February 8, 2017

Inflammation is the innate immune system response to an attack on the body. This can occur through a blunt-force or penetrating tissue injury or in response to an infection caused by a pathogen. Exposure to chemical irritants or toxins will cause inflammation, as will burns, frostbite, or other injuries.

The word inflammation comes from the Latin “inflammo”, meaning “I set alight, I ignite”. Inflammation is a process by which the body’s white blood cells and substances they produce protect the human body from infection with foreign organisms, such as bacteria and viruses. With inflammation, white blood cells are released to protect the body from injury. These white blood cells have chemicals within them that, when leaked, induce swelling. If the injury occurs near the surface of the skin, the damaged area will throb and become red and warm. Blood flow also increases during inflammation. Inflammation can also affect internal organs, displaying a variety of symptoms depending upon the organ involved. The most common symptom of inflammation is pain.

However, in some diseases like, asthma, diabetes, obesity, depression, heart disease, arthritis, Alzheimer’s disease, osteoporosis, and other aging diseases, researchers have proven significant link between inflammation and the host.

The inflammation process protects the body by isolating the damaged area, attracting immune cells and molecules to the site and, in later stages, promoting the healing of affected tissues. In fact, without inflammation, wounds or infections would never heal.

Types of Inflammation

Acute inflammation occurs within minutes of an injury such as a cut, splinter, or insect bite. Or, it can take several hours to become fully activated in cases of bacterial infection, for example. But, in either case, it is a comparatively sudden, rapid, and short-term response to infection, injury, or toxic exposure. Signs and symptoms are only present for a few days, but in some cases may persist for a few weeks. Examples include –

  • Acute bronchitis
  • Infected ingrown toenail
  • Sore throat from a cold or flu
  • A scratch/cut on the skin
  • Exercise (especially intense training)
  • Acute appendicitis
  • Acute dermatitis
  • Acute tonsillitis
  • Acute infective meningitis
  • Acute sinusitis
  • A blow

The acute inflammatory response requires constant stimulation to remain active. So, when the injury starts to heal or the source of infection has been neutralized, the symptoms of inflammation also go away.

Chronic Inflammation occurs when the immune system can launch an inflammatory response against what should be relatively harmless irritants like, for example, dust or pollen. The resulting asthma or allergy attacks can often be far worse than the effects of exposure to the allergen itself. In some cases, the body can sustain a long-term inflammatory state in response to a lingering, low-grade infection that is never fully knocked out by the rest of the immune response. Examples include –

  • Asthma
  • Chronic peptic ulcer
  • Tuberculosis
  • Rheumatoid arthritis
  • Chronic periodontitis
  • Ulcerative colitis and Crohn’s disease
  • Chronic sinusitis
  • Chronic active hepatitis

However, chronic inflammation can eventually cause several diseases and conditions, including some cancers, rheumatoid arthritis, atherosclerosis, periodontitis, and hay fever. Inflammation needs to be well regulated.

CAUSES

There are many causes of inflammation ranging from blunt trauma and injuries to long-term, chronic health conditions. Inflammation can also be provoked by sore joints, muscles, and broken bones that have either not healed at all, or have healed incorrectly. Inflammation is one of the man conditions that can result from a compromised immune system.

  • Microbial infections – One of the most common causes of inflammation is microbial infection. Microbes include viruses, bacteria, protozoa, fungi and various parasites. Viruses lead to death of individual cells by intracellular multiplication, and either cause the cell to stop functioning and die, or cause explosion of the cell (cytolytic), in which case it also dies. Bacteria release specific toxins – either exotoxins or endotoxins. What’s the difference? Exotoxins are produced specifically for export (like anthrax toxins or tetanus toxins) whereas endotoxins are just part of the cell walls of Gram negative bacteria and they do terrible things to the body too but they aren’t as specific in their actions as the exotoxins.
  • Hypersensitivity reactions – A hypersensitivity reaction occurs when an altered state of immunologic responsiveness causes an inappropriate or excessive immune reaction that damages the tissues.
  • Physical agents, irritant and corrosive chemicals Tissue damage leading to inflammation may occur through physical trauma, ultraviolet or other ionizing radiation, burns or excessive cooling (‘frostbite’). Corrosive chemicals (acids, alkalis, oxidizing agents) provoke inflammation through direct tissue damage. These chemical irritants cause tissue damage that leads directly to inflammation.
  • Tissue necrosis – Death of tissues from lack of oxygen or nutrients resulting from inadequate blood flow (infarction) is a potent inflammatory stimulus. The edge of a recent infarct often shows an acute inflammatory response.

