubis or ischium.

• Fracture wing of ilium (Duverney).

• Fracture sacrum.

• Fracture or dislocation of [18]coccyx.

Single Break in the Pelvic Ring

• Fracture of both ipsilateral rami.

• Fracture near or subluxation of symphysis pubis.

• Fracture near or subluxation of [19]sacroiliac joints.

Double Breaks in the Pelvic Ring

• Double vertical fracture or dislocation of pubis (Straddle fracture).

• Double vertical fracture or dislocation of pelvis (Malgaigne’s fracture).

Acetabuium Fractures

• Undisplaced.

• Displaced.

Tile’s Classification

This is a mechanical classification based on the injury forces.

1. Type A Stable.

2. Type A1 Fracture Pelvis not involving ring.

3. Type A2 Stable, but minimally displaced.

4. Type B Rotationally unstable but vertically stable.

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5. TypeB1 Open book [20]injury.

6. Type B2 Lateral compression Ipsilateral.

7. Type B3 Lateral compression-Contralateral.(Bucket handle).

8. Type C Rotationally and vertically unstable.

9. Type C1 Rotationally and vertically unstable.

10. Type C2 Bilateral.

11. Type C3 Associated with [21]ace tabular fractures.

Clinical Features

Symptoms

The patient most often gives a history of high-velocity trauma and usually presents in a state of hypo-volaemic shock. Features of intra-abdominal [22]injuries and genitourinary injuries are frequently present.

Clinical Signs

The patient may present with all signs of shock. Tenderness over the fracture site and one has to lookfor three important signs described by Milch.

Quick facts

Look for the signs of shock in pelvic fracture

• Pale look

• Cold nose

• Sweating

• Tachycardia

• Hypotension

• Cold and clammy skin

• [23]Unconsciousness.

Clinical Tests

• Compression test: When a compressive force is applied through the two iliac bones, the patientcomplains of [24]pain in pelvic fracture.

• Distraction test: When distraction force is applied to the two iliac bones at the anterosuperior iliacspine, the patient complains of pain.

• Direct pressure test: Direct pressure over the [25]symphysis pubis elicits pain.

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Following this, an examination for abdomen and [26]pelvis injuries is carried out and next urethral catheteri-zation or urethrogram is done.

Investigations

Radiography

Different radiographic views are recommended to study the fracture configuration, displacements, etc. inpelvic fractures:

• Plain AP view.

• Oblique view-45 degree oblique projections.

• Internal and external rotation view.

• Inlet view- 40 degree caudad views.

• Outlet view-40 degree cephalad view.

CT scan

Further radiographic studies include CT scans and 3-dimensional imaging. This is the gold standardin the evaluation of pelvic fractures.

Management

One should remember that pelvic fractures are usually due to high-velocity trauma and is associated withmultiple fractures and multiple system injuries. Resuscitation and correction of [27]hypovolemic shock takesprecedence over the management of fracture per se. nevertheless, once the general condition is stabilizedattention should be given to treat the fracture, which will prevent further blood loss and damage to visceralorgans.

Different types of pelvic fractures, their clinical features and [28]treatment are listed.

Treatment points

Three main pitfalls in the treatment of pelvic fracture

• Treating only fracture overlooking visceral injuries.

• Over treating a stable fracture.

• Treating an unstable fracture.

Treatment Methods

Initial [29]treatment is carried out as follows:

Resuscitation and other general measures, to improve the general condition of the patient.

39

Blood transfusion and other medical and [30]surgical emergency measures are carried out.

Avulsion fractures: Conservative treatment like bed rest, traction, [31]physiotherapy, etc. gives goodresults. They rarely need surgery.

Undisplaced fractures: Respond to bed rest, traction, pelvic slings, non steroidal anti-inflammatorydrugs (NSAIDs), etc.

Displaced fractures: Reduction by [32]lateral compression methods as described by Watson Jones isvery helpful. Retention is by Spica cast, canvas sling or external fixators.

Role of external and internal fixators: The above methods usually suffice, but the fractures asso-ciated with multiple system injuries need to be stabilized either by external fixators or by open reductionand internal fixation (ORIF). These two methods have the following advantages:

• Gives firm stability.

• Helps [33]early mobilization.

• Reduces period of bed rest.

• Helps early control of osseous bleeding.

Complications

Pelvic fracture is a dreaded injury as it is associated with a [34]plethora of complications. The follow-ing are some of them.

The [35]Center for Advanced Orthopedics represents two board certified orthopedic surgeons with com-bined experience in bone & joint problems of over 45 years.Our Services include are Total Joint ReplacementSurgery – Hip and Knee,Hip Resurfacing & Partial Knee Resurfacing, Arthroscopic Surgery – Shoulders,Knees and Ankles, Sports Medicine, Musculoskeletal Conditions, Arthritis of the Hip, Knee and Shoulder,Osteoarthritis, Computer Assisted Surgery, Fracture Management, Sports Medicine. We severe two locations.For More Information Call Now at : [36](301) 645-5410

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1.9 December

How to treat Arthritis Disease? (2012-12-18 06:01)

Clinical Features And Treatment of Rheumatoid Arthritis:[1]

[2]Rheumatoid arthritis is the most common inflammatory disease of the [3]joints. It is a systemic [4]diseaseof young and middle-aged adults characterized by proliferative and destructive changes in synovial membrane,periarticular structures, [5]skeletal muscles and perineural sheaths. Eventually, joints are destroyed, fibrosedor ankylosed. It is a widespread vasculitis of the small arterioles.

Clinical Features in Rheumatoid Arthritis

[6]Rheumatoid arthritis usually presents in three forms:

1. Classical Presentation

In this group, the patient is usually a woman in her mid 30s, [7]Pain, swelling, stiffness of the smalljoints of[8] hands and feet are the common presenting complaints. The patient also gives history of weight loss,lethargy and depression. [9]Joint swelling could be symmetrical and the patient presents with deformities of[10]bones and joints in the late stages. The patient gives history of remissions and exacerbation of symptomswith seasonal variations. This is a very classical complaint in the absence of which diagnosis of [11]rheumatoidarthritis should be carefully made. Symptoms fluctuate from day-to-day.

2. Other Presentations

This consists of palindromic presentation involving one or two [12]joints, systemic presentation-usuallyseen in middle-aged men presenting with pleurisy, pericarditis, etc. It mimics malignancy. It may present aspolymyalgia particularly in elderly patients. It may present as [13]monoarthritic swelling,

Sometimes the presentation may be very explosive unlike the usual [14]chronic presentation.

3. Extra-articular Features

• Two or more features are present in 75 percent of the cases, [15]Rheumatoid factor is invariably presentand indicates a bad prognosis.

• Subcutaneous nodules are present in 25 percent of the cases. It is seen over the [16]elbow, sacrum andocciput. Nodules may also be present in lungs, eye, hearts, etc. When present over [17]flexor tendon, itmay cause trigger finger.

42

• Widespread vasculitis.

• Blood abnormalities commonly encountered in [18]rheumatoid arthritis are chronic anemia, iron defi-ciency anemia, vitamin B12 and folate deficiency, leukocytopenia, thrombocytosis and marrow hypopla-sia.

• [19]Osteoporosis could be generalized or localized in [20]bones around the joints.

• Eye changes seen in rheumatoid arthritis are keratoconjunctivitis sicca or Sjogren’s syndrome, episcleritis(common), scleritis (serious problem), secondary glaucoma and scleromalacia perforans.

• Lung affections in rheuma told [21]arthritis are pleurisy, pleural effusion, Kaplan’s syndrome (RA +pneumoconiosis involving the upper lobes) and fibrosing alveolitis in 2 percent.

• Heart affections in rheumatoid arthritis are pericardial friction (10 %), pericardia } effusion (30 %),arrhythmias and heart block.

• Neuromuscular system involvement includes [22]carpal tunnel syndrome, mononeuritis multiplex, musclewasting, subluxation of CI and C2, etc.

• Reticuloendothelial system affections include splenomegaly (5 %), Felty’s syndrome in 1 % (RA+splenomegaly + Neutropenia), generalized lymphadenopathy and painless pitting edema of the [23]feetand ankles.

ORTHOPEDIC DEFORMITIES IN RHEUMATOID ARTHRITIS

Rheumatoid arthritis can affect any joint in the body. It involves the [24]peripheral joints more oftenand very rarely affects the larger joints. Of particular importance are the affection of the temporomandibularjoint and [25]atlantoaxial joint, which can prove lethal due to the [26]cord compression. It has involvement ofvarious joints in rheumatoid arthritis.

Investigations

Hb percentage is low and shows normochromic, [27]hypo chromic anemia. WBCs are decreased or nor-mal, there are increased lymphocytes and the ESR is raised.

1. Serological Tests: Basis [28]Rheumatoid patient’s serum contains RA factor, which in the pres-ence of g-globulin agglutinates certain strains of streptococci sensitized by sheep cells and latex particles.

2. Latex Fixation Test: Unknown serum + 7-globulin latex suspension

3. Inhibition Test: This test uses the characteristics of euglobulin from unknown serum; Euglobulinfrom normal serum neutralizes the rheumatoid factor thereby inhibiting agglutination. Euglobulin from[29]rheumatoid serum has no effect on the rheumatoid factor and agglutination occurs. This is the mostsensitive test. Positive even when rheumatoid arthritis factor is present in minute amounts.

Radiological Features of Rheumatoid Arthritis

• Soft tissue swelling.

• Juxta-articular osteoporosis.

43

• Erosion of joint margins.

• Joint spaces are decreased.

• Deformities.

• Atlantoaxial subluxation.

• Subchondral erosions and cyst formation.

• Fibrous and bony ankylosis develops in the stages.

Other Common Abnormalities

These include increased C-reactive protein (CRP), increased alkaline phosphatase, increased platelets, anddecreased serum albumin. Citrulline antibody is present in most cases of early[30] rheumatoid arthritis.Antinuclear antibody (ANA) is also frequently raised in patients with rheumatoid arthritis.

