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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.

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.

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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

3. Osteogenesis Imperfecta:

‘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.
Inadequate bone formation with defective bone matrices
Due to mutation in bone collage gene
Clinical: unexpected fractures, family history, blue sclera (Photo 4:45)
Diagnose with DNA tests or collagen analysis
Treatment: bisphosphonates, surgery, no cure

4. Rickets and Osteomalacia:

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

Osteomalacia_rickets

5. Osteoporosis:

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

Osteoporosis Treatment:

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

Osteoporosis

For more information talk to a healthcare provider.

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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.

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.

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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.

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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 fibula Talus (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 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 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.

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.

syndesmosis syndesmosis 1

Cartilaginous joint:

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

These joints can be subclassified into two types

Synchondroses
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,

The sagittal axis, which passes horizontally from anterior to posterior.
The frontal axis, which passes horizontally from left to right.
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

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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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,

Bad Posture
Overuse and misuse of joints like in the case of athletes such as footballers, sprinters, and tennis players.
Nutritional deficiencies in the diet.
Osteoarthritis.
Rheumatoid arthritis.
Certain neurological problems.
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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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.

Scapula Humerus Glenohumeral (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 Major Deltoid Trapezius Latissimus 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 Cuff Head of Humerus Glenoid 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:

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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.

infraspinatus supraspinatus

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.

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 Muscle Teres 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 1 Subscapularis 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.

If you have any questions about Rotator Cuff, please feel free and leave a comment.

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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,

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.
Lunate bone: Lunate means ‘moon’ in Latin because it has a shape like a moon.
Triquetrum bone: This bone is articulate in the medial side of the wrist joint. It is a pyramidal-shaped bone.
Pisiform bone: Pisiform bone has a shape of a pea that comes from the Latin word.
Trapezium bone: The trapezium bone is the last in the row of wrist bones and is located beneath the thumb joint.
Trapezoid bone: Trapezoid bone is Latin for table shaped.
Capitate bone: Capitate bone is Latin for head-shaped.
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

Thumb finger
Index finger
Swear finger
Ring finger
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.

If you have any questions about Bones of the hand please feel free and leave a comment.

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

Supraspinatus:

Infraspinatus:

Teres Minor Muscle:

Subscapularis:

Metacarpophalangeal joints (MCP)

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