Tennis Elbow (Featured Image)

Tennis elbow: Causes, Signs and Symptoms, Diagnosis and Treatment

Tennis elbow is a condition characterized by painful inflammation of the outer part of the elbow. Also known as lateral epicondylitis.

Tennis elbow occurs when the tendons in the elbow become overloaded usually by repetitive motion of the arm and wrist. The pain is mostly located on the lateral side of the elbow but may radiate down into the back of the forearm and grip strength may become weakened.

About 2% of people are affected, it can pop up in people of any age but it’s more common in those who are 30 to 50 years.

 

Causes:

Tennis elbow is a type of repetitive strain injury that is caused by the repeated contraction of the forearm muscle

The specific forearm muscle that plays a role is the extensor carpi radialis brevis (ECRB) muscle. This muscle helps to straighten and raise or extend the wrist repetitive stress weakens the ECRB muscle, causing a series of tiny tears in the muscle’s tendon at the point where it attaches to the outside of the elbow.

Causes_ Tennis

 

Over time the tears damage the ECRB muscle leading to inflammation and pain.

ECRB muscle

Tennis elbow can be triggered by any activity that involves repetitive twisting of the wrist such as:

  • Tennis and other racquet sports
  • Golfing
  • Swimming
  • Turning a key
  • Using plumbing tools
  • Repetitive computer mouse use
  • Frequently using hammer
  • Painting
  • Cutting up cooking ingredients, particularly meat

 

Symptoms:

Pain on the outer part of the elbow that is mild at first but gradually gets worse,

  • A weak grip.
  • Pain radiating from the outside of the elbow down to the forearm and wrist.
  • Increased pain when shaking hands.
  • Squeezing an object
  • Turning a doorknob
  • Holding a coffee cup
  • Pain when lifting something or using tools

 

Diagnosis and Treatment:

Tennis elbow is usually diagnosed during a physical exam. The doctor will inquire about your job, whether you are into any sports, and how the symptoms developed. The doctor will perform simple tests to help make a diagnosis.

The doctor may apply pressure on the affected area or may ask you to move your elbow, wrist, and fingers in various directions physical examination and medical history are enough to make a diagnosis in most cases.

However, if the doctor suspects that something else may be causing your symptoms. The doctor may suggest imaging tests, such as an X-ray or MRI scan.

Tennis elbow often resolves on its own. About 80 to 95 cases can be treated with self-care measures.

During treatment, the doctor will first prescribe one or more of the following:

  • Rest
  • Ice pack
  • Nonsteroidal anti-inflammatory medicine such as ibuprofen
  • Physical therapy
  • Steroid injection
  • Ultrasound Therapy

Surgery may be needed if symptoms don’t improve after six months or a year of treatment surgery may be performed through a large incision made directly over the elbow open surgery or through several small incisions. Both methods are employed to remove any dead tissue and to reattach healthy muscle to the bone a splint may be used to immobilize your arm after surgery to help restore muscle strength and flexibility.

Splint

 

 

For more information talk to a healthcare provider.

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Tuberculosis of hip (Featured Image)

Tuberculosis of Hip Joint

Tuberculosis (TB) of the musculoskeletal system, thought accounts for only 1-3 % of total TB cases 1 however, as n fourth of all TB cases are in India.

TB of the hip joint is comprised of 15% of all osteoarticular tuberculosis.

The area of infection that is majorly targeted is,

  • Acetabular roof (A)
  • Synovium (B)
  • Epiphysis (C)
  • Metaphysis (D)
  • Greater trochanter (E)

Infection of areas

 

 

Pathogenesis:

The synovial membrane is one of the most commonly affected. Here, the tubercle formation causes synovial hypertrophy resulting in pannus formation. This pannus destroys the articular cartilage resulting in the development of fibrous ankyloses of the hip.

The smaller tubercles coalesce, undergo caseation, and form a cold abscess. This cold abscess tracks down along the areas of least resistance and may point in any one of the following sites.