Synovial Fluid Analysis

This is not performed routinely for diagnostic purposes but performed to exclude other causes ofinflammation such as [31]infection. Synovial fluid in RA is typically yellow, watery and turbid due to highWBC and has low sugar content.

MRI

This gives valuable information about the various [32]soft tissue damages in rheumatoid with farmore greater accuracy.

Differential Diagnosis

Differential diagnosis of rheumatoid arthritis with various other conditions. However, for the differ-ential diagnosis of rheumatoid arthritis with the all-important [33]osteoarthritis.

Management

Aims of Treatment

To keep inflammatory process at a minimum, thereby, preserving joint motion, maintaining healthymuscles and preventing secondary [34]joint stiffness and deformity. To keep constitutional symptoms ata minimum. The possible deformities are anticipated and prevented by appropriate splinting. Finally,[35]surgical measures to correct the deformities, eliminate pain and provide stability are undertaken.

General Measures

It aims at improving the general condition of the patient and to keep the [36]joints properly splinted infunctional position to guard against the ensuing [37]ankylosis.

• Rest in bed.

• Good diet, rich in proteins and minerals.

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• Transfusion and hematinics to correct the anemia.

• Hormones combination of estrogen and androgen to improve the [38]bone stock.

• Removal of infective foci.

• Splinting in the functional position helps in the event that ankylosis ensues. The splint is removed daily.Hot packs are given or the patient is placed.

• Hubbard tank at (92.6-102degree F) and the joints are put into full range of motion. While the [39]jointsare immobilized, muscle-setting exercises are advocated. After removal of the splints, resistance exercisesare begun.

Splints

• These are known to serve three main functions:

• Rest and [40]relief of pain (rest splints).

• Prevention and correction of deformity (corrective splints).

• Fixation of damaged joint in a good functional position (fixation splints).

Surgical Procedures in Rheumatology

Aim of [41]surgery in rheumatoid arthritis is to:

• Relieve pain.

• Correct the deformity of the joints.

• Reduce joint instability.

• Improve the range of movements of the joints.

• [42]Surgical advice should be sought only when the disease is clearly progressive and conservativemeasures are failing, but before the patient starts to lose a significant amount of bone stock. If surgeryis delayed, more bone is lost, the [43]soft tissue deteriorates and the deformity increases.

Preoperative Considerations

Before surgery for rheumatoid disease, a number of specific points should be checked. Related condi-tions such as diabetes, [44]hypertension and anemia should be adequately treated and:

• Steroid dosage should be reduced.

• There should be no active infection.

• A radiograph of the [45]cervical spine should be obtained to exclude instability.

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Self-Management Techniques for Rheumatoid and Other Forms of Arthritis

Self-management is the most important aspect of the [46]treatment of rheumatoid and other forms ofarthritis. People practicing self-management techniques tend to experience less pain and are more activethan those who do not practice self-management. In this management, the patient is made aware of the[47]disease and the rationale behind the treatment. They are made to realize that the success of the treatment istheir ultimate responsibility.

Ten Self-Help Techniques

1. Positive Mental Attitude: The patient is told to focus on things other than [48]pain and their ownbody. They are encouraged to think positively.

2. Regular Medications: The patient is told the value of regular and correct medication.

3. Regular Exercises: The patient should follow a regular and appropriate exercise program, mostsuited for them.

4. Use of Joints: The patient is told the value of correct posture and the methods of using the jointswisely to reduce stress on the [49]painful joints.

5. Energy Conservation: Patients are instructed to listen to the body’s ”inner signals” for rest. Slowingdown and avoiding too many activities reduces the stress on the joints.

6. Assistive Devices: Devices linked splints, braces and walking sticks can help stabilize the joints,provide strength and [50]reduce pain and inflammation.

7. Adequate Sleep: A good adequate sleep provides rest to the ailing joints and reduces the pain andswelling.

8. Massage: A good moderate [51]massage brings warmth and relieves pain due to arthritis.

9. Relaxation Techniques: Relaxation techniques like yoga, medication, etc. help to relax the muscles,mind and controls respiration, heart rate, blood pressure. This helps in the [52]control of pain.

Modification in the Daily Activities:

• Using Western toilets.

• Bath aids and railings.

• Long handle broomstick and mop to clean the floors.

• Use of walking sticks while walking, climbing, etc.

• High chairs.

• Avoid squatting on the ground for food, etc. Use of dining table and chairs are recommended.

• To avoid squeezing clothes after washing and just rinse they dry.

• To avoid walking on hard and uneven and rough surfaces.

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• To sleep on a hard surface.

You are being affected by this illness then Our Center for Advanced Orthopedic Clinic is always beneficialfor you. Come Instantly and Call Now at: [53](301)373-4303. For more detailed information – includingdetailed surgery information – the following websites might be useful: [54]http://www.centerforadvancedorth-opedics.com/

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What will causes of Ankle Pain Injury? (2012-12-28 07:34)

Symptoms, Classification And Treatment of Ankle Pain Injuries:[1]

Definition of Ankles Injury:

A complex [2]joint made up of distal ends of [3]tibia, fibula and the talus. The [4]tibiofibular joint functionsas a uni planar hinge joint and in which about 25 degree of dorsiflexion and 35 degree of [5]plantar flexiontakes place. The stability is provided by the configuration of the [6]ankle mortise and the ligaments, whichare arranged in the following groups:

• Medial Collateral Ligament

• Anterior and Posterior Talofibular Ligaments

• Anterior Tibiofibular Ligament

Signs of Ankles Injury:

Post described [7]ankle injuries for the first time in 1768

• Interesting ’Incidence Facts’ about [8]ankle fractures

• More commonly in Elderly Women.

• About 2/3 are isolated Malleolar fracture.

• About 1/4 are Bimalleolar fracture.

• Trimalleolar fracture seen only in 7 percent.

• Open fracture 2 percent.

Mechanism of Ankles Injury:

Ankles are usually injured due to low [9]injury rotational forces due to:

• Twisting injury while walking, running, sports, athletes, etc. are the most common mode of [10]ankleinjuries.

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• Fall from a height: Ankle injuries are indirect injuries here brought about by the displacing [11]talus.

Classification of Ankles Injury:

[12]Ankle injuries are classified after the mechanism causing them. Hence, it is of paramount importance tounderstand the movement of the [13]ankle to comprehend the classification. What complicates the issue isthe practice of using more than one term to describe the same motion.

There are six movements of the ankle and the hind foot.

• Plantar flexion and dorsiflexion are the up and down movements of the [14]foot.

• Movement causing the[15] toes to point inwards is called internal rotation and movement causing thetoes to point outwards is called external rotation.

• Supination is the movement, which raises the medial aspect of the foot and the [16]heel off the ground.In pronation, the motion is to bring the lateral aspect of the foot and the heel from the ground.

• In adduction, the hind [17]foot is moved towards the mid line and in abduction is moved laterally.

• Pure vertical loading position as in landing, jumping, falling, etc. will cause Pylon [18]fracture by thedriving of the talus into the tibia.

1. Lauge Hansen’s Classification

Four major types are described. The [19]mechanism of injury could be adduction force, abduction force orexternal rotation force. The foot could be in supination or pronation. The first word refers to the position ofthe [20]foot at the time of injury and the second to the direction of injuring force.

2. Denis Weber Classification

This is the other classification proposed for ankle injuries and it is based on the level of the [21]fibularfracture, while the Lange Hansen’s system is based on experimentally verified [22]injury mechanism likeadduction, abduction, etc.

AO Classification of Malleolar Fractures:

• Type A: Infrasyndesmotic ([23]Fracture of fibula below the syndesmosis)

• Type A1: Isolated

• Type A2: With medial malleolus fracture

• Type A3: With posteromedial fracture.

• Type B: Transsyndesmotic (Fracture of fibula at syndesmosis level).

• Type B1: Isolated.

• Type B2: With medial lesion (Mallelor or ligament injury).

• Type B3: With medial lesion and posterolateral tibial fracture.

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• Type C: Suprasyndesmotic (fracture of fibula above the sydesmosis).

• Type CI: Simple diaphyseal fracture of fibula.

• Type C2: Complex diaphyseal fracture of fibula.

• Type C3: [24]Proximal fracture of fibula.

Clinical Features:

The patient usually gives history of inversion injury, following which there is[25] pain, swelling, defor-mity of the ankle. Movements are decreased, Drawer’s test, inversion and eversion [26]stress tests may bepositive. Note the color and condition of the skin. Examine the entire [27]leg.

Investigations:

Anteroposterior, lateral and mortise non-weight bearing views of the ankle are recommended in the ra-diographs. CT scan, MRI and [28]arthroscopy evaluation is extremely helpful.

Radiographic Parameters of the Normal Ankle:

• Talocrural angle-83 degree and 4 degree.

• Medial clear space 4 mm.

• Tibiofibular clear space < 6 mm.

• Subchondral bone line between the distal tibia and medial surface of lateral malleolus should becontinuous.

Treatment of Ankles Injury:

Goals

• Anatomical positioning of the talus beneath the tibia.

• To obtain a [29]joint line that is parallel to the ground.

• Smooth articular surface.

If these three things are not achieved, post-traumatic [30]osteoarthritis results.

• Stable Injuries: No reduction is required, immobilization with only plaster splints till the swellingdecreases and then a below [31]knee plaster cast is applied with foot in neutral position.

• Unstable Injuries: Require reduction and [32]immobilization in plaster casts . The commonlyencountered unstable injuries are:

• Fracture Due to External Rotation: This is more common and can be managed both by conservativeand operative methods.

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• Conservative Method: This consists of reversal of the [33]injuring forces by closed reduction and abelow knee plaster cast application.

• A walking cast is applied after a period of one month.

• Surgical Method: In this, the malleoli are fixed, first the lateral malleolus is fixed with pin or screwsand later the medial [34]Malleolar fracture is fixed with a single screw perpendicular to the [35]fractureline. Below knee splint is given initially and later a cast is applied. Fracture primarily due to

• Abduction: These are less common than the fractures due to external rotation. Nevertheless, theprinciples of the [36]treatment remain the same. Adduction force is required to bring about reductionand if closed reduction fails, open reduction is preferred. During the open reduction, both the malleoliare fixed.

