Arthrodesis (Featured Image)

Arthrodesis: Joint Fusion to Relieve Arthritis pain

Anterior ankle fusion is an open surgical procedure that fuses or joins the ankle bones together.

The ankle is the joint that connects the leg in the foot, the ankle joint includes the two lower leg bones called the tibia and fibula. And the ankle bone is called the talus.

tibia and fibulaTalus (ankle)

Together the ends of the tibia and fibula create a mortise or slot for the talus which forms the bottom of the ankle joint. Tissues called ligaments and tendons support the ankle bones ligaments attach bone to bones and tendons attach muscles to bones.

The ankle joint allows the foot to move up and down.

Articular cartilage on the ends of bones is a smooth gliding covering that allows fluid joint movement.

What is Ankle Fusion?

Ankle fusion also known as arthrodesis is a surgical procedure that joins the ankle bones together, so they no longer move or rub against each other.

Doctors may recommend this procedure for conditions that lead to severe ankle joint damage and pain.

The most common condition is osteoarthritis also known as degenerative joint disease.

In the late stage of osteoarthritis, the cartilage covering the ends of the bones has worn away exposing bare bone.

This along with the growth of bony projections called bone spurs causes swelling pain and limited movement of the joints.

Another condition that may require ankle fusion is rheumatoid arthritis, where the patient’s own immune system attacks the joints.

Any condition that destroys the joint surface such as a severe bone infection or death of bone tissue called osteonecrosis. May also require fusion of the ankle joint.

 

For more information talk to a healthcare provider.

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Types of Human Joints (Featured Image)

Types of Joints in the Human Body – Anatomy

Overview:

A joint is defined as a connection between two bones in the skeleton. There are many ways in which joints can be classified.

They can be classified according to their structure, their mobility, and their range of motion.

Joint classification:

Structure

There are three distinct types-

  • Synovial joint
  • fibrous joint
  • Cartilaginous joints

Synovial jointFibrous JointCartilaginous joint

Synovial joint:

The synovial joint as it’s the most common joint found in the human body. Synovial joints have several characteristic features as a sagittal illustration of the knee joint.

First of all, synovial joints are surrounded by an articular capsule. This capsule consists of an outer fibrous layer that helps us to stabilize the joint and an inner synovial layer that absorbs and secretes synovial fluid lubricating the joints.

synovial joints 1

The articular surfaces of a synovial joint are covered in hyaline cartilage. This cartilage is also known as articular cartilage and acts to reduce friction and assists in shock absorption.

Additional structures may also be found within synovial joints such as articular discs.

We can see examples of these in the knee joint- the medial and lateral menisci.

medial and lateral menisci

The bursae, which are small sacs lined by the synovial membrane and filled with synovial fluid.

synovial fluid

The bursae act to reduce friction caused by muscles and tendons which are located over bony joints.

The synovial joints can be further sub-classified according to the shape of their articular surfaces and their range of motion.

These include,

  • Ball and socket joint
  • Hinge joint
  • Pivot joint
  • Condylar joint
  • Saddle joint
  • Plane joint

Fibrous joint:

In a fibrous joint, the bones are bound by a tough fibrous connective tissue. These joints exhibit little to no mobility.

fibrous joint

Types of fibrous joints:

  • Sutures
  • Gomphoses
  • Syndesmoses

 

The sutures, which are fibrous joints found exclusively between the bones of the skull.

This is the coronal suture. The suture connects the frontal bone to the parietal bones via suture ligaments.

Coronal suture

Gomphosis is found in the mouth, where the roots of the teeth articulate with the dental alveoli at the dentoalveolar joints.

dentoalveolar joints

The tooth is bound into its socket by the strong periodontal ligament.

periodontal ligament

The syndesmosis, which is formed by ligaments and a strong membrane that holds two bones in place. The interosseous membrane runs between the radius and ulna.

syndesmosissyndesmosis 1

Cartilaginous joint:

In a cartilaginous joint, the bones are connected by fibrocartilage or hyaline cartilage.

These joints can be subclassified into two types

  1. Synchondroses
  2. Symphyses

 

Synchondroses or primary cartilaginous joint, where the bones are connected by hyaline cartilage.

hyaline cartilage

This type of joint is found between the diaphysis and epiphysis of a growing long bone and will eventually become completely ossified in adulthood.

The second type of cartilaginous joint is known as a symphyses or secondary cartilaginous joint, where the bones are connected by fibrocartilage.

This type of joint is found primarily along the midline of the body; for example, the pubic symphysis.

pubic symphysis

Mobility:

Diarthrosis:

A diarthrosis is a freely mobile joint, and an example of this is the knee joint which is a synovial hinge joint. It’s worth noting that every synovial joint is a diarthrosis.

 

Amphiarthrosis:

An amphiarthrosis is a slightly mobile joint, and an example of this is the pubic symphysis. Which is a secondary cartilaginous joint.

The syndesmosis, which is a fibrous joint, is also an example of amphiarthrosis.

 

Synarthrosis:

 

A synarthrosis, which is an immobile joint, and an example of this is the coronal suture of the skull.

Other examples, of this type of joint include,

  • Gomphosis
  • Synchondrosis, which is a primary cartilaginous joint.