  • Inguinal region (A)
  • Medial side of the thigh (B)
  • Femoral triangle (C)
  • Gluteal region (D)
  • Lateral aspect of the thigh (E)

Pathogenesis

 

Clinical Features:

  1. Painful limp is the most common and early symptom.
  2. Antalgic gait with short stance phase.
  3. Pain becomes maximum at night.
  4. There may be wasting of the thigh and gluteal muscles.
  5. Tenderness may be elicited by direct pressure applied on specific points.

 

Stages of Tuberculosis (TB):

 

Stage 1: Stage of Synovitis

The disease is synovial with the patient assuming flexed, abducted, and externally rotated position of the limb. There is no real shortening and the extremes of movements are decreased and painful.

 

Stage 2: Stage of Early Arthritis

The local signs are exaggerated. The spasm/b s of the adductors and flexors results in flexion, adduction, and internal rotation of the affected limb. There is apparent shortening; significant muscle wasting and hip movement are decreased in all ways.

 

Stage 3: Stage of Advanced Arthritis

The flexion, adduction, internal rotation deformity found in Stage 2 are exaggerated. There is a true shortening with considerable restriction of hip movements and muscle wasting. There is gross destruction of the articular cartilage of the head of the femur.

 

Stage 4: Advanced Arthritis with Subluxation of Dislocation

Migrating acetabulum, frank pathological posterior dislocation, mortar and pestle hip, protrusio acetabuli are the features in this stage.

 

Deformities: 

 

1. Flexion Deformity

In the initial stages of the disease, the patient keeps the hip in flexion, as this is the position of ease and of maximum joint capacity. Soft tissue contractures convert this into a fixed flexion deformity (FFD) making locomotion impossible. In an effort to bring the limb on the ground and make locomotion possible, the lumbar spine undergoes exaggerated lordosis and thus conceals the fixed flexion deformity.

 

2. Adduction Deformity

Soft tissue contractures convert the adduction position adopted by the patient due to the spasm of the adductor muscles following damage to the articular cartilage, to one of the fixed adduction deformities. The limb is now brought to the ground by the elevation of the pelvis as evidenced by the anterior superior iliac spine being at a higher level on the affected site. There is scoliosis of the spine away from the deformity.

 

3. Abduction Deformity

In the initial phases of the disease, because of the increase in the joint space due to effusion, the limb assumes a position of flexion, abduction, and external rotation. If fixed in this position by soft tissue contractures, the patient develops deformity. This limb is then brought to the ground by the downward tilt of the pelvis as evidenced by an anterior superior iliac spine (ASIS) lying at a lower level with the corresponding scoliosis of the spine towards the affected side.

 

4. Limb Length Discrepancy

In the initial stages, there may be apparent lengthening; but in the advanced stages, the patient develops shortening.

 

 

Preoperative Rehabilitation

  1. Helps to develop a patient-specific rehabilitation program to follow post-operative, taking assessment findings into consideration.
  2. Benefits: decreased length of stay, decreased anxiety levels, improved self-confidence, establish a relationship of trust between the therapist and patient.

 

 

Postoperative Rehabilitation

  1. Address the functional needs of the patient (e.g. start mobilizing) and improve mobility, strength, flexibility, and reduce pain. This starts off as an assisted process, but the aim is to get the patient as functional as possible.
  2. As a result of the underlying pre-operative pathology, patients may present with muscle atrophy and loss of strength, particularly in the gluteus medius and quadriceps muscles.
  3. Accelerated rehabilitation programs and early mobilization have been shown to give patients more confidence in their post-operative mobilization and activities of daily living, as well as being more comfortable with earlier discharge.

 

 

For more information talk to a healthcare provider.

If you have any questions about Tuberculosis of the Hip, please feel free and leave a comment.

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Septic Arthritis (Featured Image)

Septic Arthritis: Overview (causes, pathophysiology, treatment)

In this article, we are going to talk about septic arthritis. This is an introduction and overview. It is important to rule out septic arthritis as this can cause irreversible damage to the joint.

Symptoms:

Silent symptoms of septic arthritis include:

  • Fever
  • Monoarthritis (which means one inflamed joint)
  • Inflammation of the joint is characterized by warmth, redness, effusion, pain, decreased function, or range of movement.

Causes:

The person presenting with an inflamed joint requires a thorough history and examination for septic arthritis the main causative agent include Staphylococcus aureus bacteria, Group A streptococcus, and Neisseria gonorrhoeae (which is a sexually transmitted bacteria).