• Fracture Primarily Due to Adduction: Unlike external rotation and abduction, adduction violenceis more frequently an isolated event. Wedging of small-comminuted fragments into the fracture lineoften prevents closed reduction, so that open reduction and internal fixation (ORIF) is required morefrequently. Medial malleolus is approached first, since it is more unstable, and the fracture is fixed withtwo screws, one at right angle to the[37] tibial cortex and another at right angle to the fracture line.Lateral fibular is stabilized with plate and screws.

• Fracture Resulting From Primary Vertical Compression: This may be isolated or associatedwith other forces described above. The [38]anterior and posterior tibial plafond margins are fractured.Two types are described:

1. Posterior Marginal Fracture for Undisplaced Fracture: Below [39]knee cast is sufficient. Formore than 25 percent of articular surface involvement. ORIF with two screws is preferred.

2. Anterior Marginal Fracture (Tibial Plafond Injury): It may include a crush of the anteriorlip or it may include a major fragment. If crushed, calcaneal traction is given and if there is a large[40]fragment, ORIF is required.

Complications of Ankle Fracture:

Complications of ankle fractures include post-traumatic [41]arthritis, reflex sympathetic dystrophy, [42]neu-rovascular injury (injury to posterior tibial vessels and nerve), nonunion (due to soft tissue interposition),Malunion, etc.

The foot and ankle are two of the most versatile and complex areas of your body. If you are being af-fected of Ankle Pain Injury .Our Center for Advanced Orthopedic Clinic is always beneficial for you. ComeInstantly and Call Now at: [43](301) 645-5410. For more detailed information – including detailed surgeryinformation — the following websites might be useful: [44]http://www.centerforadvancedorthopedics.com/

1. http://centerforadvancedorthopedics.wordpress.com/2012/12/28/what-will-causes-of-ankle-pain-injury/

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ipad covers (2013-04-25 15:50:15)Way cool! Some very valid points! I appreciate you penning this write-up and the rest of the site is also really good.

Center For Advanced Orthopedics (2013-06-24 04:54:40)Thanks.

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Chapter 2

2013

2.1 January

To Know About Genu Valgum (Knock Knees) (2013-01-02 11:40)

Treatment For Knock Knees:

Definition

It is an outward deviation of the longitudinal axes of both [1]tibia and femur. Apex of the curve orangulations of the [2]knee are medial.

Incidence[3]

Seventy-five percent children have [4]genu valgum upto 4 years of age. This is called physiological genuvalgum, which usually disappears by 7 years.

Types

It is broadly classified into [5]physiological and pathological; the latter could be unilateral or bilateral.

Clinical Features

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Genu Valgum Complex: The primary deformity in a Genu Valgum is a medial angulation of the knee.In response to this, secondary deformities develop in the [6]femur, tibia and [7]foot. Primary and secondarydeformities together form the Genu Valgum complex.

Clinical Assessment

• Intermalleolar Gap: The severity of the deformity is measured by noting the [8]intermalleolardistance.

• Method: In the spine position, the patella is brought to [9]vertical by rotating both the legs and madeto touch lightly at the knee. Then holding both the [10]knees in position, the distance between the twomalleoli is measured. The acceptable normal limit is 8-10 cm. In genu valgum deformity, it will bemore than 10 cm.

• Plumb Line Test: Normally, a line drawn from anterosuperior iliac [11]spine (ASIS) to middle of the[12]patella, if extended down strikes the [13]medial malleolus. In Genu valgum, the medial malleoluswill be outside this line.

• Knee Flexion Test: This is to detect the cause of Genu Valgum whether it lies in the femur or tibia.If the deformity disappears with [14]flexion of the knee, the cause lies in the lower end of femur and ifit persists on flexion, the cause lies in the upper end of the tibia.

Radiographs

Clinical assessment of Genu Valgum is less accurate in adults and an assessment by radiology is preferred.X-ray of the entire [15]lower limb is taken with the patient weight bearing. The angle formed between the[16]femoral and tibial shafts is measured on the radiographs and allowing for a normal angle of 60, GenuValgum is calculated.

Treatment of Genu Valgum

Mild Cases: Child is seen at intervals of 3 months and the progress is recorded. These cases usuallyrequire no [17]treatment, and raising the inner side of the heels by 4-5 mm may possibly relieve [18]strainon ankles. The knock-knee braces may be useful. If by the age of 4 years, intermalleolar distance is 10 cmor more, operation may become necessary and unless deformity is increasing rapidly, [19]operation is bestpostponed until the child is 10 years old.

Severe Cases

If lateral portion of [20]epiphyseal plate is intact as seen in the radiographs, it contributes to the longi-tudinal growth at a reduced rate. This situation is suitable for stapling of the medial epiphysis, whicharrests the growth on the [21]medial side, allows the growth on the lateral side, and thus helps to correct thedeformity.

After skeletal maturity, an [22]osteotomy must be performed at the site of maximum deformity of tibiaor femur. If limb is long, medial close wedge osteotomy is done. If limb is short, lateral open wedge osteotomyis done. [23]Knock-knee deformity more than 10 cm at the age of 10 years is an indication for [24]surgery.

Our Center For Advanced Orthopedic is one of the best comprehensive orthopedic programs. Talk with a

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physician about the Best Orthopedic Treatment for you. The Center for Advanced Orthopedics representstwo board certified orthopedic surgeons with combined experience in bone & joint problems of over 45 years.This compassion and competence in problems related to arthritis, joint replacements, and sports relatedinjuries is second to none in this field. For More Detailed Information Call Now at: [25](301)373-4303





3. http://centerforadvancedorthopedics.wordpress.com/2013/01/02/to-know-about-genu-valgum-knock-knees/

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How can we prevent Medial Meniscus Injury? (2013-01-15 05:27)

Clinical Features, Investigations And Treatment of Knee Pain:[1]

[2]Medial meniscus is more commonly injured than the lateral and is usually associated with other lig-ament injuries of the [3]knee.

Smillie’s Classification

Medial meniscus injury is seen in over 71 percent of the cases. In 5 percent of cases, [4]injury of me-dial meniscus is bilateral. Lateral meniscus is less commonly injured than the medial meniscus because itis smaller in diameter, thicker in periphery, wide, more mobile, attached to both [5]cruciate ligaments andstabilized posteriorly to the [6]femoral condyle by popliteus.

• Longitudinal tears (35 %)-in these [7]peripheral attachments tear 10 percent, complete tear 23 percent(bucket handle tear), and segmental tear 2 percent (ant/post).

• Horizontal tears (48 %)-could be posterior, middle, or anterior.

• Cystic degeneration (12 %).

• Congenital abnormalities 5 percent.

• Regenerative lesions.

Mechanism of injury

Mechanism of injury is a rotational force when a flexed [8]knee extends.

• In young, it can occur only when weight is being taken, knee is flexed and there is a twisting [9]strain.Young active athletes are more prone.

• In middle life, fibrosis has decreased the mobility of meniscus and hence tear occurs with less force.

• Predisposing Factors: These could be abnormal menisci shape, abnormal stress due to [10]chronicligament laxity, etc.

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Clinical Features

The patient with medial meniscus injury presents with [11]pain on the inner aspect of the knee. His-tory of locking is seen in 40 percent of the cases and [12]swelling if present is minimal. There is remarkablerecovery after the initial acute attack and there could be periodic complaints pertaining to the knee. One ormore clinical signs mentioned in the box can be elicited with careful examination of the knee.

Investigations

Radiograph is usually normal. The views recommended are anteroposterior, lateral, [13]Intercondylarnotch and sunrise views of the patella.

• Arthroscopy helps to identify the torn [14]meniscus.

• Arthrography may reveal the tear. Double contrast arthrography is 95 percent accurate.

• MRI is expensive but useful.

Differential Diagnosis

Fracture of [15]tibial spine if present may give clue to the possible ACL tear. It also helps to exclude[16]osteochondritis dissecans, osteocartilaginous loose bodies, etc.

Treatment

Conservative: This is indicated in patients soon after [17]injury with no locking and with infrequentattacks of pain and in tears less than 10 mm, partial thickness tears.

Measures

• Abstinence from weight bearing.

• Rest, ice packs, compressive bandage.

• Buck’s skin traction.

• [18]Joint aspiration.

• [19]Quadriceps exercises.

• If symptom persists, a cylindrical cast may be considered.

Manipulation under Anesthesia: If joint is locked due to the torn menisci, manipulation under [20]anes-thesia is recommended.

Surgery

Indications: Surgery is indicated, if joint cannot be unlocked and if [21]symptoms are recurrent.

Methods

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• Arthroscopic Menisci Repair: This is the [22]treatment of choice of late. Repair is indicated if thetear is > 10 mm or is unstable on probing. Repair is successful in the outer third (red-red zone) edgeof the [23]vascular rim (red-white zone) and even in a few vascular zones (white-white zone).

• Closed Partial Meniscectomy Via: An arthroscopy is better than total removal of the menisci byopen [24]surgery.

• Meniscal Transplant: In cases with total menisectomies, cadaver menisci transplant may be consid-ered. However, this is still in the evolving stage.

Complete removal of the menisci incapacitates the [25]knee hence; the emphasis is on conservative surgerythan the radical removal.