Range of Motion:

When classifying a joint based on its range of motion, it’s important to first understand the various axes of movement that the movements are occurring along in joint movement, there are three main axes

Axes of Movement:

There are three main axes,

  1. The sagittal axis, which passes horizontally from anterior to posterior.
  2. The frontal axis, which passes horizontally from left to right.
  3. The vertical axis, which passes vertically from superior to inferior.

Types:

  • The joint that can move back and forth along a single axis is called uniaxial. Examples of these are the hinge joint and the pivot joint.
  • Joints that move about two distinct axes are called biaxial. For example, the condylar joint and the saddle joint.
  • Joints that can move through all three axes are called polyaxial or multiaxial. The only example of this is the ball and socket joint.

Synovial Joints: Anatomy

Ball and socket joint:

ball and socket joint

The ball and socket joint, which is also known as the spheroid joint.  This is the only polyaxial joint and therefore, the most mobile of all joint types.

The movements that occur at these joints are,

  • Flexion and extension, which occur around a frontal axis.
  • Adduction and abduction, which occur around a sagittal axis.
  • Internal rotation and external rotation, which occur around a vertical axis.

Two examples of this joint are the acetabulofemoral joint or the hip joint and the glenohumeral joint, which is known as the shoulder joint.

Hinge joint:

Hinge joint

The hinge joint, which is only one axis of motion making it uniaxial.

The movements that occur at these joints are,

  • Flexion
  • Extension

Two examples of these joints are the tibiofemoral joint or the knee joint and the elbow joint.

So, we use our hinge joints when we show off to flex our biceps!

Pivot joint:

Pivot joint

Like the hinge joint, the pivot joint is also uniaxial. So, pivot joints, also known as rotary joints, allow movement around a single axis –this movement being rotation.

Condylar joint:

The condylar joint, which is also known as the ellipsoid joint. Condylar joints allow movement around two axes that are at right angles to each other. Therefore, they are described as biaxial joints.

An example of this joint is the radiocarpal joint or the wrist joint.

The movements that take place at this joint are,

  • Radial deviation and ulnar deviation, which occur around the sagittal axis.
  • Flexion and extension, which occur around the frontal axis.
  • These movements combine to produce circumduction of the wrist joint.

Saddle joint: 

Saddle Joint

Similar to the condylar joint, the saddle joint is a biaxial joint.

The movement that takes place at this joint is,

  • Abduction and Adduction
  • Flexion and Extension
  • Circumduction

An example of such a joint is the Carpometacarpal joint of the thumb.

Plane joint:

Plane joint

The plane joint is also known as the gliding joint. The plane joint performs a sliding or a gliding movement, where one bone moves across the surface of another.

An example of this joint is the acromioclavicular joint, which increases the flexibility of the shoulder.

 

For more information talk to a healthcare provider.

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Causes of Hip Pain (Featured Image)

Causes of Hip Pain

What are the common causes of hip pain?

Pain can arise from the structures that are within the hip joint or from the structures surrounding the hip joint. The most important thing is to ask the patient to locate the site of pain.

Ask the patient to point at the site of pain. When the patient states that their hip hurts, it doesn’t mean that the pain is coming from the hip joint itself, so ask the patient to point at the site of the pain.

The pain can arise from structures that are within the hip joint or from structures surrounding the hip.

The hip joint is a weight-bearing joint. The joint consists of two main parts: the femoral head (ball) and the acetabulum (socket).

  • The hip pain can be anterior hip pain (deep groin pain).
  • The pain can be lateral hip pain.
  • The pain can be posterior hip pain.
  • The pain can be far posterior hip pain, coming from the sacroiliac joint and the lower spine.

Anterior hip pain is usually deep within the groin, and it can result due to arthritis of the hip.

Treatment:

Conservative treatment is:

  • physical therapy
  • anti-inflammatory medication
  • possible injections
  • Surgery (Is done in late cases, usually by a total hip replacement.)

 

It is usually diagnosed by clinical examination with a provocative test of flexion, adduction, and internal rotation. The diagnosis is confirmed by an MRI arthrogram.

Conservative Treatment:

  • Therapy
  • Anti-inflammatory medication
  • Injections

Surgical Treatment:

  • Provides good results.
  • Usually done by arthroscopic debridement or repair of the tear.

Diagnosis:

A stress fracture is usually diagnosed by an MRI. The x-ray may be normal. Early diagnosis is important before the fracture displaces and gives a bad result.

Avascular Necrosis (AVN)

Treatment of avascular necrosis is usually surgical fixation of the fracture. Fixation of the fracture is usually performed utilizing screws. Femoral head replacement is done in rare, late cases.

Avascular necrosis means the death of a segment of the bone. When the blood supply of the femoral head is interrupted, a segment of the bone dies and becomes necrotic (femoral head will collapse).

AVN

Treatment for early stages of AVN without collapse of the femoral head includes decompression by drilling of this segment in the femoral head to bring a new blood supply to the area.

The vascularized fibular graft may be used also. In severe cases with the collapse of the femoral head (usually diagnosed by an x-ray), the treatment is usually total hip replacement.

Treatment of an inflamed bursa is usually the conservative treatment of physical therapy, anti-inflammatory medication, and injection. Surgical treatment by excision of the bursa is rarely done.

In case of chronic, resilient trochanteric bursitis, try to get an MRI to exclude a tear of the abductor muscles of the hip (gluteus medius and gluteus minimus muscle tear).

Lateral-hip-pain

Posterior hip pain is usually due to piriformis syndrome. The sciatic nerve can be irritated from piriformis syndrome.