Pathogenesis:

The pathogenesis of septic arthritis is an inflamed joint a skin infection such as from staphylococcus aureus can spread into the joint causing septic arthritis osteomyelitis which is inflammation fiction of the bone marrow usually caused by staphylococcus aureus again can locally invade the joint causing septic arthritis.

Upper respiratory tract infections or lower respiratory tract infections from Group A streptococcus can hematogenous go-to bone closing osteomyelitis which then can lead to septic arthritis.

Procedures such as injections to the joint space can introduce bacteria into the joint causing septic arthritis.

Further, it’s important to consider surgery as a cause of septic arthritis during surgery bacteria may enter the joint from the skin or from aseptic techniques.

 

Diagnosis:

Investigations to be performed in a person presenting with monoarthritis include a full blood count c-reactive protein, ESR (to check for signs of inflammation and infection).

Joint aspiration is usually indicated for any mono arthritic presentation.

The joint aspiration will also need to be cultured in microscopy culture and sensitivity. It’s important to also do blood cultures if you suspect systemic infections or bacteremia also perform electrolyte urea creatinine and glucose.

Finally, imaging including ultrasound and x-ray can also be done. An X-ray may reveal dislocation of the joint and there is joint space widening because of the swelling and inflammation occurring within the joint itself.

After performing the investigations notably cultures and joint aspiration administration of broad-spectrum antibiotics is a priority.

Surgical emergency is needed involving joint drainage usually joint aspiration arthroscopic drainage or open drainage.

 

 

For more information talk to a healthcare provider.

If you have any questions about Sepic Arthritis, please feel free and leave a comment.

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Osteogenesis Imperfecta (Featured Image)

Osteogenesis Imperfecta (OI): Causes, Signs and Symptoms, Diagnosis and Treatment

Osteogenesis imperfecta is a group of genetic disorders marked by extremely fragile bones that break or fracture easily. Often from little or no apparent trauma or cause.

The condition is also called brittle bone disease. The severity of osteogenesis imperfecta varies from person to person, even among individuals of the same family.

Brittle bone
Brittle bone

It ranges from mild to severe. A person may have just a few or as many as several hundred fractures in their lifetime.

Most cases are mild resulting in few bone fractures, the severe form can cause hearing loss, spinal cord problems, and heart failure as well as permanent deformities.

  • The condition can be life-threatening if it occurs in babies either before or after birth.
  • The condition affects both males and females equally and affects about 1 in 15,000 people.

 

Causes:

Osteogenesis imperfecta is a genetic disorder that is caused by a mutation in the COL1A1 or COLIA2 gene inherited in an autosomal dominant pattern or occurs via a new mutation.

Mutation

This means that a child inherits the defective gene from one of their parents. Or neither parent has it but the defect occurs due to a spontaneous mutation (change) in the gene, and it stops working properly. This gene produces a protein (type 1 collagen), a major component of the connective tissues in bones.

Type 1 collagen is also important in forming teeth, ligaments, and sclera (the white outer tissue of the eyeballs)

 

Types:

There are eight types with type 1 being the least severe and type 8 being the most severe.

The first four types are the most common while the last four are extremely rare, and most are subtypes of type 4 osteogenesis imperfecta (OI),

 

Type 1 (OI):

This is the mildest and the most common of the condition. In this type, the body produces the normal quality of collagen but in insufficient quantities.

These results in mildly fragile bones a bone fracture may occur due to mild trauma. The bone fracture usually occurs during childhood through puberty and maybe less common after puberty.

 

Features may include:

  • Bluish discoloration of the sclera (blue sclera)
  • Abnormalities in the middle or inner ears resulting in hearing impairment
  • Loose joints
  • Low muscle tone
  • Bone fractures easily
  • Abnormal outward curvature of the upper spine (Scoliosis)
  • An abnormal outward curvature of the upper spine (Kyphosis)
  • Slight protrusion of the eye

 

Type 2 (OI):

 

This type is the most severe type and can cause life-threatening complications at, or shortly after birth.