Possibly, one of the greatest reasons for inflammation is an imbalance of essential fatty acids. It is very important to maintain a balance between omega-3 and omega-6 fatty acids in the diet. Omega-3 fatty acids help reduce inflammation and most omega-6 fatty acids tend to promote inflammation. An inappropriate balance of these essential fatty acids contributes to the development of disease while a proper balance helps maintain and even improve health.

A healthy diet should consist of roughly one to four times more omega-6 fatty acids than omega-3 fatty acids. The typical American diet tends to contain 11 to 30 times more omega-6 fatty acids than omega-3 fatty acids and many researchers believe this imbalance is a significant factor in the rising rate of inflammatory disorders in the United States.

The four Principle Effects of Inflammation

  • Redness (rubor) – An acutely inflamed tissue appears red, due to dilatation of small blood vessels within the damaged area (hyperemia).
  • Swelling (tumor) – Swelling results from edema, the accumulation of fluid in the extravascular space as part of the inflammatory fluid exudate, and to a much lesser extent, from the physical mass of the inflammatory cells migrating into the area.
  • Heat (calor) – Increase in temperature is readily detected in the skin. It is due to increased blood flow (hyperemia) through the region, resulting in vascular dilation and the delivery of warm blood to the area.
  • Pain (dolor) – Pain results partly from the stretching and distortion of tissues due to inflammatory edema and, in part from some of the chemical mediators of acute inflammation, especially bradykinin and some of the prostaglandins.
  • Loss of function (functio laesa) – Loss of function, a well-known consequence of inflammation. Movement of an inflamed area is inhibited by pain, either consciously or by reflexes, while severe swelling may physically immobilize the affected area.

Autoimmune Diseases and Inflammation

An autoimmune disease, also known as autoimmune disorder, is one where the body initiates an immune response to healthy tissues, mistaking them for harmful pathogens or irritants. The immune response triggers an inflammatory response. These include –

  • Rheumatoid arthritis – There is inflammation in the joints, tissues surrounding the joints, and sometimes some other organs in the body
  • Ankylosing spondylitis – There is inflammation of the vertebrae, muscles, ligaments, and also the sacroiliac joints (where the spine and hips meet)
  • Celiac disease – There is inflammation and destruction of the inner lining of the small intestine
  • Crohn’s disease – The gastrointestinal tract becomes inflamed. Inflammation is most common in the ileum (small intestine), but may occur anywhere in the GI tract, from the mouth to the anus
  • Fibromyalgia – Often a set of symptoms related to another autoimmune disorder, such as lupus or rheumatoid arthritis. There is pain in various parts of the body. Location and even the existence of inflammation is unclear
  • Graves’ disease – One of the signs is goiter; when the thyroid gland is inflamed. Exophthalmos, inflammation of the muscles behind the eyes. Grave’s dermopathy, inflammation of the skin, usually the shins and the top of feet (uncommon)
  • Idiopathic pulmonary fibrosis – The role of inflammation is unclear. Experts used to think that the disease was mainly caused by inflammation within the alveoli (tiny sacs within the lungs
  • Lupus – There can be inflammation in the joints, lungs, heart, kidney and skin
  • Psoriasis – There is inflammation of the skin. In some cases, as in psoriatic arthritis, the joints and tissue surrounding the joints may also become inflamed
  • Type 1 Diabetes – Inflammation in various parts of the body are likely if the diabetes is not well controlled
  • Addison’s disease – Inflammation of the adrenal glands. The stress to the body caused by this disease can also lead to inflammation elsewhere
  • Vaslculitis – Refers to a group of disorders in which inflammation eventually destroys blood vessels, both arteries and veins
  • Transplant rejection – There is already substantial inflammation caused by the transplant operation. If the organ recipient’s immune system rejects the new organ, there is typically inflammation in and around the donated organ
  • Various allergies – All allergies have inflammation. Asthma has inflammation of the airways, in hay fever the nose, ear and throat mucous membranes become inflamed, people who are allergic to bee stings may have serious life-threatening inflammation which affects the whole body (anaphylaxis)
  • Vitamin A deficiency – Inflammatory responses are much more likely if the person is deficient in vitamin A.

Inflammation and Gut

Inflammation leads to disturbed gut flora, malfunctioning toll-like receptors, and leaky gut, allowing proteins to enter the body and provoke an inflammatory response by the immune system. More inflammation, more bacterial overgrowth. A bout of antibiotics thrown in for good measure which wipes out the bacteria, leaving a clean slate and prompting another mad dash by microbes to fill the vacancies, and the result is – potentially – a permanently altered/disrupted distribution of gut flora both supporting and supported by chronic systemic inflammation. When damaging proteins (like lectins from grains and legumes, for example, or gluten)  slip into the blood stream, they are recognized and the immune system responds as it normally would to foreign, damaging intruders: with inflammation.