Treatment is:

  • Usually physical therapy
  • Stretching
  • Anti-inflammatory medications
  • Injections

Surgical treatment is usually rare:

  • It is the last resort.
  • It includes the release of the piriformis tendon and exploration of the sciatic nerve.
  • It is done in cases that fail to improve with conservative treatment.

Posterior Hip Pain:

Far posterior pain may come from the sacroiliac joint or from the lower spine conditions. Sacroiliac joint (SI) problems are a challenging diagnostic and treatment entity.

There are a lot of clinical diagnostic examinations that can be used to diagnose sacroiliac joints (SI) problems such as the Faber test and others.

However, injection of the SI joint is probably the method to diagnose pain originating from the SI joint. If there is an improvement of the condition of the patient after injection of the SI Joint, then we will probably consider that the problem is in the SI joint.

The SI joint problems are usually underestimated and are unappreciated. Lower spine conditions can cause referred pain to the buttock and hip area.

In fact, symptoms of hip and lower spine conditions can overlap or both of them can coexist in the same patient. You have to separate pain from the hip from the pain that comes from the spine.

 

For more information talk to a healthcare provider.

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

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Food for Joint Pain (Featured Image)

Diet For Joint Pain – Best Foods for people with Arthralgia

Chronic joints pain affects millions of people across the world every year. Thousands of patients routinely seek medical attention for joint pain, and it is one of the leading causes of disability.

To give you an estimate of the disease, in 2002, about 10.5 million people in the United States of American said they experienced severe joint pain, but by 2014 that number had jumped to 14.6 million, said a researcher from the U.S. Centers for Disease Control and Prevention.

Severe Joint pain can limit a person’s ability to perform basic functions and seriously compromise their quality of life.

Joint pain in medical terms is known as ‘arthralgia’. Which is as common as the flu, and can be caused by a wide range of problems – such as,

  1. Bad Posture
  2. Overuse and misuse of joints like in the case of athletes such as footballers, sprinters, and tennis players.
  3. Nutritional deficiencies in the diet.
  4. Osteoarthritis.
  5. Rheumatoid arthritis.
  6. Certain neurological problems.
  7. Kidney and liver problems.

Luckily with strict precautions, good exercise, proper diet, and supplementation. Joint pain can be managed.

 

The number one food that we have on our list for people with chronic joint pain is:

1. Oily Fish:

Fish oil

Oily fish can reduce joint pain and morning stiffness as it contains unsaturated fats such as Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA). EPA and DHA also limit the production of certain negative proteins that inhibit certain types of arthritis.

The Omega-3 fatty acids present in fish also increase blood flow throughout the body during exercise, which can help reduce joint pain and swelling.

It is recommended that each person should consume at least two to four weekly servings of fish like salmon and sardines.

It’s hard for many people to consume such quantities. Hence, omega-3 fish or krill oil supplements can help support joint health.

2. Walnuts & Brazil Nuts:

Brazil nuts

Like oily fish, walnuts are a rich vegetarian alternative source of omega- 3 fatty acids, which reduce inflammation. Also eating walnuts regularly can lower cholesterol, relax blood vessels to lessen stress on the heart, and reduce blood pressure.

Also, Brazil nuts are high in selenium, which improves the quality of cartilage proteins present in our bones and joints. Snack on 3 or 4 each day and you should get all they required. Selenium also helps to boost your immunity which is very important considering the pandemic.

3. Dark Green Leafy Vegetables:

Dark Green Leafy vegetables

Broccoli, cauliflower, and cruciferous vegetables have been shown to protect against the development of arthritis and joint pain.

These also contain antioxidants like carotenoids, which fight free radicals in the body and prevent damage to our cells and tissues. Not only do free radicals damage our cells, but they also have been linked to rheumatoid arthritis (RA) and inflammation.

Green, leafy vegetables such as broccoli, spinach, Brussels sprouts, kale, Swiss chard are packed with antioxidants and vitamins A, C, and K, which protect cells from free-radical damage.

These foods are also high in bone-preserving calcium.

 

4. Onion & Garlic:

Garlic.

Onions are a rich source of quercetin, an antioxidant that works to reduce inflammation. Red onions are particularly high in antioxidants.

Garlic contains allicin, a compound that can help to alleviate symptoms of rheumatoid arthritis.

Garlic also contains Diallyl Di-sulphide which is highly effective for the body and can help you with a number of diseases include joint pain.

 

5. Bone Broth:

bone broth

Glucosamine, chondroitin, and amino acids are well documented to help maintain healthy joints, while calcium is essential for bone density. Bone broth contains all of these.

The gelatin-like substance that comes from cooking bones mimics collagen that occurs naturally in our joints, tendons, and ligaments.

Taken regularly as an oral supplement, it has been known to reduce joint pain and increase function for people with arthritis.

 

For more information talk to a healthcare provider.

If you have any questions about Diet for Joint Pain, please feel free and leave a comment.

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Rotator cuff (Final Featured Image)

What Is My Rotator Cuff, and Why Does It Hurt?

A rotator cuff is a group of four small muscles within the shoulder. Which originated from the scapula and detached from the humerus to the humerus to provide dynamic stability at the Glenohumeral (Shoulder) Joint. 

ScapulaHumerusGlenohumeral (Shoulder) Joint

 

These muscles are found deep within the shoulder. So, the pectoralis major, deltoid, trapezius, and latissimus dorsi muscle are some of the large muscles involved in moving our shoulder.