In this type, the body produces insufficient collagen or produces collagen that is of poor quality. Most children born with type 2 die within the first year of life due to respiratory failure, due to underdeveloped lungs.

This type is sub-classified into groups A, B, C which are distinguished by bone formation seen only on x-ray.

 

Features:

  • Underdeveloped lungs
  • Severe bone deformity and small stature
  • Narrowed chest
  • Type 2A have broad and short long bones with broad and beaded ribs
  • Type 2B demonstrates broad and short long bones with thin ribs with little or no beading
  • Type 2C shows thin and longer long bones with thin and beaded ribs

 

Type 3 (OI):

In type 3, enough collagen is made but it is defective and causes the bone to break easily. Bone deformities are common and present at birth. They may become worse as affected children age.

 

Features:

  • Severe bone deformities
  • Loose joints
  • Triangular face
  • Poor muscle tone in arms and legs
  • Early loss of hearing is possible
  • Discoloration of the sclera
  • Short Stature
  • Respiratory problem is possible
  • Brittle, discolored teeth may also be present

 

Type 4 (OI):

This type is the most variable because symptoms range from mild to severe. In this type, enough collagen is made but it is not of high quality.

 

Features:

  • Bone fracture easily, especially before puberty
  • Short stature
  • Mild to moderate bone malformation
  • Hearing impairment
  • Spinal curvature
  • Bowed legs that may lessen with age.

 

Diagnosis:

The condition is diagnosed by taking x-rays. This allows the doctor to see current and broken bones as well as view defects in the bones.

A laboratory test may be done. This may include taking blood or tissue samples for genetic testing.

 

Treatment:

No cure exists for this condition. But, there are supportive therapies that help reduce the risk of broken bones and may increase the quality of life.

  • Physiotherapy is used to strengthen muscles.
  • Physical aids such as crutches, wheelchairs, grabbing arms
  • Medicine to reduce any pain
  • Bisphosphonate medications to strengthen a child’s bone
  • Low-impact exercise for bone building
  • Surgery may include inserting a metal rod in the long bones to improve strength

 

For more information talk to a healthcare provider.

If you have any questions about Osteogenesis Imperfecta, please feel free and leave a comment.

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Metabolic Bone Disorders (Featured Image)

Metabolic Bone Disorders

This is a brief article on metabolic bone disorders. We are going to be talking about five bone diseases that are caused by disturbed bone metabolism.

Metabolic Bone Disorders chart

Any deviation from the above chart might be a result of a metabolic bone disorder. So, let’s jump into the first one,

1. Osteitis Fibrosa Cystica:

  • AKA brown tumor of hyperparathyroidism.
  • Caused by excessive bone resorption (mediated by osteoclast activity)
  • Hyperparathyroidism -> increased PTH -> resorb bone
  • Pathology -> diminished bone strength
  • Subperiosteal resorption (below connective tissue)
  • Bone cysts
  • Radiology: cyst formation, mimics bone neoplasms.
  • Histology: fibrous tissue, hemorrhage (hemosiderin pigment)
  • Treatment: the underlying cause of hyperparathyroidism.

Osteitis Fibrosa Cystica

2. Paget’s Disease of Bone:

Paget’s disease of bond is characterized by an increase in the quantity of bony matrix but despite this increase in the quantity of bony matrix. These bonds are fragile and weak because the structure of bone is highly disorganized.

This disorganization of bony structure leads to weakness of bone. So, we call this pathology Paget’s disease of bone.

Now, this patient’s disease of bone is characterized by three stages,

  • The first stage is an osteolytic stage in which there is the destruction of bone.
  • The second stage is a mixed phase in which there is destruction as well as the formation of bone.
  • The third stage is an osteosclerotic phase in which there is just the formation of bone but this formation of bone is highly disorganized.