Our Center For Advanced Orthopedic is one of the best comprehensive orthopedic programs. Talk with aphysician about the Best Orthopedic Treatment for you. The Center for Advanced Orthopedics representstwo board certified orthopedic surgeons with combined experience in bone & joint problems of over 45 years.This compassion and competence in problems related to arthritis, joint replacements, and sports relatedinjuries is second to none in this field. For More Detailed Information Call Now at: [26](301) 645-5410


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2.2 February

How to treat Hip Dislocation? (2013-02-05 10:26)

Types and Treatment of Hip Dislocation: [1]

[2]Dislocations of hip are grievous [3]injuries. Head of [4]femur slips out through the weak inferior as-pect of capsule and displaces according to direction of the force. It is commonly seen in high-energy injuriesamong young adults. 50 % of cases are associated with [5]fracture of acetabular lip, which may preventreduction. They are easily missed when associated with fracture shaft of femur. Dislocations of hip are ofthree types:

• [6]Posterior Dislocation (commonest)

• Anterior Dislocation

• Central Fracture Dislocation

POSTERIOR DISLOCATION OF HIP JOINT

Posterior dislocation of [7]hip joint is the most common dislocation of hip. This is also known as [8]DashboardInjury.

Clinical Features

Usually the young adult is involved in a road traffic accident (RTA). Characteristically the limb is in

61












[9]flexion, adduction and internal rotation with appreciable shortening and painful restriction of movements.Head of [10]femur may be palpable in the gluteal region.

Investigations

Anteroposterior view of [11]pelvis shows the head lying outside the acetabulum. Shenton’s line showsa break in continuity. Occasionally the dislocation may be associated with [12]fracture of the posterior lip ofacetabulum.

Treatment

Reduction of the hip dislocation is an [13]orthopaedic emergency. Dislocation is reduced by manipula-tion under general anaesthesia (GA). Reduction can be done by Following methods:

• Bigelow’s method

• Stimson ’ s method

• Classical Watson-Jones method

After-treatment: The [14]limb is immobilized in a Thomas splint for 3 weeks in the position of abduction.Open reduction may be contemplated in cases of:

• Irreducible reductions

• Cases with fracture of the acetabular lip

• Instability/redislocation of [15]hip.

ANTERIOR DISLOCATION

[16]Anterior Dislocation is less common type of hip dislocation. It is seen in collision accidents whenthe motorist is hit on the medial aspect of the [17]thigh with the thigh in [18]flexion and abduction. Head offemur dislocates and may lie on the:

• Obturator foramen

• Symphysis pubis

Clinical Features

The limb is in external rotation and extension with apparent lengthening. Radiologically the femoralhead may be present below the [19]acetabulum.

Treatment

Reduction is achieved by manipulation under GA. Open reduction is attempted if closed manipulationfails.

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Complications

Complications are injury to the femoral [20]neurovascular bundle.

CENTRAL FRACTURE DISLOCATION

Central [21]fracture dislocation is a rare type. It is caused by a violent [22]injury on greater trochanter.Head of the femur is driven through the acetabulum. Depending upon the comminution and displacement offracture fragments, Judet classified this as:

• Undisplaced fracture acetabulurn.

• Fracture acetabulum with intact weight bearing part

• Superior [23]rim fracture

• Comminuted displaced fracture (bag of bones)

Clinical Features

Clinically the patient presents with severe [24]pain in the hip with restriction of [25]abduction and ro-tations. Per rectal examination is diagnostic with a bony mass palpable laterally.

Treatment

The aim of [26]treatment is attaining congruous [27]bone surface. This can be achieved by:

• Continuous skeletal traction to the [28]leg with additional trochanteric pin traction with the thigh in30 degree abduction for 8-12 weeks.

• Open reduction and internal fixation with reconstruction plates.

Complications

• Thrombophlebitis of iliac and femoral veins.

• Secondary [29]osteoarthritis.

• Myositis ossificans

• [30]Infection

Hip Dislocation is caused by violence directed in the line of shaft of femur with the hip flexed and adducted.This dislocation commonly occurs in automobile accidents with the occupants thrown forward and kneestriking the dashboard. Call today for best Orthopedics Surgeons: [31](301) 645-5410

[32]http://www.centerforadvancedorthopedics.com

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How to diagnose Knee Joint Injury? (2013-02-21 09:48)

Information about Knee Joint Disease:

[1] [2]Knee joint is one of the most common [3]joints affected by degenera-tive joint disease, tuberculosis, [4]pyogenic infection etc. The common complaints are:

• Pain: It may be present on walking squatting making the person unable to rise from sitting position. Itis usually dull [5]aching and at times it may radiate down the leg.

• Swelling: [6]Knee effusion is one of the common complaints which may present as [7]swelling of the knee.Other swellings seen around the knee are cysts from the [8]menisci and [9]bursitis from various bursae.

• Stiffness: It is one of the aftermath of prolonged immobilization either due to disease or [10]treatmentgiven.

• Deformity: In [11]arthritis of the knee joint, the knee joint goes in for flexion deformity which maymake the patient unable to do his daily activities. History of giving way or locking episodes must beasked for to rule out internal derangement of the knee. In [12]Intra-articular loose bodies, there may beepisodes of locking. History of bleeding diatheses should be asked to rule out haemophilic arthritis dueto repeated bleeding episodes.

Examination

• Examination of the [13]knee joint includes examination of the entire lower limb from sacroiliac joint tothe [14]foot because any disorder in the [15]limb can have an adverse effect on the knee which may bethe presenting symptom.

• The knee joint should be examined in various positions such as standing, sitting, squatting, supine andwalking positions.

Palpation

The [16]knee should be palpated in anterior aspect, sides and in the popliteal fossa for any abnormali-ties.

• Superficial Palpation: The knee should palpate for increased warmth, [17]tenderness a crepitus. Tender-ness should be elicited gently find whether it is due to [18]soft tissue inflammation or bony tenderness.

65

• Soft Tissues: The knee joint should be palpated for [19]synovial thickening and bursal enlargements inand around it. Synovial thickening is felt like feeling a bag of earthworms, especially over medial femoralcondyle. The medial femoral condyle is covered by vastus medialis [20]muscle which gets atrophiedearner than other muscles in knee joint disorders. This makes synovial thickening to be felt easier overthe medial femoral condyle.

• Bony Palpation: The bony structures are medial and lateral femoral and [21]tibial condyles, patellaand head of fibula. These landmarks are palpated for their shape, smoothness, tenderness, irregularityand thickening. Joint line is palpated for any irregularity, tenderness and [22]osteophytes. Joint lineis palpated by running the thumb over the medial surface of the tibial condyle upwards until a dip isfelt which is the joint line. Lateral joint line is palpated similarly. Articular surface of [23]patella ispalpated by sliding the patella laterally or medially and the undersurface of the patella is palpatedfor tenderness, irregularity and osteophytes. Presence of loose bodies can be felt easily on alternate[24]flexion and extension of knee.

• Joint Effusion: Minimal effusion of the knee joint manifests as fullness of infrapatellar fossae. If thefluid is more, suprapatellar fossa bulges out. Presence of fluid is ascertained by demonstrating thepresence [25]patellar tap.

• Crepitus: Fine crepitus in a young person suggests [26]chondromalacia. Chondromalacia is a conditionin which softening of patella occurs due degenerative changes. Coarse crepitations in elderly personsare seen in degenerative arthrosis and neuropathic joint.

Movements

A normal knee can be flexed until the back of leg touches the back of [27]thigh. If the [28]knee can-not be extended completely, both actively and passively, then the knee is said to be in fixed flexion deformity.If active extension of the knee is not possible, but passive extension is possible, then it is called extensorlag. This represents the weakness of [29]quadriceps mechanism. Extensor lag is measured by the degree ofmovement left behind to complete extension.

Neurovascular examination

• Lateral popliteal [30]nerve is located behind the head of [31]fibula and it is rolled against it for anytenderness or thickening.

• [32]Popliteal artery aneurysms are felt in the posterior aspect of the knee joint. Normally the poplitealartery pulsations are not easily felt or seen.

• If it is easily seen or felt, a popliteal aneurysm should be ruled out.

• Lymphatic system: The nodes to be examined are vertical group of inguinal lymph nodes and poplitealgroup of [33]lymph nodes.

The [34]Center for Advanced Orthopedics represents two board certified orthopedic [35]surgeons with com-bined experience in bone & joint problems of over 45 years. Call now at: [36](301) 645-5410

[37]http://www.centerforadvancedorthopedics.com

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5. http://www.centerforadvancedorthopedics.com/Total-partial-knee-replacement-surgery.aspx


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7. http://www.centerforadvancedorthopedics.com/Pain-and-swelling-in-foot-and-ankle.aspx

8. http://www.centerforadvancedorthopedics.com/Joint-pain-disorders-causes-and-orthopedic-treatment.aspx

9. http://www.centerforadvancedorthopedics.com/Shoulder-pain-orthopedic-treatment-in-md.aspx


11. http://www.centerforadvancedorthopedics.com/Rheumatoid-osteoarthritis-joints-diseases-treatment.aspx

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22. http://www.centerforadvancedorthopedics.com/Patient-Survey-Form-Center-For-advanced-orthopedics.aspx



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http://www.centerforadvancedorthopedics.com/Pain-and-swelling-in-foot-and-ankle.aspx

http://www.centerforadvancedorthopedics.com/Joint-pain-disorders-causes-and-orthopedic-treatment.aspx

http://www.centerforadvancedorthopedics.com/Shoulder-pain-orthopedic-treatment-in-md.aspx


http://www.centerforadvancedorthopedics.com/Rheumatoid-osteoarthritis-joints-diseases-treatment.aspx

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Center For Advanced Orthopedics (2013-07-29 03:12:47)Thanks for the appreciation.

Center For Advanced Orthopedics (2013-07-29 03:12:59)Thanks.

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2.3 March

Obesity is emerging as a serious health threat among children (2013-03-06 07:05)

Definition and Prevention of Obesity:

[1] [2]Obesity has emerged as a major health threat in the United States. Thechallenge is now affecting our children who are following the path of the adults. Obesity is a direct precursoror contributor to several serious [3]ailments, such as [4]diabetes, hypertension, heart disease, stroke, cancer,degenerative [5]joint disease, [6]chronic back pain, higher risk of [7]injuries and a plethora of ailments.

In the United States, obesity contributes to more than 360,000 deaths every year and is a major fac-tor in escalating health care costs.