Pectoralis MajorDeltoidTrapeziusLatissimus Dorsi

 

Underneath these, we can find the rotator cuff muscles. So, our shoulder joint is made up of the head of the humerus. Which sits within the shallow glenoid fossa. At any one time, there was only about one-third of that humeral head sitting in the glenoid fossa.

Rotator CuffHead of HumerusGlenoid Fossa

This configuration allows lots of mobility of the joint but in return the shoulder joint sacrifices stability.

To regain stability we have four rotator cuff muscles, which are:

  1. Supraspinatus
  2. Infraspinatus
  3. Teres minor
  4. Subscapularis

S.I.T.SS.I.T.S (1)

Supraspinatus:

The supraspinatus originates any supraspinous fossa. As with many anatomical terms, the name of the muscle “Supra” refers to above and “Spinous” refers to the spine of the scapula.

Spinous

 

So the supraspinatus sits in the supraspinous fossa above the spine of the scapula.

Spine of the scapula

 

The supraspinatus then passes underneath the acromion to attach to the greater tuberosity on its superior facet.

Acromion and Greater Tuberosity

In terms of its action, the supraspinatus muscle in isolation creates abduction of the humerus. The muscle is innervated by this suprascapular nerve.

Infraspinatus:

The infraspinatus so from its name we can tell that it’s located below the spine of the scapula and it sits within the infraspinous fossa.

infraspinatussupraspinatus

The infraspinatus muscle inserts onto the greater tuberosity of the humerus on its middle facet. Just below the insertion of the supraspinatus muscle.

In isolation, the infraspinatus muscle performs lateral rotation or external rotation of the humerus.

It’s worth noting that the supraspinatus and infraspinatus share supply derived from the suprascapular nerve, which comes off the superior trunk of the brachial plexus to supply both of these muscles.

suprascapular nerve

Teres Minor Muscle:

The teres minor muscle is located just inferior to the infraspinatus on the lateral border of the scapula. It then inserts onto the greater tuberosity of the humerus on its inferior facet.

Teres Minor MuscleTeres Minor Muscle (GT)

In isolation, the teres minor muscle performs external or lateral rotation of the humerus. The nerve supply to the teres minor muscle is derived from the axillary nerve.

 

Subscapularis:

The Subscapularis muscle sits on the anterior surface of the scapula. The subscapularis originates in the subscapular fossa, which is this depression occupying almost all of the anterior part of the scapula from its origin on the scapula the subscapularis muscle inserts onto the lesser tuberosity of the humerus.

Subscapularis muscle 1Subscapularis muscle 2

The subscapularis is the largest and strongest rotator cuff muscle accounting for approximately 50% of the cuff strength output.

When you isolate this muscle it performs medial or internal rotation of the humerus.

The subscapularis is innervated by the subscapular nerves, which are comprised of the upper subscapular nerve and the lower subscapular nerve. Both these nerves originate from the posterior cord of the brachial plexus.

So, that’s an overview of the basic anatomy of the rotator cuff muscles.

 

For more information talk to a healthcare provider.

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Bones of the hand (Featured Image)

Bones Of The Hands

We are going to talk about the bones of the hand. And there are some questions like what are the bones of the hand? What are the primary bony landmarks? And what are some reasons to learn about them?

Let’s begin with the principle bone of the hand. Those bones consist of carpals, metacarpals, and phalanges.

Carpals, metacarpals, phalanges

 

Carpal bones are the wrist. In the surface anatomy, the christ is showing you the location of carpal bones. If you go right in the middle and distal then, there is an area called the carpal tunnel.

Carpal tunnel

 

Carpal bones form a concave surface and this has a roof called transverse carpal ligament (flexor retinaculum). It is made of dense regular collagen collective tissue and this is extremely tough as most as bones.

Transverse carpal ligament

 

The transverse carpal ligament forms a carpal tunnel it contains 4 tendons of the flexor digitorum superficialis (FDS), 4 tendons of the flexor digitorum profundus (FDP), and 1 flexor pollicis longus (FPL) tendon.

These 9 tendons all are wrap in synovial sheaths shown in blue color below image,

Synovial Sheaths

And there is a median nerve which is basically, it’s a connection between the forearm and the surface of the hand.

There are 8 carpal bones are organized in two rows. There is a proximal row 4 of carpal bones and distal row 4 of carpal bones.

Carpal bones 8 (rows)Ulna, Radius

 

There is a radius and ulna. Let’s, look at the 8 carpal bone are,

8 Bone names

  1. Scaphoid bone: The scaphoid articulates with the radius and it lies on the thumb side of your wrist. The scaphoid fracture is the most common fracture of the carpal bone.
  2. Lunate bone: Lunate means ‘moon’ in Latin because it has a shape like a moon.
  3. Triquetrum bone: This bone is articulate in the medial side of the wrist joint. It is a pyramidal-shaped bone.
  4. Pisiform bone: Pisiform bone has a shape of a pea that comes from the Latin word.
  5. Trapezium bone: The trapezium bone is the last in the row of wrist bones and is located beneath the thumb joint.
  6. Trapezoid bone: Trapezoid bone is Latin for table shaped.
  7. Capitate bone: Capitate bone is Latin for head-shaped.
  8. Hamate bone: Hamate bone is Latin for hook-shaped.