Symptoms: usually asymptomatic, but some get bone pain/fracture/deformity, arthritis, neuro complications

Paget's disease of bone

3. Osteogenesis Imperfecta:

  1. ‘Osteo’ refers to the bone ‘Genesis’ means formation. So, this is imperfect bone formation this is a congenital defect is also known as brittle bone disease.
  2. Inadequate bone formation with defective bone matrices
  3. Due to mutation in bone collage gene
  4. Clinical: unexpected fractures, family history, blue sclera (Photo 4:45)
  5. Diagnose with DNA tests or collagen analysis
  6. Treatment: bisphosphonates, surgery, no cure
      sclera eyes
      Sclera eyes

       

      4. Rickets and Osteomalacia:

       

      1. Caused by abnormal bone mineralization and vitamin D deficiency.
      2. Due to insufficient calcium or phosphorus
      3. Most frequently caused by vitamin D deficiency.
      4. Bone softening. (So, that malacia means softening)
      5. Adults (osteomalacia) -> bone pain, muscle weakness, fracture risk.
      6. Children (rickets) -> bone deformities, dental issues.
      7. Treatment: restore vitamin D levels, calcium, and phosphorus

      Osteomalacia_rickets

       

      5. Osteoporosis:

      1. Most prevalent metabolic bone disease in adults.
      2. Affects an estimated 20 to 25 million Americans, with 4:1, female: male predominance.
      3. Believed to cause 1 to ½ million fractures annually.
      4. Diagnosis: Based on clinical characteristics or a DEXA scan.
      5. Fragility fracture: fracture occurring at an inappropriate degree of trauma.

      Osteoporosis Treatment:

      1. Directed at the primary consequence of disease: fracture
      2. Modification of preventable risk factors, such as smoking and alcohol consumption.
      3. Evaluation of fall risk.
      4. Consideration of walkers, handrails, night lights, hip pads.
      5. Adequate dietary calcium and vitamin D.
      6. Prevention for those with family history: minimize bone loss, increase bone density, and prevent fracture.
      7. Medication.

      Osteoporosis

       

      For more information talk to a healthcare provider.

      If you have any questions about Bone Disease, please feel free and leave a comment.

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        Pelvic fracture (featured Image)

        Overview: Pelvic Fracture

        Anatomy:

        A pelvic fracture is a disruption of the bony structures of the Pelvis. The pelvic is a ring made up of two innominate bones in the sacrum. The innominate bones are joint anteriorly at the pubic symphysis- a synchondrosis and posteriorly at the sacroiliac joints.

        Pelvis_Fractures

        The innominate bone is composed of three bones that fuse in adolescence. Those bones are the ilium, ischium, and pubis bones.

        The pelvis opens up in two places when it breaks.

        Many important vascular structures lie in close proximity to the pelvic bones. There is a rich venous plexus that is responsible for much of the bleeding that is seen with public fractures.

        In addition to the venous plexus, there are numerous branches of the internal iliac artery that may be injured by displaced bone fragments.

         

        Stability of the Pelvis:

        The sacroiliac joint has posterior ligaments that are very strong and the stability of the pelvis depends on the integrity of the posterior weight-bearing Sacroiliac joint complex. Transfer of weight-bearing forces from the spine to the lower extremities.

        Pelvic ring stability
        Dorsal sacroiliac ligaments. Sacrotuberous ligs. Ventral sacroiliac ligs. Sacrospinous ligs.

         

        The pelvis is a ring. When a force occurs between the injured ring in the front and the back that is anterior injury and posterior injury.

         

        Anterior Injury:

        • Anterior injury is obvious.
        • Usually noted on radiographs.
        • Usually associated with posterior injury or fracture.

        pelvic ligaments

        Posterior Injury:

        • Could be occult.
        • Always look at the back of the pelvis
        • An unstable pelvis will have a gap or comminution.

        The posterior fracture is serious. For that, it needs a significant blood transfusion, needs surgery, and unpredictable outcomes.

        Posterior fracture with disruption of the posterior ring complex is a serious injury as it leads to instability of the pelvis and can cause profuse bleeding.

        The resultant instability if not fixed surgically can cause late deformity, limb length discrepancy, and pain.

         

        Types of Pelvic Fractures:

        Three types of pelvic fracture

        1. Lateral Compression (LC):

        • The lateral compression type 1 starts with the simple fracture type and then it gets complicated. The simple type will be an impacted sacrum and maybe the pubic rami will have transverse or oblique fractures.
        • The best example of lateral compression is the crescent fracture and which is considered to be Type 2. If the force does not involve the bone for the crescent fracture, it is going to involve the posterior tension band ligaments. The fracture will be unstable to internal rotation.
        • In Type 3, you will have lateral compression fracture on one side and anteroposterior compression on the other side. One of the iliac crests will be in internal rotation and the other side will be in external rotation. It is a roll-over injury or a windswept pelvic.