Treatment

Conventional Treatment

Analgesics – These reduce pain, but do not reduce inflammation. These include Acetaminophen like Tylenol. Side effects include depleted Glutathione, which plays a critical part in the detoxification and anti-oxidation processes of the enzyme system.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) – These are the most widely used and prescribed medications, since they reduce pain as well as inflammation. These include Aspirin which reduces inflammation, suppresses fever, and acts as an anticoagulant. Side effects include reduction in the levels of Folic acid, iron, potassium, sodium, and vitamin C.

Corticosteroids – These are synthetic forms of naturally occurring hormones produced by the adrenal glands that provide powerful and immediate short-term relief of inflammation. These include Cortisone, Hydrocortone, and Prednisone.

Alternative Treatment

Essential Fatty Acids – GLA (GammaLinoleicAcid) & Omega-3 essential fatty acids (EPA/DHA from fish oils). The daily consumption of fish oil, omega-3 reduced both inflammation and anxiety in a group of young healthy people.

Antioxidants – Acai, blueberry, cranberry, grape seed, green tea, hesperidin, lycopene, mangosteen, pomegranate, quercetin have has anti-allergy, antibacterial, anti-inflammatory, antifungal and antihistamine properties.

Minerals – Calcium,magnesium, phosphorus, potassium, sodium are powerful anti-inflammatory nutrient.

Vitamin D – The increased levels of vitamin D was shown to improve muscular function, control blood pressure and improve levels of glucose in the body.

Vitamin C – A hardworking antioxidant, vitamin C offers two added bonuses: it helps the body deal with stress, and it boosts the activity of another outstanding anti-inflammatory, vitamin E.

Vitamin E – While vitamin E is commonly known as a fat-soluble antioxidant, it is also becoming a more popular choice to use as an anti-inflammatory.

Trace Minerals – Boron, chromium, copper, iodine, iron, manganese, molybdenum, selenium, silver, zinc help in inflammation.

Herbs

Harpagophytum procumbens – also known as devil’s claw, wood spider or grapple plant comes from South Africa and is related to sesame plants. European colonists brought devil’s claw back home to treat arthritis, fever and pain.

Ginger, also known as ginger root, is the mass of roots (rhizome) of the Zingiber officinale plant. It is used as a medicine or a spice. It has been used for hundreds of years to treat dyspepsia, constipation, colic, other gastrointestinal problems, as well as rheumatoid arthritis pain.

Curcumin a powerhouse anti-inflammatory, curcumin is the active ingredient in turmeric, the spice used in curries and other Indian foods.

Boswellia (frankincense). Similarly, the boswellia plant, from which the aromatic resin frankincense is derived, contains powerful anti-inflammatory compounds known as boswellic acids.

Spirulina. This increasingly popular blue-green microalgae variety is poised to become the next big thing as far as “superfoods” are concerned, and for good reason.

Cannabis contains a cannabinnoid called cannabichromene, which has been shown to have anti-inflammatory properties.

 

Reference

http://www.medicalnewstoday.com/articles/248423.php?page=2

http://articles.mercola.com/sites/articles/archive/2013/03/07/inflammation-triggers-disease-symptoms.aspx

http://lpi.oregonstate.edu/mic/micronutrients-health/inflammation

http://www.webmd.com/a-to-z-guides/prevention-15/vitamins/chronic-pain-relief

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011108/

http://www.nutrishield.com/the-science/anti-inflammatory/

http://www.aboutibs.org/site/what-is-ibs/gut-bacteria

http://www.marksdailyapple.com/gut-flora-inflammation/#axzz3r0tcTbCh

http://kellybroganmd.com/article/from-gut-to-brain-the-inflammation-connection/

http://articles.mercola.com/sites/articles/archive/2013/03/07/inflammation-triggers-disease-symptoms.aspx

 

Posted in MUSCULOSKELETAL
February 8, 2017

Headaches are one of the most common neurological problems presented to GPs and neurologists. They are painful and debilitating for individuals, an important cause of absence from work or school and a substantial burden on society.

A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and sometimes by taking medicines.

Anyone can experience a headache. Nearly 2 out of 3 children will have a headache by age 15. More than 9 in 10 adults will experience a headache sometime in their life. Headache is our most common form of pain and a major reason cited for days missed at work or school as well as visits to the doctor. Without proper treatment, headaches can be severe and interfere with daily activities. Certain types of headache run in families. Episodes of headache may ease or even disappear for a time and recur later in life. It’s possible to have more than one type of headache at the same time.