The Metacarpals bones get their name because the prefix ‘Meta’ is Greek for ‘after the wrist’. These are the bones after the wrist. There is the bone from 1 to 5.

Metacarpals 1 to 5

 

They are found in the palm area. So, there are metacarpals 1, 3, and 5. The medial shaft of the metacarpals in the body in the distal portion is called the “head” and the proximal portion is called the “base”.

Metacarpals (head, base)

 

 

The Phalanges are,

Phalanges

  1. Thumb finger
  2. Index finger
  3. Swear finger
  4. Ring finger
  5. Pinky finger

 

If we look at from finger 2 to finger 5, they are composed of three phalanges: proximal phalanges, middle phalanges, and distal phalanges. The thumb only has proximal and distal phalanges.

finger 2 to finger 5

Metacarpophalangeal joints (MCP)

The joint between metacarpals and proximal phalanges is called the Metacarpophalangeal (MCP) joint.

(DIP, PIP)IP Joint

  • The joint between the phalanges is called Proximal Interphalangeal (PIP) joint.
  • The joint between the proximal Interphalangeal and distal is called the distal interphalangeal (DIP) joint.
  • There are only two phalanges in the thumb, so there is only the Interphalangeal (IP) joint.

DIP, PIP, MCP

 

 

For more information talk to a healthcare provider.

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Aging disc Featured Image (Final)

The Aging Disc – Everything you need to know

To understand the aging disc, you must understand the normal intervertebral disc. We know that the disc has an annulus fibrosus outside and a nucleus pulposus inside.

With aging, there is degeneration of the disc that will alter the function of the disc.

What is the function of the intervertebral disc?

It links the vertebral bodies together and is responsible for about 25% of the spinal column height.

It is a cushion between the vertebrae, so it allows spinal motion, but also provided stability.

 

Normal Intervertebral Disc Is Made of two components:

Aging Disc (Anulus fibrosus, Nucleus pulposus)

Annulus Fibrosus (outside part):

  • Has high collagen and low glycosaminoglycan (GAG) concentrations.
  • Collagen gives the disc its tensile strength.
  • The collagen is Type 1 collagen, the same collagen present in bones.
  • The annulus fibrosus is a hard outside structure that protects the nucleus pulposus.
  • The annulus fibrosus has a multi-layer laminar architecture made of Type 1 collagen.
  • Each successive layer is oriented at 30 degrees to the horizontal in the opposite direction, leading to a criss-cross type of pattern.
  • The composition allows the annulus fibrosus. Which has the highest tensile modulus to resist the torsion the axial, and the tensile loads.
  • The inner part of the annulus fibrosus has fibrocartilaginous tissue that gradually blends with the nucleus pulposus.
  • Posterolateral, the annulus fibrosus is thinner. Has disorganized collagen, and has a greater proportion of vertical fibers.
  • It is the weakest part of the annulus fibrosus and this area contributes to the majority of disc herniation.
  • The nucleus pulposus is the central part of the intervertebral disc.
  • This is the part that is surrounded and protected by the annulus fibrosus.
  • It has Type 2 collagen and also has proteoglycans and a large percentage of the water.

 

2. Nucleus Pulposus (Inside part):

  • High in glycosaminoglycans (GAG) and low in collagen content.
  • Because it is low in collagen, it is a soft structure that is good in compression.
  • It allows compressibility (allows the load to be placed on the spine).
  • The collagen is type 2 collagen, the same collagen present in cartilage. (gentler, softer collagen)
  • The annulus fibrosus has high collagen and a low proteoglycan ratio.
  • The nucleus pulposus has type 2 collagen and also has a lot of proteoglycans, and has a high percentage of water.
  • The hydrophilic nature of the proteoglycans will be responsible for the height of the intervertebral disc.
  • The molecule of the proteoglycan is responsible for the hydrophilic behavior of the nucleus pulposus and it contributes to most of its ability to maintain the hydrostatic pressure.
  • The proteoglycans constitute a low percentage of dry weight within the annulus fibrosus and a high percentage of dry weight within the nucleus pulposus, and it interacts with water to resist compression.

 

Within the functional spine unit, the nucleus pulposus function is to resist compressive loads.

We should know that pressure within the nucleus pulposus of an adult intervertebral disc is greatest when sitting unopposed and the lowest pressure is when lying supine.

The nucleus pulposus is elastic, so it has low collagen and a high proteoglycan ratio.

It also has chondrocyte-like cells that are responsible for producing Type 2 collagen and proteoglycans. We have to connect these cells to nutrition or blood supply.

 

What is the blood supply of the disc?

The intervertebral disc is an avascular structure in adults. The capillaries will terminate at the endplate.

The nucleus pulposus receives the majority of its nutrition from diffusion from the blood vessels within the endplates.

The annulus fibrosus is not porous enough to allow diffusion of the fluids.

The nutrients will come from the blood vessels at the margins of the disc and it has to go through the cartilaginous endplate to reach the disc cells.

blood supply of the disc

The blood supply to the endplate and outer annulus decreases with age and the cellular metabolism is affected by decreased nutrition.

With aging, there will be intervertebral disc degeneration and there will be decreased nutrition to the intervertebral disc due to decreased vascularity.

The nucleus pulposus of the intervertebral disc has chondrocyte-like cells that have a limited blood supply and it generates energy through anaerobic glycolysis.