• Obesity limits mobility, reduces motivation, impacts self-image, promotes depression and other healthrelated behavior [8]disorders. These conditions set in a negative vicious cycle that further perpetuatesthe obesity problem.

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• Obese children run a higher risk of getting bullied than slimmer children. Weight status is a documentedpredictor for bullying that is independent of child’s intelligence, gender, social skills and academic oreconomical status. The risk peaks between the ages of 6 and 9.

• [9]Obesity does not result from just overeating. Types of foods that we consume also impact our weight.Soda, liquor, fructose-laden fruit juices, fruit drinks, fast and fried foods, refined flour, pork and redmeat are some of the common culprits. Plastics and growth [10]hormones in commercial foods havealso been implicated in its causation.

Passive entertainment such as television, excessive Internet usage, movies, video games and hours of fictionreading all contribute to the disorder.

Prevention of Obesity:

The very first step toward prevention is awareness of the problem and a diligent watch of the belt size.Waistline across the [11]umbilicus should measure 50 percent or less than the body height. Standardweight/height charts and BMI measurement methods are widely available and provide reliable measures tomonitor progress.

Lifestyle assessment and gradual [12]dietary and activity adjustments provide consistent and enduringresults when compared to crash diets or other extreme programs. Cutting down 100 calories per day andburning an additional 100 calories per day can result in two pounds lost per month. Relapses are far lesscommon in lifestyle adjustment methods. Home meals are far superior to restaurant meals.

Normalizing weight ends up normalizing several other aspects of life with demonstrable enhancement of life,its quality, [13]health, energy, self-image, relations, productivity and overall improved sense of self.

Visit our Website: [14]http://www.centerforadvancedorthopedics.com

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2.4 April

Carpal Tunnel Syndrome (2013-04-10 05:52)

Symptoms and Treatment of Carpal Tunnel Syndrome:

[1] For vast majority, [2]Carpal Tunnel Syndrome has no known cause.This condition presents in all age groups and children are no exception. Most common age group involvesmiddle aged women of 50-55 yrs.

Conditions such as diabetes, [3]thyroid dysfunction, vitamin D deficiency, [4]rheumatoid arthritis alsoinfluence the development of Carpal Tunnel Syndrome and [5]treatment of primary condition can alleviate orresolve [6]symptoms of CTS.

20-25 % of pregnant women develop symptoms of CTS during the last trimester and symptoms usually resolveafter childbirth.

Use of pneumatic tools and work in very cold environments may be associated with relatively higherfrequency of CTS. Key board operations or other [7]repetitive motions of the upper extremities have noproven association with CTS

Younger people with recent onset respond to conservative treatment such as night [8]splinting or corti-costeroid injection into the [9]carpal tunnel. Pregnant patients also respond well to splining.

Older patients who have chronic symptoms for more than 12 months may present with numbness, weaknessand [10]muscle wasting. This population may temporarily respond to splinting or injections and do betterwith surgical release. Patients with concomitant conditions, such as; diabetes also respond well to surgicalrelease.

Surgery can be performed trough standard open method, mini-incision method or through endoscope. Local,regional or general [11]anesthesia may be used based upon patient’s preference. 85-88 percent patients reportexcellent results after surgery with complete resolution of [12]symptoms. Recurrence rate is about 1.8-3 %.

Visit here for more Information: [13]http://www.centerforadvancedorthopedics.com

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skythia (2013-08-08 16:00:48)Carpal tunnel syndrome is a compression on the the median nerve due to prolong typing, computer gaming and writing.You can check more information on this site and read more articles on our experts advice. http://carpaltunnelhq.com

2.5 June

How to Recover from Rheumatoid Arthritis? (2013-06-24 11:16)

Investigations and Treatment of Rheumatoid Arthritis:

[1] [2]Rheumatoid arthritis is a systemic [3]disease. It involvessystems/organs other than the [4]joints. However, only the [5]orthopaedic aspects of this disease will bediscussed here.

Seropositive Rheumatoid Arthritis

Seropositive rheumatoid arthritis is a systemic inflammatory disease. It is an autoimmune disease mainlyaffecting the connective tissue. Hence the greatest effect is seen in the parts with more of connective intersti-tium.

Clinical Features

• The onset of the disease is insidious and is common between the age group of 20 and 40 years.

• Women are affected more than men in the ratio of 3:1.

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• The initial symptoms are [6]pain, [7]swellings and morning stiffness of small joints of the hands and[8]feet.

• Involvement of the synovial lining of tendon sheaths, bursae and ligaments gives rise to pain, swelling,increased warmth and [9]stiffness.

• The disease usually involves metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints ofthe hand.

It can also involve the wrist and [10]elbow joints. These joints are swollen and tender. Involvement ofhand manifests as ulnar drift, boutonniere (buttonhole) deformity and swan neck deformity. Involvementof foot is seen as hallux valgus, hammer-toe, claw toe or callosities. Rarely this disease may present as amonoarticular lesion affecting the larger joints of lower limb. The joint is swollen and painful on movements.With progressive destruction of the articular cartilage the joints go in for fixed deformities.

Investigations

• Laboratory findings: Haematological investigation may show anaemia and an elevated ESR. TheC-reactive protein is also raised and the rheumatoid factor (Rh factor), i.e. immunoglobulin M (IgM)is positive in about 80 % of the patients. About 20-30 % of patients may have clinical features ofrheumatoid arthritis but negative serological tests; called seronegative [11]rheumatoid arthritis.

• Radiological features: Radiographs show juxta-articular [12]osteoporosis with joint space narrowingand subchondral cysts. There is erosion of the articular margins. In later stages, there is generalisedosteoporosis with deformity of the hand and feet.

• Synovial biopsy can be obtained by open or arthroscopic methods.

Treatment

Rheumatoid arthritis is one of the most common chronic ailments in the world. It causes the greatestdisability among young adults affecting their commercial capability. Its treatment therefore needs interdisci-plinary approach involving a rheumatologist, [13]orthopaedician, physiatrist, psychologist and occupationaltherapist. The goal of [14]treatment in rheumatoid arthritis is:

• Control of synovitis and pain

• Maintaining joint function

• Prevention of deformity

The ideal regime should be: physical rest and drug therapy in the acute phase and physical therapy andmaintenance drug therapy during the remission stage.

[15]The Center for Advanced Orthopedics represents two board [16]certified orthopedic surgeons with com-bined experience in bone & joint problems of over 45 years. This compassion and competence in problemsrelated to arthritis, [17]joint replacements, and [18]sports related injuries is second to none in this field.


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2.6 July

Diving and Swimming Tips (2013-07-29 03:35)

Expert advice from your Orthopedist:

[1]Swimming is one of the top summer activities. Swimming provides both relaxation and exercise. Withoutsafety cautions swimming can be hazardous. Children 17 and younger are more susceptible to [2]injuriesif they fail to exercise caution. U.S Consumer Product Safety Commission reported more than 237,500swimming and 25,522 diving injuries in 2012. Most of these [3]back and [4]neck injuries are preventableby adherence to safety tips. American Academy of [5]Orthopedic Surgeons and American Spinal InjuryAssociation provide the following safety tips for swimmers:

Diving Tips:

• Don’t ever dive into shallow water. Before diving, inspect the depth of the water to make sure it isdeep enough for diving. If diving from a high point, make sure the bottom of the [6]body of water is

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double the distance from which you’re diving. For example, if you plan to dive from eight feet abovethe water, make sure the bottom of the body of water, or any rocks, boulders or other impediments areat least 16 feet under water.

• Never dive into above-ground pools

• Never dive into water that is not clear, such as a lake or ocean, where sand bars or objects below thesurface may not be seen.

• Only one person at a time should stand on a diving board. Dive only off the end of the board and donot run on the board. Do not try to dive far out or bounce more than once. Swim away from the boardimmediately afterward to make room for the next diver.

• Refrain from body surfing near the shore since this activity can result in [7]cervical spine injuries, somewith quadriplegia, as well as [8]shoulder dislocations and [9]shoulder fractures.

Swimming Tips:

• Do not [10]swim alone or allow others to swim alone.

• Make sure children are supervised at all times. Back yard pools should have a 5-foot minimum highfence that completely surrounds it.










8. http://www.centerforadvancedorthopedics.com/Orthopedic-center-for-shoulder-joint-replacement.aspx

9. http://www.centerforadvancedorthopedics.com/Shoulder-structure-function-pain-orthopedic-treatment.aspx


2.7 August

Safety Tips for Young Drivers (2013-08-21 06:39)

Expert advice from your Orthopedic Surgeon:

• [1] Summer months brings more time for fun and activities for the young people. Theactivities include travelling and driving. While driving is fun, distracted driving can result in tragiccrashes, serious [2]injuries and fatalities. Fortunately these tragic events are [3]preventable.

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• According to The National Highway Traffic Safety Administration (NHTSA), approximately 387,000Americans were injured in distracted driving-related crashes in 2011, and there were an estimated 3,331fatalities.

• Ten percent of [4]injury crashes in 2011 were reported as “distraction-affected,” and 11 percent of alldrivers under the age of 20 involved in a fatal crash were reportedly distracted at the time of the crash.

• According to AAA, summer is the most dangerous time of year for teen drivers with seven of the top10 deadliest days occurring between Memorial Day and Labor Day holidays.

• [5]Young drivers should keep their hands on the steering wheel and eyes on the road to ensure thatthey, their friends, family and fellow travelers, stay safe.

• Sending or receiving a text takes a driver’s eyes off the road for an average of 4.6 seconds, according tothe U.S. Department of Transportation. At 44 mph, that’s like driving the entire length of a footballfield, blind. New NHTSA research found that drivers are more than three times more likely to get in acar crash while reaching for an object in the car; 23 times more likely while texting.

• A CDC study showed that 45 % of driving teens admitted to texting while driving and 25 % of thesepracticed that as a regular habit.

• These teens also are more prone to other risky behaviors, such as; drinking alcohol. Students whotexted while driving were also more likely to be irregular seat belt wearers and to ride in a car with adriver who had been drinking alcohol.