Symptoms & Types

There are two types of headaches –

Primary headaches – This occur independently and are not caused by another medical condition. It’s uncertain what sets the process of a primary headache in motion. A cascade of events that affect blood vessels and nerves inside and outside the head causes pain signals to be sent to the brain. Brain chemicals called neurotransmitters are involved in creating head pain, as are changes in nerve cell activity (called cortical spreading depression). Migraine, cluster, and tension-type headache are the more familiar types of primary headache.

  • Tension headaches – These are caused by muscle tension in the shoulders, neck, and head. The tension may  come from fatigue, an uncomfortable body position, or emotional stress. Tension headaches typically begin in the  morning or early afternoon and can get worse during the day. They often involve a tight pressure feeling like a band  around the forehead, but pain may spread over the entire head and downward into the neck and shoulders.
  • Cluster headaches – These types of headaches can be very painful. The intensely sharp pain usually involves one side of the head and spreads around the eye. Cluster headaches start suddenly and generally last about an hour. Attacks come in groups hence the name “cluster” occurring several times a day or each week and continuing for 6 to  8 weeks.
  • Migraine headaches – Often marked by intense throbbing head pain… blurred vision with shimmering light specks, dizziness or nausea, sensitivity to light, sound, or odors. Migraines are certainly a different type of headache.

Secondary headaches – These are  symptoms of another health disorder that causes pain-sensitive nerve endings to be pressed on or pulled or pushed out of place. They may result from underlying conditions including fever, infection, medication overuse, stress or emotional conflict, high blood pressure, psychiatric disorders, head injury or trauma, stroke, tumors, and nerve disorders (particularly trigeminal neuralgia, a chronic pain condition that typically affects a major nerve on one side of the jaw or cheek).

  • Headaches related to high blood pressure – As the blood vessels and circulatory system throughout the body  are affected by high blood pressure, headaches may result. The pain is typified by a throbbing sensation throughout the  head, though the headaches are generally not chronic in nature.
  • Headaches resulting from eye or sinus problems – Sinus congestion or built­up pressure in the eyes due to  glaucoma are examples of the types of physical problems that can occur with your eyes, ears, nose and/or throat that result  in headaches. These headaches will often disappear when the underlying condition is effectively treated.
  • Headaches associated with facial disorders – One such disorder (originally known as temporomandibular joint or TMJ syndrome), now known as myofascial pain dysfunction (MPD), is characterized by a dull aching pain in and  around the ear that is associated with chewing food. The pain may radiate to the side of the scalp causing a headache. Difficulty opening the mouth or a clicking/popping sound in the jaw joint may also be present. Once symptoms are recognized, treatment can be effective.

Causes

Anything that stimulates the pain receptors in a person’s head or neck can cause a headache, including –

  • Stress
  • Muscular tension
  • Dental or jaw problems
  • Infections
  • Diet
  • Eye problems
  • Hormonal influences
  • Medications
  • Disorders of the ear nose or throat
  • Disorders of the nervous system
  • Injury to the head, neck or spine
  • High blood pressure
  • Poor posture – puts unnecessary strain on the muscles of the back and neck
  • Hangover from abuse of alcohol or drugs
  • Temperature – extremes of heat or cold
  • Dehydration – affects blood pressure
  • Noise – especially loud noises
  • Temporal arteritis – inflammation of the artery at the temple, most common in elderly people
  • Arthritis

In rare cases, a headache can be a sign of something more serious, such as:

  • Bleeding in the area between the brain and the thin tissue that covers the brain (subarachnoid hemorrhage)
  • Blood pressure that is very high
  • Brain infection, such as meningitis or encephalitis, or abscess
  • Brain tumor
  • Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus)
  • Buildup of pressure inside the skull that appears to be, but is not a tumor (pseudomotor cerebri)
  • Carbon monoxide poisoning
  • Lack of oxygen during sleep (sleep apnea)
  • Problems with the blood vessels and bleeding in the brain, such as arteriovenous malformation (AVM), brain aneurysm, or stroke

Treatment

Pain reliever — A pain reliever may be recommended first for the treatment of tension type headache. These drugs include –

  • Aspirin
  • Acetaminophen (eg, Tylenol®)
  • Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen (eg, Motrin or Advil), indomethacin, or naproxen (eg, Naprosyn or Aleve).