The nucleus pulposus needs glucose because they obtain their energy through glycolysis, even in the absence of oxygen.

The disc cells do not need oxygen to remain alive, but they need glucose, so they die at a low glucose level or acidic ph.

The aging of the spinal column begins very early.

It can be slowed by permanent attention to maintaining the spinal curves (including during the most common activities of daily living)

Normal weight must be maintained throughout life.

 

For more information talk to a healthcare provider.

If you have any questions about Aging Disc please feel free and leave a comment.

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Rheumatoid Arthritis featured Image

Rheumatoid Arthritis – causes, symptom, diagnosis, and treatment

 

In rheumatoid arthritis, “arthr- refers to joints, “-itis” means inflammation, and “rheumatoid” comes from rheumatism, which more broadly refers to a musculoskeletal illness.

Bones provide support for the body and aid in its movement. The place where two or more bones meet is called a joint. Joints may be immovable slightly movable or freely moveable.

A synovial membrane surrounds movable joints inside the membrane synovial fluid lubricates and nourishes joint tissue such as cartilage.

Articular cartilage is a tough slippery covering on the ends of the bones which allows smooth joint movement.

Joints give the body flexibility precision of movement and help in supporting the body’s weight.

Arthritis is any disorder that affects joints it can cause pain and inflammation.

Rheumatoid arthritis is the second most common type of arthritis. The joints most commonly affected area in the wrists, hands, knees, ankles, and feet.

It typically occurs at the same joint on both sides of the body. It can affect other organs in the body such as the eyes, skin, heart, lungs, kidneys, nervous system, and digestive tract.

All right, so a healthy joint typically has two bones covered with articular cartilage at the ends.

 

articular cartilage

 

Articular cartilage is a type of connective tissue that acts like a protective cushion and is a lubricated surface for bones to smoothly glide against.

One type of joint, like the knee joint, is a synovial joint. A synovial joint connects two bones with a fibrous joint capsule. That is continuous with the periosteum or outer layer of both bones.

 

synovial cells

 

Rheumatoid arthritis is an autoimmune disorder this means the body attacks itself by mistake in rheumatoid arthritis. The immune system attacks joint and organ tissues.

Here’s how it happens, the white blood cells of the immune system move into the joint. They release chemicals called cytokines. Which attacks the cell of the synovial membrane.

These chemicals cause synovial cells to release other destructive substances. They also cause the synovial membrane to new blood vessels and form a thickened area called a pannus.

Over time as the pannus grows it invades and destroys areas of cartilage and bone inside the joint. Inflammation causes fluid build-up in the joint making the joint swell.

Eventually, without treatment, the joint space narrows, and ankylosis can occur. Ankylosis is the fusion or growing together of bones in the joint. This results in the loss of the ability to move the joint.

There is no cure for rheumatoid arthritis. However, doctors commonly prescribed various combinations of the following medications that when taken together can reduce inflammation, pain, and slow down joint damage.

 

Rheumatoid arthritis medications:

These include non-steroidal anti-inflammatory drugs (NSAIDs), Steroids, and standard disease-modifying antirheumatic drugs (DMARDs).

If standard DMARDs aren’t working doctors may prescribe newer drugs called biologics also known as biologic DMARDs.

 

Diagnosis:

Diagnosis of rheumatoid arthritis usually involves confirmatory blood tests like looking for the presence of rheumatoid factor and anti-citrullinated peptide antibody.

Additionally, imaging studies, such as X-rays, usually reveal decreased bone density around affected joints, soft tissue swelling, narrowing of the joint space, and bony erosions.

Arthritis X-rays

 

Rheumatoid arthritis treatment:

  • Physical therapy
  • Occupational therapy
  • Low-impact exercise (can increase muscle strength and help keep joints limber.)

 

Rheumatoid arthritis treatment: Surgical procedures

 

For severe rheumatoid arthritis that has not been helped by other treatments, a doctor may recommend a surgical procedure. For example, a joint replacement procedure also known as an arthroplasty may be recommended.

For joints that are difficult to replace joint fusion also known as arthrodesis may be recommended.

During, this procedure the joint is removed, and the bones are fused together with a bone graft.

Another surgical procedure for severe rheumatoid arthritis is a syndesmectom. During this procedure, the synovial membrane surrounding the joint is removed.

In some cases, an arthritic joint may need to be replaced with an artificial joint.

 

 

For more information talk to a healthcare provider.

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

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Supracondylar Fracture Featured Image (2)

Supracondylar Fracture of the Humerus in Children

 

Supracondylar fractures constitute approximately 50% of all elbow fractures. The supracondylar region is thin and weak and thus it can fracture easily.

Fracture Types:

  1. Extension fracture
  2. Flexion fracture

Extension type fracture:

  • Most common type (95-98%)
  •  Occurs due to falling onto an outstretched hand.
  •  The distal fragment displaces posteriorly.
  •  Anterior interosseous neurapraxia (AIN) is the most common nerve palsy occurring with supracondylar fractures.
  •  Injury to the anterior interosseous nerve will lead to weakness of the flexor digitorum profundus muscle to the index finger and the flexor pollicis longus (FPL) muscle.
  • The patient cannot do the OK sign or bend the tip of his index finger.
  • Radial nerve neurapraxia is the second most common palsy and is evident by weakness in wrist and fingers extension.