         

        2. Anterior Posterior Compression (APC):

        • If the symphysis pubic is open, it will be less than 2.5 cm opening because Type 1 is small and insignificant. Because it did not open a lot, the ligaments are still holding and it is rotationally and vertically stable.
        • In Type 2, the symphysis pubis will be open with injury to the sacrospinous and sacrotuberous ligaments (STL). In type 2, the symphysis pubic will be opened more than 2.5 cm and the anterior sacroiliac joint ligament will be injured. So, the pelvis becomes rotationally unstable, but it is vertically stable.
        • This is the important type for open book fractures Type 3, and if you rupture these posterior ligaments, the pelvis becomes unstable rotationally and vertically. All of the ligaments are gone and the pelvis is totally unstable. The anterior-posterior compression type 3 is associated with the highest blood transfusion requirements and shock.

         

        3. Vertical Shear (VS):

        • In the vertical shear fracture, all of the ligaments are disrupted and it is rotationally and vertically unstable.
        • In the vertical shear fracture, the patient will also lose a lot of blood.

         

         

        For more information talk to a healthcare provider.

        If you have any questions about Pelvic fracture, please feel free and leave a comment.

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        Biologics (Featured Image)

        What is a Biologics / How it works?

        What is biologics?

        Biologic drugs or biologics are produced from living organisms or comprise components of any living organisms. These are genetically engineered proteins targeting specific parts of the immune system to treat the medical indication.

        Biologics or biological products have significantly improved the treatment of diseases such as,

        • Anemia
        • Inflammatory Bowel Disease (IBD)
        • Psoriasis
        • Rheumatoid Arthritis (RA)
        • Leukopenia
        • Several forms of Cancer

        The first biological drug was human insulin and was marketed in 1982. Biologics include a comprehensive variety of therapeutic formulations derived from humans, animals, or microorganisms by using biotechnology or other cutting-edge technologies.

        Some examples of biologics include blood & blood components, vaccines, tissues, cells, genes, allergens, and recombinant proteins.

         

        How are Biologics different from Pharmaceutical Drugs?

         Biologics are manufactured in a living system, for example, microorganisms, or animal or plant cells.

        Many of the biologics are large and complex molecules. Most biologics are manufactured via recombinant DNA technology.

        However, a drug is usually manufactured through a chemical process, which implies that it is made by mixing specific chemical ingredients in an ordered process.

         

         How are Biologics Approved?

        Like pharmaceutical drugs, for approval of biologics, the application needs to be submitted to the regulatory authorities of the specific countries.

         

        Helping Fracture Heal (Orthobiologics)

         Orthobiologics are substances that orthopedic surgeons use to help injuries heal more quickly. They are used to improve the healing of broken bones and injured muscles, tendons, and ligaments. These products are often made from substances that are naturally found in your body. When they are used in higher concentrations, they may help speed up the healing process.

         

        Healing Process

         When you injure a bone, muscle, or tendon, there is bleeding into the injured area. This bleeding is the foundation for the healing response. It provides a way for healing factors to reach the injury site.

        In addition to bleeding, there are three factors necessary for healing. All three are orthobiologic substances. They include:

         

        Matrix. This can be thought of like the house in which the cells live and where they will thrive and eventually make bone, tendon, or ligament. The matrix material is conductive. This means it can form the building blocks that help fill bone gaps.

        Growth factors. These are the many different kinds of proteins necessary for cells to work during the healing process. Some proteins help speed up the healing process, while others help to control it or slow it down. These elements are much like the vitamins that we take every day to try to improve our health and body function.

        Stem cells. These are special cells in your body that can turn into certain types of cells. During the healing process, stem cells are called to the area of your body that needs repair. Factors in the area influence the stem cells to become repair cells. Note that the same stem cell that repairs bone can also repair a tendon or ligament.

        For more information talk to a healthcare provider.

        If you have any questions about Biologics Tricell, please feel free and leave a comment.

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