• The first priority for all drivers is the safe operation of their car or truck which means keeping eyes onthe road and [6]hands on the wheel.

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2.8 October

Experts’ Advice to Avoid Medical Errors (2013-10-22 08:22)

Expert advice from your [1]orthopedic surgeon:In 1999, the Institute of Medicine (IOM) issued a report. According to this report, 44,000 to 98,000 peopledie in hospitals each year as the result of medical errors that could be prevented. These figures would makemedical errors the eighth leading cause of death in the U.S., ahead of deaths from motor vehicle accidents,breast cancer or AIDS. Medication errors alone may be responsible for about 7,000 deaths per year.

What is Patient Safety?

The [2]patient safety is defined as freedom from accidental injury and medical error. Medical error is

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”the failure to complete a planned action as intended or the use of a wrong plan to achieve an aim.

[3] EXPERT ADVICE FROM YOUR ORTHOPEDICSURGEON

Where Errors Occur?

Errors occur in [4]hospitals as well as in other health care settings, such as physicians’offices, nursinghomes, pharmacies, urgent care centers, and homes. Unfortunately, very little data exist on the extent of theproblem outside of hospitals. Many errors probably occur outside the hospital.

The Costs of Errors

Medical errors are costly. The IOM report estimates that medical errors cost the nation about $37.6billion each year. About $17 billion of those costs are associated with preventable errors. About half of theexpenditures for preventable medical errors are for direct [5]health care cost.

Public Fears

Awareness of the problems of medical errors and [6]patient safety has been growing. Americans have avery real fear of medical errors. According to a national poll conducted by the National Patient SafetyFoundation:

1. Four out of 10 people who responded (42 percent) had been affected by a medical error, either personallyor through a friend or relative.

2. Nearly one third of people who responded (32 percent) indicated that the error had a permanentnegative effect on the patient’s health.

Overall, the people who responded thought the [7]health care system was ”moderately safe.” But anothersurvey, conducted by the American Society of Health-System Pharmacists, found that Americans are ”veryconcerned” about:

1. Being given the wrong medicine (61 percent).

2. Being given two or more medicines that interact in a negative way (58 percent).

3. Complications from a[8] medical procedure (56 percent).

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Where’s the problem? Most people believe that medical errors are the fault of a healthcare provider. Whenasked about possible solutions to medical errors:

1. Three out of four people who responded thought it would be most effective to ”keep health professionalswith bad track records from providing care.”

2. Nearly 70 percent thought the problem could be solved through ”better training of health professionals.”

But the IOM report said that most medical errors are not due to a person. Instead, they are related to theway things happen. The key to reducing medical errors is to improve the way care is delivered and not toblame a person.

[9]Health care professionals are human. Like everyone else, they make mistakes. Improving the systemcan reduce error rates and improve the [10]quality of health care:

1. A 1999 study showed that if a pharmacist went along with [11]doctors on medical rounds, errors relatedto medication ordering could drop by as much as 66 percent.

2. Using standard guidelines, establishing protocols, and standardizing equipment has reduced errorsrelated to anesthesia by nearly seven fold.

3. One veteran’s hospital uses hand-held computers and bar codes for ordering medicines. The hospital’smedication error rate dropped by 70 percent. Soon, all VA hospitals will use this system.

Types of Errors:

Most people believe that medical errors usually involve drugs or surgeries where something goes wrong.A patient may get the wrong prescription or dosage, or a sponge used to soak up blood during a surgery maybe left in the patient.

However, there are many other types of medical errors, including:

Diagnostic errors. The wrong diagnosis may mean that the[12] patient doesn’t get the right kind oftherapy or treatment. Test results could be misinterpreted. The patient may fail to receive an indicateddiagnostic test.

1. Equipment failure. Perhaps a battery is dead, or a valve pump doesn’t work properly.

2. Infections. The patient may get an infection unrelated to the illness while in the hospital, or a surgicalsite may become infected.

3. Blood transfusion-related injuries. A patient may receive blood that doesn’t match his or her ownblood type.

4. Misinterpreted medical orders. A [13]doctor prescribes a ”no salt” diet, but the hospitalized patientgets a meal seasoned with salt.

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Preventing Errors:

Research indicates that more than half, and maybe as many as 75 percent, of medical errors can be prevented.For example:

1. Using computers to order medications and treatments could eliminate problems with not understandinga doctor’s handwriting.

2. Medicine packages and names should look and sound different to prevent mix-ups and confusion.

3. Standard treatment policies and protocols help avoid confusion about what to do and what works bestin most cases.

The American Academy of [14]Orthopedic Surgeons (AAOS) believes that patient safety is a major concern. Itis working to reduce medical errors through its Patient Safety Committee. The AAOS and other organizationsof [15]healthcare professionals, hospitals and consumers are developing a national plan to measure healthcarequality and ensure accurate reporting of errors. It also has a public education campaign called ”Take Care:Patient Safety Is No Accident.” Talk to your [16]orthopedic surgeon about preventing medical errors.

[17]Shaheer Yousaf MD

[18]Center For Advanced Orthopedics




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Steroid Injection Therapy May Increase Risk of Spinal Fracture (2013-10-29 07:33)

[1] Steroid Injection Therapy May Increase Risk of SpinalFracture

Most aging adults will experience [2]back pain or a spinal disorder at some time in their life. In fact,about 25.8 million visits were made to physicians’ offices due to primary back problems.[3]Treatment focuseson pain relief and is available in both non-surgical (medication or physical therapy) and [4]surgical forms.

A retrospective study in the June 5th issue of the Journal of [5]Bone and Joint Surgery (JBJS)lookedat one type of back treatment– a lumbar epidural steroid injection (LESI) – and whether or not that treat-ment had an impact on bone fragility and vertebral fractures (spinal fractures). A higher number of injectionswas associated with increased risk. Authors concluded that LESIs may lead to increased bone fragility overtime, and while injection therapy is useful in some cases, it should be approached cautiously for patients atrisk for fractures associated with [6]osteoporosis.

[7]Patients at a high risk for vertebral fractures after an epidural injection include older women, thosewho have had an earlier fracture, those who smoke and those who are underweight. Young and active malepatients have a lower risk of vertebral fracture.

“In the appropriate setting, and for the right patient, LESI provides effective symptomatic relief and improvedlevel of function, said Shlomo Mandel, MD, MPH, lead author of the JBJS study and orthopedic surgeon atHenry Ford Health System. “Through careful screening and monitoring steroid exposure, the risk of a fracturecan be minimized. As [8]orthopedic surgeonswho specialize in spine, we know there is a role for injectiontherapy, but the challenge is to make sure it is administered safely and still provide long-term benefits.”

“It’s important to remember that when contemplating an epidural steroid injection a [9]physician should havea symptomatic history, physical findings and corresponding imaging of direct pressure on a single nerve, ”added Dr. Mandel. “Together with our patient, we review the benefits and risks of alternative treatmentsbefore selecting an epidural steroid injection.”

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2.9 November

Advantages of Computer Assisted Surgery (2013-11-20 10:14)

CAS([1]Computer Assisted Surgery) is a contemporary technology employed by[2] orthopedic surgeons forthe progressive verification of the [3]surgical procedure and accurate alignment and positioning of [4]jointimplant. This is a perfect option for the patients who can not afford repeated surgical procedures due totheir age and medical deterioration. Furthermore, the joint geometry of each and every individual is specificand different as well and this technique forwards a patient specific and computer guided accuracy to surgicalprocedure accordingly.

CAS forwards following unprecedented advantages when used for [5]surgical procedures :

• Eliminates trauma to underlying muscles and soft tissues as a small incision is made during the sur-gical procedure.• Lessens pain, speeds up recovery and furthermore results in better range of motion.• Facilitates preoperative planning and assessment of surgical difficulties, which further helps the [6]surgeonsto optimize their surgical approach and to obtain better and accurate results as far as possible.• Heightens the life span and strength of [7]joint implant.• Minimizes the risk of [8]dislocation and repeated surgery as it provides the [9]surgeons with comprehensivedata about a patient’s anatomy. Hence resulting in proper and precise placement of[10] joint implant.• Improves overall functioning of [11]replaced joint.• Needs less hospitalization and shortens post-operative rehabilitation.• Provides surgeons with feedback information during the surgical procedure thus enabling them to operateas planned.• Enhances the balancing of soft tissues.[12]joint implant • Very beneficial in the case of over weighted patients, in whom even the slightest of themisalignment can shorten the life span of .• Minimizes the errors in the positioning component and limb alignment, that normally occurs duringconventional[13] joint surgery.• Less scaring leads to reduced blood loss which further lessens the need of blood transfusion.• By replacing conventional instrumentation, eliminates the risk of getting fat particles into your bloodstream which can cause pulmonary and cognitive complications.

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• Provides additional control to restore operated leg to appropriate length, which is crucial after [14]total hipreplacement.

[15]Contact Center For Advanced Orthopedics for Computer Assisted Surgery and various other contemporarytechniques prevalent in medicine today. It is our top most priority to present our patients with utmost careand treatment as per their specific needs and requirements.















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aspx

2.10 December

Treatment for Achilles Tendon Injuries (2013-12-19 09:36)

What do you mean by Achilles Tendon Injury?

[1]Achilles tendon is a longer tendon which stretches from your heel to your calf muscles and more over, it isone of the most commonly injured tendons of your body. This injury occurs, when the [2]Achilles tendonruptures or tears away due to over-stretching. This type of rupture can be complete or partial as well. Itusually affects your walking ability.

Achilles tendon is responsible for the every movement made by your [3]feet i.e. it enables your [4]footto point downwards, rise on your toes and push off your foot as well.

What causes injury to Achilles Tendon?

Regular stress to [5]Achilles tendon from the various causes is responsible for its rupture or tear. This

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stress may occur due to:

• Over exertion

• Quickly raising the intensity or level of exercises.