Pain medicine combinations — Mild pain relievers are also available in combination with caffeine, which enhances the drug’s effect. As an example, Excedrin® contains a combination of acetaminophen-aspirin-caffeine. This combination may be recommended if a pain reliever alone does not relieve the headache. However, this combination is not recommended more than nine days per month due to the potential risk of developing medication-overuse headaches.

Antidepressants — Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches. Examples of TCAs include amitriptyline (used most commonly), nortriptyline, and protriptyline.

The dose of TCAs used for people with headaches is typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses, although it is not exactly clear how the medicines work.

Other treatments — Tricyclic antidepressants are sometimes used in combination with behavioral therapy to prevent tension-type headaches. The goal of behavioral therapy is to identify and try to avoid behaviors that can trigger a headache. (See ‘Lifestyle changes’ below.)

Alternative treatment

Magnesium – Magnesium plays a vital role in multiple physiologic processes and therefore it is a vital component in a healthy diet. It is absorbed through the gastrointestinal tract (gut), with more absorbed when the internal content is lower. Magnesium also appears to facilitate calcium absorption.

Feverfew (Tanacetum parthenium) – Feverfew (Tanacetum parthenium) is a species in the chrysanthemum family, whose dried leaves have long been used as a headache remedy.

Coenzyme Q10 (CoQ10) – Coenzyme Q10 (CoQ10) is often described as a vitamin, or a vitamin-like substance. CoQ10 is involved in the creation of the important substance in the body known as adenosine triphosphate (ATP). ATP serves as the cell’s major energy source and drives a number of biological processes including muscle contraction and the production of protein. CoQ10 also works as an antioxidant.

Riboflavin – Riboflavin, also known as vitamin B2, is found in small amounts in many foods. It is needed for converting food to energy, and like CoQ10 also works as an antioxidant by mopping up the damaging free radicals.

Butterbur (Petasites hybridus) – Butterbur is a perennial shrub, found throughout Europe as well as parts of Asia and North America. It is usually found in wet, marshy ground, in damp forests, and adjacent to rivers or streams. The common name is attributed to the large leaves being used to wrap butter during warm weather.

Melatonin – There are many reasons melatonin should be beneficial in headache, but no proof exists presently. It has been shown to be useful for insomnia.

Vitamin D3 – Vitamin D deficiency/insufficiency is common and harmful.

Acupuncture – This ancient technique uses hair-thin needles inserted into several areas of the skin at defined points. While the results are mixed, some studies have shown that acupuncture helps reduce the frequency and intensity of chronic headaches.

Biofeedback – Patients might be able to control headaches by becoming more aware of and then changing certain bodily responses, such as muscle tension, heart rate and skin temperature.

Massage – Massage can reduce stress, relieve pain and promote relaxation. Although its value as a headache treatment hasn’t been determined, massage may be particularly helpful if someone has tight muscles in the back of the head, neck and shoulders.

 

Reference –

http://www.mayoclinic.org/symptoms/headache/basics/causes/sym-20050800

http://www.medicalnewstoday.com/articles/73936.php#signs_and_symptoms

http://www.healthline.com/health/tension-headache#Causes2

https://www.wtamu.edu/webres/File/Student%20Life/Medical%20Services/Headaches.pdf

http://www.ihs-classification.org/_downloads/mixed/International-Headache-Classification-III-ICHD-III-2013-Beta.pdf

http://www.sign.ac.uk/pdf/sign107.pdf

https://www.nice.org.uk/guidance/cg150

 

Posted in MUSCULOSKELETAL
February 8, 2017

Gout is one of the most painful forms of arthritis and is the source of disability for many. It is caused by an accumulation of uric acid crystals in the joints. The crystals form when there are abnormally high levels of uric acid (hyperuricemia) in the body. The classic symptoms include abrupt, burning pain, with swelling, redness, warmth, and stiffness in the joint. Gout most commonly affects the joints of the big toe, but can occur elsewhere in the body, including the joints and surrounding areas of the foot, ankle, or knee.

Today, gout is among the fastest growing diseases in the United States. More than 8.3 million people in the United States are living with gout. It   is one of the oldest known diseases, known as far back as 4,000 years ago. Myths about its causes and treatment are common. One of the most popular myths is that gout is “the disease of kings” and other rich people and is caused by overindulgence. And while historically gout has been a male disease (three-fourths of cases occur in men), the incidence has been rising in older women, with as many as one in 20 over age 70 now afflicted.

What is Uric Acid?

Everyone has uric acid in their body. It is naturally present in small amounts. It is a waste product that results from the body’s normal processes. Cells die and release chemicals called purines. Uric acid is made from purines. When we eat or drink high-purine foods, uric acid levels go up. High uric acid levels are part of what triggers a gout attack.