Extension-type-supracondylar-fracture

 

Flexion Type Fracture:

  • It is rare and occurs due to falling directly on a flexed elbow.
  • The distal fragment is displaced anteriorly.
  •  This type of fracture may be accompanied by Ulnar nerve neurapraxia.
  •  Injury of the Ulnar nerve will lead to loss of sensation along with the little finger.
  •  Later on, the patient may also have weakness of the intrinsic hand muscles and claws.

Flexion-type-supracondylar-fracture

 

Garland’s Classification System:

 

Garland’s classification for supracondylar elbow fractures,

Type 1: This is a Non-displaced fracture.
Type 2: Is angulated with an intact posterior cortex
Type 3: This is a fracture showing complete displacement.
Type 4: Complete periosteal disruption and shows instability in both flexion and extension.

Garland’s Classification System:
Garland’s Classification System:

Radiology:

 

Plain Anterior-Posterior (AP) and lateral X-rays should be obtained.

A posterior fat pad sign seen on a lateral view X-ray should increase your suspicion of an occult fracture around the elbow.

 

Anterior humeral line:

 

  • On a lateral view X-ray, the anterior humeral line is drawn along the anterior border of the distal humerus.
  • Normally the anterior humeral line should run through the middle third of the capitellum.
  • In extension type fractures the capitellum will be displaced posteriorly relative to the anterior humeral line.

Humerus Children Fracture

 

Baumann’s Angle:

 

  • Is formed by a line perpendicular to the axis of the humerus and a line going through the physis of the capitellum.
  • Normally, Baumann’s angle should measure at least 11 degrees.

 

Examination:

  • It is very important to assess the neurovascular structures.
  • The Anterior interosseous nerve is assessed by asking the patient to do the OK sign with his hand.
  • The Radial nerve is assessed by asking the patient to extend the wrist and fingers.
  • The Ulnar nerve is initially assessed by loss of sensation along with the little finger. Later on, the patient may also have weakness of the intrinsic hand muscles and claws.

 

Treatment:

1. Non-operative treatment:

  • Indicated for type 1 fractures.
  • Usually consists of splinting or casting the elbow for a duration of 3-4 weeks.
  • It is very important to remember not to flex the elbow in the splint or cast beyond 90 degrees in order to avoid vascular compromise and compartment syndrome.

2. Operative treatment:

  • Type 2 and 3 fractures are usually treated by closed reduction and percutaneous pinning.
  • During reduction, pronation of the forearm during elbow flexion helps to correct a Varus deformity.
  • After reduction, check for a gap in the fracture.
  • The neurovascular bundle may be trapped.
  • Free the brachialis muscle from the fracture site, if it is inter-positioned.
  • Fixation is usually achieved with 2-3 divergent lateral pins, depending on stability.
  • Medial pins can also be added depending on stability.
  • Open reduction is indicated only when closed techniques are unable to achieve the appropriate reduction of the fracture.
  • Avoid posterior dissection to preserve vascularity of the fractures segment.
  • Fracture reduction and fixation should be done emergently in cases of vascular compromise.

 

 

If you have any questions about Supracondylar Fracture please feel free and leave a comment.

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    Muscle of Hip And thigh Featured Image

    Muscles of the hip and Thigh – Human Anatomy?

    Muscles of the hip:

    Anterior hip muscles: Large one you can see from an anterior perspective and highlight in green, which is the psoas major muscle. The psoas major originates from the bodies of the vertebrate T12 to L4 and the costal processes of the vertebrae L1 to L5.

    vertebrae L1 to L5

     

    Located a bit more laterally, we find another muscle which is known as the iliacus muscle.

    iliacus muscle

     

    The iliacus muscle originates from the iliac fossa. The psoas major and the iliacus are usually distinguished as one muscle, and this is known as the iliopsoas muscle.

     

    iliopsoas muscle

    These muscles have different points of origin, however, they come together to pass underneath the inguinal ligament and into the region of the thigh to insert onto the lesser trochanter of the femur.

     

    trochanter of the femur

     

    The last muscle of the anterior hip, we are going to be talking about is the psoas minor muscle. This is a small muscle that runs along the surface of the psoas major. This muscle is sometimes not mentioned as it is often absent. Around about 40%-70% of people do not have this muscle.

    psoas minor muscle

    Anterior Hip Muscles: Function/Innervation/Blood Supply

     

    • Function: The iliopsoas is the most powerful flexor of the thigh at the hip joint.
    • Innervation: The lumbar plexus innervates the psoas major and psoas minor muscles.
    • Blood Supply: The iliopsoas muscle receives its blood supply from the iliolumbar artery and the medial femoral circumflex artery.

     

    Muscles of the hip: Superficial gluteal muscles

    There are four superficial gluteal muscles,

    1. Gluteus maximus muscle:

    It’s the most famous muscle that defines the buttocks. The gluteus maximus originates from the surface of the ilium posterior to the posterior gluteal line and the posterior inferior surface of the sacrum and the coccyx.

    Gluteus maximus muscle

     

    It inserts onto the gluteal tuberosity of the femur and the iliotibial tract.

    2. Gluteus medius muscle:

    The gluteus medius originates from the gluteal surface of the ilium and inserts onto the greater trochanter.

    Gluteus medius muscle

    3. Gluteus minimus muscle:

    Deep to the gluteus medium muscle, we find the gluteus minimus. The gluteus minimus also originates from the gluteal surface of the ilium. Inserts onto the greater trochanter of the femur.