• Flat feet

• Poorly fitted foot wears

• Insufficient warm up before exercises

• Wearing high heels

• Over tight leg or [6]tendon muscles

• Running or jogging on hard surfaces

• Oft repeated steroid injections

• Damage or trauma to ankles

• Weak and tensed calf muscles

Apart from these, people participating in the following sports’ activities are more vulnerableto this injury:

• Gymnastics

• Dance

• Foot ball and Basket ball

• Base ball and Volley ball

• Tennis

What are signs and symbols of[7] Achilles Tendon Injury?

Pain in Achilles tendon injury is often intense and patients complain of sudden snap at the back of the leg.Following facts can be enlisted as the potential symptoms of Achilles tendon injury:

• Throbbing pain above your heels, especially while stretching or standing on your toes.

• Tenderness and Stiffness of muscles

• Swelling around the calf muscles or near your heel

• Inability to stand, run, climbing stairs, bending your foot downwards or pointing your toes,

• Snapping or popping noise during the injury.

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What are the treatments available to cure Achilles Tendon Injury?

The[8] treatment for Achilles Tendon Injury depends upon your age, level of activity and above all theseverity of injury. In most of the cases, surgery is advised to treat completely ruptured tendon. Studies haveshown that both surgical and non surgical treatments are equally affective to treat[9] Achilles Tendon Injury.

But the sports persons’ especially those participating in recreational sports or the people of younger age,opt for surgery as their treatment option. [10]Surgical treatment eliminates the chances of recurrence. Bothopen and closed surgical techniques are opted to repair tear off tendon. Majority of the people under going[11]surgical treatment , within a short time period return to their routine activities and as well regain theirstrength and endurance.

[12] Contact Center for Advanced Orthopedics and Sports Medicine

[13]Contact us at Center of Advanced Orthopedics and Sports Medicine for the compassionateand competent treatment of any of your musculoskeletal problems or injuries. Our [14]twoboard certified orthopedic surgeons with over 45 years of combined experience in bone andjoint problems use the most advanced and least invasive surgical technologies to provide qualitycare and treatment to their patients.





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Chapter 3

2014

3.1 January

Post Knee Rehabilitation: Do’s and Don’ts (2014-01-15 12:14)

Knee Replacements

[1] Post Knee Rehabilitation

[2]Knee Replacements normally help to relieve pain, improve knee functions and overall quality of lifeof an individual who is otherwise leading the life of a dependent. But the [3]recovery of the patients after[4]knee replacement largely depends upon the activities that he adopts. In other words, we can say that postreplacement phase and your involvement in this [5]recovery phase is crucially important for you to resumeyour previous routine and to once again become able to perform your daily activities hassle free.

There are certain do’s and don’ts that you should observe for your speedy and overall re-covery after your [6]replacement surgery:

• Try to follow a scheduled regime i.e. practice all the exercises prescribed by your physical therapistsand as well attend your[7] physical therapy sessions regularly.

• Take your prescribed pain relieving and other medications regularly and do not discontinue their usewithout checking with your [8]doctor.

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• Rest your [9]operated knee sufficiently.

• Take a short walk regularly for several times a day. Staying on your walking regime can speed up yourrecovery.

• Apply hot and cold packs accordingly, in order to reduce soreness, stiffness and to relax muscles as well.

• While lying down, elevate your knee above your heart level. You can do it with help of pillows.

• Practice activities like; turning, twisting, bending, kneeling and sitting initially with your physicaltherapists as you can learn to perform them safely and efficiently.

• Straighten and bend your legs as much as possible. To enhance extension, lie down with a rolled towelunder your [10]knees.

• To improve flexion, practice bending your knee back while sitting on a chair. It is advisable to practicethis posture under the observation of your [11]physical therapist.

• Take your vitamins and supplements regularly. Vitamin D and Iron helps to recover speedily and aswell to restore blood count after surgery.

• To minimize the risk of blood clotting, put on compression stockings; if recommended and advised byyour doctor.

• Observe a strict exercising regime, as regular exercising will build up your strength and endurance.

• Engage yourself in low-impact or low-stress activities viz. hiking, golfing, walking, stationerybiking or biking on leveled surfaces, stationery skiing, swimming and yoga.

• Avoid or minimize the use of alcohol, if you are on a blood thinning medication.

• Avoid smoking, as it may constrict your blood vessels thus leading to slow healing.

• Don’t get obese, as over weight can put unnecessary stress on your operated knee thus slowing downyour healing process.

• Keep away from high-impact activities like; high impact aerobics, jogging or running, down-ward skiing, rope jumping etc.

• Do not twist or kneel down on your operated knee.

• Do not cross your legs, knees or ankles.

• Avoid heavy lifting as it can put unnecessary pressure on your operated knee or can possibly damage it.

[12]Contact Center for Advanced Orthopedics and Sports Medicine

[13]Contact Center for Advanced Orthopedics and Sports Medicine for any of your arthri-tis and joint related problems. Our experienced and [14]board certified surgeons go over anextra mile to provide you with quality care by making use of state of the art techniques andtechnologies.

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7. http://www.centerforadvancedorthopedics.com/Home-Exercise-for-knee-pain-treatment.aspx




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3.2 February

Morton’s Neuroma (2014-02-14 05:38)

Morton’s Neuroma: Causes, Symptoms and Treatment

If at times, you feel as if you are walking on a marble or pebble or you feel continuous pain in the ball of[1]foot, you may have [2]Morton’s Neuroma. It is a condition affecting on e of the nerves between the toes.This condition is more common among women than men as they tend to wear uncomfortable footwear likehigh-heeled or narrow shoes.

What do we mean by Morton’s Neuroma?

[3]Morton’s Neuroma also referred to as Morton’s Metatarsalgia or Interdigital Neuroma, is a non-cancerousgrowth of nerve tissue that commonly develops at the ball of foot between the third and fourth toe. In otherwords, [4]Morton’s Neuroma is a pinched or inflamed nerve between the bones at the ball of foot.

What are the factors leading to Morton’s Neuroma?

The exact [5]cause of Morton’s Neuroma is not known. Various factors including the following are con-sidered as the major reasons to develop this painful condition:

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[6] Morton’s neuroma - Treatment

• Regular or chronic stress and irritation of [7]plantar digital nerve

• Narrower space between the long bones (metatarsals) of the foot

• Wearing narrow or high heeled shoes

• Growth of a fatty lump (lipoma) around the joint

• Formation of fluid filled sac around the joint

• Wearing constrictive (tight) foot wear

• Inflammation in the joints

• [8]Foot problems including; flat feet, high foot arches, bunions and hammer toes

• Abnormally positioned toes

• Sports including running and jumping

What are the signs and symptoms of Morton’s Neuroma?

The signs and symptoms of [9]Morton’s Neuroma usually occur unexpectedly and more likely to worsen overtime. Its symptoms mainly include:

• Pain starts from the ball of the foot and extends up to the affected toes

• Burning or sharp pain while walking, performing weight bearing activities, when the ball of the foot issqueezed or foot itself is pressurized

• Numbness at the bottom of the foot

• Parasthesia or pins-and-needles feeling

• Toe-pain

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• Affected toes may spread apart which doctors refer to as ‘V’ sign

• Swelling between the toes

• Feeling as if there’s something in the shoe or a sock has bunched up

What are the [10]treatment options available to relieve the condition?

The [11]orthopedic surgeons will develop a treatment plan evaluating the stage and severity of your conditionor problem. Following non-invasive treatment techniques are adopted to [12]treat Morton’s Neuroma:

• Padding options are recommended to lessen the pressure on nerve and to decrease the compression aswell

• Placing the ice-pack on the affected area may be suggested to reduce swelling

• [13]Surgeons may also provide custom [14]orthotic devices to support your metatarsal arch

• Activities placing pressure on the nerves are suggested to avoid till the condition improvises

• Shoe-modifications are advised i.e. wear shoes with wide toe-box and avoid narrow-toed or high-heeledshoes

• Calf-stretching exercises may be advised to lessen the pressure on your foot

• Injection therapy may be employed including; cortisone and local anaesthetics

If non-surgical treatment options do not improve your condition then your [15]orthopedicsurgeon may discuss surgical options with you, where either a small portion of the nerve isresected or tissues around the nerve is released.

[16]Contact Center for Advanced Orthopedics and Sports Medicine

Contact[17] Center of Advanced Orthopedics and Sports Medicine for the state-of-art treatment of anyof your musculoskeletal problems and injuries. Our [18]board certified and experienced surgeons make useof latest techniques and technologies to provide you quality care and to make you as staunch and sturdy asbefore.







6. http://centerforadvancedorthopedics.files.wordpress.com/2014/02/mortons-neuroma-treatment.jpg



9. http://www.centerforadvancedorthopedics.com/Foot-and-ankle-pain-orthopedic-treatment.aspx




12. http:

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3.3 March

BONE & JOINT (2014-03-14 07:13)

Smoking Impact on Spine, Discs and Bones

[1] Impact of Smoking on the Bones

In the United States [2]smoking claims more than 440,000 lives each year. In general, it reduces lifeexpectancy by 7-10 years. Besides heart and lungs diseases,[3] smoking seriously affects spine, discs, bonesand joints Every tissue in the human body is affected by smoking, but several effects are reversible. Byavoiding or quitting smoking, you can reduce your risk for incurring many conditions. Quitting [4]smokingcan also help your body regain some of its normal healthy functioning. Following are the scientific findingsabout that explain relationship between smoking and [5]musculoskeletal health.

• [6]Smoking increases your risk of developing [7]osteoporosis a weakness of bone that causes fractures.Elderly smokers are 30 % to 40 % more likely to break their hips than their non-smoking counterparts.Smoking weakens [8]bones in several ways, including:

• [9]Studies have shown that smoking reduces the blood supply to bones, just as it does to many otherbody tissues.

• The nicotine in cigarettes slows the production of bone-forming cells (osteoblasts) so that they makeless [10]bone.

• Smoking decreases the absorption of calcium from the diet. Calcium is necessary for bone mineralization,and with less bone mineral, smokers [11]develop fragile bones (osteoporosis).