Normally, uric acid is dissolved in the blood and passes through the kidneys and out into the urine. But when more uric acid is produced than the kidneys can get rid of, high uric acid levels – hyperuricemia develop. High uric acid may turn into crystals in the joints. When uric acid crystals accumulate in the joints they can make for a painful attack of gout.

A gout attack is extremely painful. Some people report it feels like the affected joint is caught in a mechanical device. 

Causes

Gout is caused initially by an excess of uric acid in the blood (hyperuricemia). Uric acid is produced in the body through the breakdown of purines – specific chemical compounds that are found in high amounts in certain foods such as meat, poultry and seafood.

Normally, uric acid is dissolved in the blood and is excreted from the body in urine via the kidneys. If too much uric acid is produced or not enough is excreted then it can build up and form the needle-like crystals that trigger inflammation and pain in the joints and surrounding tissue.

There are a number of factors that can increase the likelihood of hyperuricemia, and therefore gout –

  • Age and gender– Men produce more uric acid than women, though women’s levels of uric acid approach those of men after the menopause
  • Genetics – a family history of gout increases the likelihood of the condition developing
  • Lifestyle choices – Alcohol consumption interferes with the removal of uric acid from the body. Eating a high-purine diet also increases the amount of uric acid in the body
  • Lead exposure – Chronic lead exposure has been linked to some cases of gout
  • Medications – certain medications can increase the levels of uric acid in the body; these include some diuretics and drugs containing salicylate
  • Weight -Being overweight increases the risk of gout as there is more turnover of body tissue, which means more production of uric acid as a metabolic waste product. Higher levels of body fat also increase levels of systemic inflammation as fat cells produce pro-inflammatory cytokines.

Other health problems –renal insufficiency and other kidney problems can reduce the body’s ability to efficiently remove waste products, leading to elevated uric acid levels. Other conditions associated with gout include high blood pressure (hypertension), diabetes and hypothyroidism. 

Symptoms

For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Gout may also appear in another low-body joint such as the ankle or knee. Subsequent attacks may occur off and on in other joints, primarily those of the foot and knee, before becoming chronic.

Gout usually affects one joint at a time, but if left untreated it can affect many joints. Joint pain that used to resolve in a week to 10 days could become a milder, but constant pain. Eventually, untreated gout can cause other problems.

Tophi – painless but disfiguring lumps of crystals formed from uric acid may develop under the skin around joints. The crystals can also form kidney stones.

Gout is associated with other serious health risks such as high blood pressure, diabetes, chronic kidney disease and cardiovascular disease.

Four Stages of Gout –

  • Asymptomatic Hyperuricemia – At this stage, symptomatic treatment is not required, though urate crystals are being deposited in tissue and causing slight damage.
  • Acute Gout – This stage occurs when the urate crystals that have been deposited suddenly cause acute inflammation and intense pain.
  • Interval or Inter Critical Gout – Subsequent flares may not occur for months or years, though if not treated over time they can last longer and occur more frequently.
  • Chronic Tophaceous Gout – This final stage is the most debilitating form of the disease, where permanent damage may have occurred in the joints and the kidneys.

Treatment

Conventional Treatment

Medications

  • Colchicine – May be most effective when taken within the fi rst 12 hours of an acute attack. Patients may have side effects such as nausea, vomiting, abdominal cramps or diarrhea.
  • Glucocorticosteroids (cortisone) – This quickly suppresses the inflammation of an acute attack.
  • Nonsteroidal anti-infl ammatory drugs (NSAIDS)
  • Allopurinol – It decreases the body’s production of uric acid and is recommended for patients with a history of kidney stones or tophi.
  • Febuxostat – This medication is taken orally and decreases the body’s production of uric acid.
  • Pegloticase – This is an intravenous infusion of an enzyme used to dissolve gout crystals in advanced and diffi cult to control gout.
  • Probenecid – This medication increases the kidneys’ ability to remove uric acid from the body.

Alternative Treatment

Nutritional Supplements

  • A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc and selenium.
  • Omega-3 fatty acids, such as fish oil helps to decrease inflammation and promote general health. Cold-water fish, such as salmon or halibut, are good sources.
  • IP-6 (inositol hexophosphonate)
  • N-acetyl cysteine for antioxidant effects.
  • Vitamin C acts as an antioxidant. Studies suggest that higher vitamin C intake helps to lower the risk of gout.
  • Acidophilus (Lactobacillus acidophilus) helps to maintain gastrointestinal tract and immune health.
  • Methylsulfonylmethane (MSM) helps to decrease inflammation.