    Gluteus minimus muscle

     

    4. Superficial gluteal muscle:

    The muscle extends from its origin at the anterior superior iliac line to its insertion at the iliotibial tract.

    Superficial gluteal muscle

    Muscles of the hip: Superficial gluteal muscles (Function/Blood Supply)

    Function: Extension, Abduction, Rotation of the thigh at the hip joint, Stabilize the pelvis.

    Blood supply: The muscles receive their blood supply from the superior gluteal artery and the inferior gluteal artery.

     

    Muscles of the Hip Deep Gluteal:

     

    Piriformis muscle: The muscle originates from the pelvic surface of the sacrum and is insert onto the greater trochanter of the femur.

    Obturator internus muscle: The obturator internus originates from the obturator membrane and inserts onto the greater trochanter and trochanteric fossa.

    Superior gemellus muscle: This muscle originates from the ischial spine and inserts onto the greater trochanter of the femur.

    Inferior gemellus muscle: The inferior gemellus originates from the tuberosity of the ischium and inserts onto the greater trochanter.

    Quadratus femoris muscle: This muscle originates from the tuberosity of the ischium and inserts into the intertrochanteric crest.

     

    Muscles of the Hip Deep Gluteal: (Function/Innervation/Blood Supply)

     

    Functions: lateral rotation of the thigh at the hip joint.

    Innervation: Is supplied by the sacral plexus.

    Blood supply: The muscle receive their blood supply from the superior gluteal artery and the inferior gluteal artery.

     

    Muscles of the Thigh: Anterior Compartments

     

    Sartorius muscle: This is the longest muscle in the human body and it extends from its origin at the anterior superior iliac spine. All the way to its insertion on the medial surface of the tibia.

    This muscle has various functions including flexion of the thigh and knee, lateral rotation of the thigh, and medial rotation of the knee.

     

    Quadriceps femoris muscle: The muscle is formed by four muscles –the rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis.

    These muscles all have different sites of origin. However, they all insert into the quadriceps tendon.

    Let’s take a look at these muscles individually, located most anteriorly, we have the rectus femoris muscle, and this muscle originates from the anterior inferior iliac spine and the supraacetabular sulcus.

    supraacetabular sulcus

    The vastus lateralis muscle is located laterally and it originated from the linea aspera femoris and the greater trochanter.

    vastus lateralis muscle

    In the middle, we can see another vastus which is known as the vastus intermedius muscle, and this muscle originates from the shaft of the femur.

    vastus intermedius muscle

    The next muscle is found medially and is known as the vastus medially muscle. This muscle originates from the linea aspera femoris and the intertrochanteric line.

    vastus medially muscle

    The last muscle of the anterior compartment is the articularis genu muscle, and it lies deep to the vastus intermedius

    articularis genu musclearticularis genu muscle

    This small flat muscle originates from the anterior distal femoral shaft and inserts onto the knee joint capsule.

    Muscles of the anterior compartment:

    Function:

    • Extension of the leg at the knee joint.
    • Flexion the thigh at the hip joint.

    Innervation:

    These muscles receive their innervation from the femoral nerve and their blood supply from the femoral artery and the deep femoral artery.

     

    Muscles of the thigh: Medial compartment

    Obturator externus muscle: This muscle originates from the obturator foramen and the obturator membrane and inserts at the trochanteric fossa.

    Obturator externus muscle

    The pectineus muscle originates from the iliopubic eminence and the pectineal line of the pubic bone and inserts at the linea asper femoris and the pectineal line of the femur.

    pectineus muscle

    Located most medially, the gracilis muscle is an exception within this group of the thigh muscles because it inserts on the tibia. The muscle originals from the inferior pubic ramus insert on the proximal medial surface of the tibia.

    Gracilis Muscle

    Adductors of the Thigh:

     

    Adductor Brevis muscle: The word Brevis means ‘short’ in Latin and adductor brevis is quite a short muscle. This muscle originates from the inferior pubic ramus and inserts on the linea aspera femoris.

    Adductor brevis muscle

    Adductor longus muscle: The adductor longus originates from the pubic symphysis and the superior pubic ramus and inserts on the linea aspera femoris.

    Adductor longus muscle

    Adductor Magnus muscle: This muscle originates from the inferior pubic ramus, ramus of the ischium, and tuberosity of the ischium. It inserts on the linea aspera femoris and the adductor tubercle.

    Adductor Magnus muscle

    Adductor minimus muscle: The adductor minimus originates from the inferior pubic ramus and inserts on the linea aspera femoris.

    Adductor minimus muscle

    Muscles of the Thigh: Posterior compartment

     

    The muscles of the posterior compartment are also known as the hamstring muscles.

    Biceps femoris muscle: It originates from the Sacrotuberous ligament, linea Aspera femoris, and tuberosity of the ischium. It then inserts onto the head of the fibula.

    Biceps femoris muscle

    Semitendinosus muscle: This muscle is located medially, and muscle originates from the sacrotuberous ligament and tuberosity of the ischium and it inserts on the proximal tibia medial to the tibial tuberosity.

    Semitendinosus muscle

    Semimembranosus muscle: This muscle originates from the tuberosity of the ischium and inserts on the medial condyle of the tibia and the oblique popliteal ligament.

    Semimembranosus muscle

     

     

    For further advice do reach out to your local doctor or family doctor.

    Do share this blog with your friends and family!

     

     

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