• [12]Smoking seems to break down estrogen in the body more quickly. Estrogen is important to buildand maintain a strong skeleton in women and men.

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• Smoking also effects the other tissues that make up the [13]musculoskeletal system, increasing the riskof injury and disease:

• [14]Rotator cuff (shoulder) tears in smokers are nearly twice as large as those in nonsmokers, which isprobably related to the quality of these tendons in smokers.

• Smokers are 1.5 times more likely to suffer overuse [15]injuries, such as bursitis or tendonitis, thannonsmokers.

• Smokers are also more likely to suffer [16]traumatic injuries, such as [17]sprains or fractures.

• Smoking is also associated with a higher risk of [18]low back pain and [19]rheumatoid arthritis.

• Smoking is associated with degradation of the intervertebral [20]discs and accelerates disc related backconditions.

• Smoking has a detrimental effect on fracture and wound healing.

• [21]Fractures take longer to heal in smokers because of the harmful effects of nicotine on the productionof bone forming cells.

• Smokers also have a higher rate of complications after [22]surgery than nonsmokers such as poor woundhealing and infection and outcomes are less satisfactory. This is related to the decrease in blood supplyto the tissues.

• Smoking has a detrimental effect on athletic performance.

Because smoking slows lung growth and impairs lung function, there is less oxygen available for muscles usedin sports. Smokers suffer from shortness of breath almost three times more often than nonsmokers. Smokerscannot run or walk as fast or as far as nonsmokers.

• Smoking can make you too thin and put you at greater risk for [23]fractures. Nicotine signals the brainto eat less and can prevent the body from getting adequate nutrition. Having a good body weight isimportant for general health.

[24]Shaheer Yousaf MDCenter For Advanced OrthopedicsSource: AAOS

1. http://centerforadvancedorthopedics.files.wordpress.com/2014/03/smokingbanner.jpg

2. http://www.centerforadvancedorthopedics.com/smoking-impact-on-spine-discs-and-bones.aspx





7. http:

//www.centerforadvancedorthopedics.com/patient-education-joint-disease-center-for-advanced-orthopedics.aspx

8. http://www.centerforadvancedorthopedics.com/lower-upper-severe-spine-back-pain-orthopedic-treatment.aspx

9. http://www.centerforadvancedorthopedics.com/orthopedic-patients-education-related-topics.aspx


11. http://www.centerforadvancedorthopedics.com/osteoarthritis-arthritis-orthopedic-symptoms-and-treatment.

aspx

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http://www.centerforadvancedorthopedics.com/patient-education-joint-disease-center-for-advanced-orthopedics.aspx

http://www.centerforadvancedorthopedics.com/lower-upper-severe-spine-back-pain-orthopedic-treatment.aspx

http://www.centerforadvancedorthopedics.com/orthopedic-patients-education-related-topics.aspx


http://www.centerforadvancedorthopedics.com/osteoarthritis-arthritis-orthopedic-symptoms-and-treatment.aspx

http://www.centerforadvancedorthopedics.com/osteoarthritis-arthritis-orthopedic-symptoms-and-treatment.aspx



videos-and-animations-patient-education-center-for-advanced-orthopedics.aspx

14. http://www.centerforadvancedorthopedics.com/shoulder-pain-orthopedic-treatment-in-md.aspx

15. http://www.centerforadvancedorthopedics.com/patient-education-general-center-for-advanced-orthopedics.

aspx

16. http://www.centerforadvancedorthopedics.com/patient-education-trauma-center-for-advanced-orthopedics.aspx

17. http://www.centerforadvancedorthopedics.com/pain-and-swelling-in-foot-and-ankle.aspx


19. http://orthoinfo.aaos.org/topic.cfm?topic=A00208

20. http://www.centerforadvancedorthopedics.com/rheumatoid-osteoarthritis-joints-diseases-treatment.aspx


22. http://www.centerforadvancedorthopedics.com/surgery-and-total-joint-replacement.aspx

23. http://www.centerforadvancedorthopedics.com/orthopedic-patients-education-related-topics.aspx

24. http://www.centerforadvancedorthopedics.com/dr-shaheer-yousaf-board-certified-md-top-best-surgeon.aspx

3.4 April

Greenstick Fracture (2014-04-26 12:30)

Greenstick Fracture: Symptoms, Causes and Treatment:

[1]Greenstick Fractures are more common among children than adults, as their bones are softer and flexiblethan the adults. At times, these[2] fractures are difficult to be diagnosed and are taken as sprains, as they donot cause much pain and swelling.

What is a Greenstick Fracture?

When a young and soft bone instead of breaking up into different pieces; bends and cracks or breaksaway partially, it is called [3]Greenstick Fracture. These fractures usually occur during the infancy andchildhood because the bones are soft and flexible during this period. In a Greenstick Fracture, only one sideof the [4]bone gets broken while the other one only bends. The term Greenstick Fracture is derived from theanalogy of breaking up of a young, fresh and green tree branch.

What are the potential signs and symbols of Greenstick Fracture?

[5] Following can be considered as the potential signs of

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http://www.centerforadvancedorthopedics.com/shoulder-pain-orthopedic-treatment-in-md.aspx

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http://www.centerforadvancedorthopedics.com/patient-education-trauma-center-for-advanced-orthopedics.aspx

http://www.centerforadvancedorthopedics.com/pain-and-swelling-in-foot-and-ankle.aspx


http://orthoinfo.aaos.org/topic.cfm?topic=A00208

http://www.centerforadvancedorthopedics.com/rheumatoid-osteoarthritis-joints-diseases-treatment.aspx


http://www.centerforadvancedorthopedics.com/surgery-and-total-joint-replacement.aspx

http://www.centerforadvancedorthopedics.com/orthopedic-patients-education-related-topics.aspx

http://www.centerforadvancedorthopedics.com/dr-shaheer-yousaf-board-certified-md-top-best-surgeon.aspx

Greenstick Fracture:

• Abnormally twisted limb

• Pain

• Swelling

• Decreased range of motion

• Inability to put weight on the affected limb

Moreover, [6]arm fractures are more common than[7] leg fractures because children usually throw open theirarms when they start falling.

What are the causes of Greenstick Fracture?

Following factors result in the Greenstick Fracture:

• Falls while playing or participating in sports

• Blow on the forearm or shin

• Activities with high risk of falling

What are the treatment options available for treating Greenstick Fracture?

Bone fractures, even [8]Greenstick Fractures needed to be immobilized to get healed and grow back to-gether. Most of the fractures require 4-8 weeks for complete healing. Following treatment techniques areemployed by the doctors of orthopaedics to treat Greenstick Fractures:

• Casts are used to keep the bones in good alignment during healing

• If the bones have misaligned, doctors may have to reposition them before using casts

• Removable splints may also be used

• To reduce swelling, doctors may advise to raise the limb higher than the heart level

But once the cast is removed, make your child to avoid high impact activities for one or two weeks in orderto avoid re-injury.

[9]Contact Center of Advanced Orthopedics and Sports Medicine for the advanced and avant-garde treatmentof any of your musculoskeletal problems. Our [10]certified surgeon goes over an extra mile to provide youquality care and help you to regain your function and mobility.





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10. http://www.centerforadvancedorthopedics.com/board-certified-orthopedic-surgeons-maryland.aspx

3.5 May

Legg- Calve Perthes Disease (2014-05-27 11:21)

Legg- Calve Perthes Disease is a [1]childhood disorder affecting children between 4 to 10 years of age. Thisdisease is more common among boys than girls. After 2 years of treatment, children normally return to theirroutine life without any major limitations.

What do we mean by Legg- Calve Perthes Disease?

[2]Legg- Calve Perthes Disease (LCP or Perthes Disease) is a pathological condition affecting hip, wherepelvis and thighbone meet in ball and socket joint. It is a temporary condition under which, blood flow supplyto ball shaped head of thigh bone is temporarily lost, resulting into collapse of thigh bone. As the bonecollapses or becomes flat, ball no longer moves smoothly in the hip socket and the area becomes inflamedand irritated. The child may begin to limp with or without pain and there is reduced range of motion. Overa period of time, blood supply retraces back and new blood cells start replacing the dead ones gradually.

How is Legg- Calve Perthes Disease diagnosed?

After your child’s through [3]physical examination and taking notes of his medical history, your [4]doc-tor of orthopedics may ask for diagnostic procedures including; x-rays, bone scans, MRI, arthrograms andblood tests.

How is Legg- Calve Perthes Disease treated?

Proper and adequate non-surgical or [5]surgical treatment is prescribed to lessen the pain and help thefemoral head to retain its shape. For the children under 6 years of age and usually for the children with lesssevere symptoms, non- surgical treatment options are adopted including:-

• Initially to help patient to regain his motion and reduce pain your [6]doctor of orthopedics may suggestrest and limit the activities involving jumping and running.

• Anti- inflammatory medication is prescribed to lessen the swelling.

• Bed rest in traction may be prescribed for some patients.

• Stretching exercises may be prescribed to retain the flexibility of hip and as well to keep the hip insocket.

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• If the[7] doctor feels that your child need to avoid bearing weight on the involved hip, crutches areprescribed to protect hip joint.

• Casts may be prescribed to keep the femoral head with in the socket.

• Night- time brace may also be used to maintain hip flexibility .

Orthopedic Surgical Treatment

Children who are more than 6 years of age and who experience more severe symptoms and pain are advised[8]surgical treatment. The surgical treatment aims at preventing dislocation or collapse of hip. Surgicaltreatment may include:-

• Contracture Release procedure is employed to lengthen the shortened tissues.

• Joint realignment is conducted where plates are used to hold the bones in place. Realignment of jointhelps to restore the normal shape of hip joint.

• Surgery is performed to remove loose bits of bone and torn flaps of cartilages.

[9]Contact Center Of Advanced Orthopedics and Sports Medicine for any of your musculoskeletal pathologiesand disorders. Our [10]board certified surgeon goes over an extra mile to provide you with the care andtreatment you require and deserve.



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