Herbs

  • Cranberry (Vaccinium macrocarpon), for kidney health.
  • Green tea (Camelia sinensis), for antioxidant and immune effects.
  • Devil’s claw (Harpagophytum procumbens), for pain and inflammation. Devil’s claw may increase the blood-thinning effect
  • Cat’s claw (Uncaria tomentosa) for inflammation, immune, and antibacterial/antifungal activity.
  • Bromelain (Ananus comosus), for pain and inflammation.
  • Turmeric (Curcuma longa), for inflammation.

Accupuncture – May help manage pain associated with gout.

 

Reference

http://www.nhs.uk/Conditions/Gout/Pages/Symptoms.aspx

http://www.medicalnewstoday.com/articles/144827.php

http://www.nytimes.com/2011/05/10/health/10brody.html?_r=0

http://gouteducation.org/wp-content/uploads/2010/05/Gout_Brochure.pdf

http://gouteducation.org/wp-content/uploads/2010/05/Gout_Brochure.pdf

http://www.emedicinehealth.com/gout/page2_em.htm#gout_causes

http://www.pamf.org/handouts/gout.pdf

http://www.pamf.org/handouts/gout.pdf

http://www.pamf.org/handouts/gout.pdf

 

Posted in MUSCULOSKELETAL
February 8, 2017

Frozen shoulder (also known as adhesive capsulitis) is a condition in which the shoulder is stiff, painful, and has limited motion in all directions. Frozen shoulder often starts out of the blue, but may be triggered by a mild injury to the shoulder. The condition usually goes through three phases, starting with pain, then stiffness and finally a stage of resolution as the pain eases and most of the movement returns. This process may take a long time, sometimes as long as two or more years.

Frozen shoulder may be associated with diabetes, high cholestrol, heart disease and is also seen in patients with scar tissue in their hands, a condition called Dupuytrens contracture. It may follow an injury to the shoulder or surgery.

The lining of the shoulder joint, known as the ‘capsule’, is normally a very flexible elastic stucture. It’s looseness and elasticity allows the huge range of motion that the shoulder has. With a frozen shoulder this capsule (and its ligaments) becomes inflamed, swollen, red and contracted. The normal elasticity is lost and pain and stiffness set in.

Frozen shoulder has three stages –

  • Freezing — Pain slowly becomes worse until range of motion is lost. (Lasts 6 weeks to 9 months)
  • Frozen — Pain improves, but the shoulder is still stiff. (Lasts 4 to 6 months)
  • Thawing — Ability to move the shoulder improves until normal or close to normal. (Lasts 6 months to 2 years)

Frozen shoulder affects 10-20 percent of people with diabetes according to the American Academy of Orthopaedic Surgeons. Women are more likely to develop frozen shoulder than men and it occurs most frequently in people between the ages of 40 and 60.

Treatment of frozen shoulder focuses on controlling pain and getting movement back to normal through physical therapy. Sometimes surgery is also considered.

Causes

The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

  • Diabetes – Frozen shoulder occurs much more often in people with diabetes, affecting 10% to 20% of these individuals. The reason for this is not known.
  • Other diseases – Some additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease.
  • Immobilization – Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.

Risk Factors

Common risk factors for frozen shoulder are –

  • Age – being over 40 years of age.
  • Gender – 70% of people with frozen shoulder are women.
  • Recent surgery or arm fracture – immobility of recovery may cause the shoulder capsule to stiffen.
  • Diabetes – two to four times more likely to develop frozen shoulder for unknown reasons; symptoms may be more severe.
  • Having suffered a stroke.
  • Hyperthyroidism (overactive thyroid).
  • Hypothyroidism (underactive thyroid).
  • Cardiovascular disease (heart disease).
  • Parkinson’s disease.

Symptoms

Early symptoms of frozen shoulder –

  • A feeling of pain and tightness in the shoulder area.
  • A feeling of tightness especially when putting the arm up and back, as you would do it you were throwing a ball overarm.
  • Pain on the back of the wrist. (This specifically relates to frozen shoulder caused by subscapularis trigger points.)

As time goes on, the symptoms will worsen although the pain may be reduced.

Complications

Complications may include –

  • Stiffness and pain continue even with therapy
  • The arm can break if the shoulder is moved forcefully during surgery

Treatment

Medication – More than 90% of patients improve with relatively simple treatments to control pain and restore motion.

  • Non-steroidal anti-inflammatory medicines – Drugs like aspirin and ibuprofen reduce pain and swelling.
  • Steroid injections – Cortisone is a powerful anti-inflammatory medicine that is injected directly into the shoulder joint.

Physical Therapy

  • External rotation — passive stretch
  • Forward flexion — supine position
  • Crossover arm stretch

Surgeries – The goal of surgery for frozen shoulder is to stretch and release the stiffened joint capsule. The most common methods include manipulation under anesthesia and shoulder arthroscopy.

  • Manipulation under anesthesia.
  • Shoulder arthroscopy

Transcutaneous electrical nerve stimulation (TENS) – numbs the nerve endings in the spinal cord that control pain and sends small pulses of electricity from the TENS machine to electrodes (small electric pads) that are applied to the skin on the affected shoulder.

Alternative Treatment

Glucosamine and chondroitin sulphate – reduces pain, swelling, and stiffness

Fish oil – reduces inflammation, stiffness, and the need for painkillers

Powdered ginger – reduces inflammation and muscle spasms

Borage seed oil – reduces pain and swelling

Devil’s claw – reduces back pain and symptoms of arthritis and rheumatism

Stinging nettles and turmeric – may reduce pain, stiffness, and inflammation

Curcumin (used topically) – may reduce inflammation.

Magnesium – Helps the body to reabsorb the calcium.

Bromelain – The frozen shoulder may sometimes lead to disorder of the bone joints that will lead to orthopedic complications. Bromelain, a natural cure for frozen shoulder that is extracted from the stems of pineapple has great anti-inflammatory effects. It greatly reduces bruising and spasm occurring on the shoulder region that brings pain relief exquisitely

Acupuncture is largely considered the single most effective treatment option of any form. The treatment functions to eliminate the trigger points eradicating the condition immediately and permanently.

Stretching is another great way to treat frozen shoulder. You can use a number of different stretching methods, but one of the most effective is lying in bed close enough to the edge to allow the affected arm/shoulder to hang down. This position should be maintained for at least 10 minutes and repeated daily until the shoulder releases.

Craniosacral therapy helps the body to release restrictions in the connective tissue (fascia, ligaments, tendons, etc) anywhere in the body.  As the fascia opens up again, the muscles can relax and lengthen.  The joint is freed up and can move with greater ease, and the brain gets the message that it no longer needs to protect the body through muscle contraction.  Moreover, this therapy is exceedingly gentle and thus more acceptable than many other therapies when the pain level is already so high.

Osteopathic treatment –Many people are referred to an osteopath who can give advice on the best exercises to use. Osteopathic treatment can significantly reduce the recovery time for frozen shoulder. Osteopathic Manipulation Under Anesthesia is a technique used by Doctors of Osteopathy to return range of motion and decrease pain in patients with severely limited joint movement.

The treatment improves articular and soft tissue movement while the patient is sedated under monitorized anesthesia care.

 

Reference –

http://www.hopkinsmedicine.org/orthopaedic-surgery/specialty-areas/shoulder/conditions-we-treat/frozen-shoulder.html

http://www.drugs.com/condition/frozen-shoulder.html

http://www.livemint.com/Leisure/LEqfopMSHccrfZic5299tM/The-bite-of-a-frozen-shoulder.html

http://www.livemint.com/Leisure/LEqfopMSHccrfZic5299tM/The-bite-of-a-frozen-shoulder.html

https://www.bupa.co.uk/health-information/directory/f/frozen-shoulder

http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/frozen-shoulder

http://www.frozenshoulder.com/frozen-shoulder-diagnosis.php

http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/adhesive-capsulitis

http://www.emedicinehealth.com/frozen_shoulder/article_em.htm

http://www.diabetes.org/living-with-diabetes/complications/related-conditions/frozen-shoulder.html?referrer=https://www.google.co.in/

http://www.healthline.com/health/frozen-shoulder

http://emedicine.medscape.com/article/1261598-overview

http://www.saga.co.uk/magazine/health-wellbeing/conditions/bones-joints/frozen-shoulder-symptoms-and-treatment.aspx

https://www.shoulderdoc.co.uk/section/16

 

Posted in MUSCULOSKELETAL
February 8, 2017

Fibromyalgia is a common and complex chronic pain disorder that causes widespread pain and tenderness to touch that may occur body wide or migrate over the body.  ‘Fibro’ refers to the fibrous tissue, ‘myo’ refers to the  muscles and ‘algia’  refers  to  pain.

The pain and tenderness tend to come and go, and move about the body. Most often, people with this chronic (long-term) illness are fatigued (very tired) and have sleep problems. The diagnosis can be made with a careful examination.

Fibromyalgia is most common in women, though it can occur in men. It most often starts in middle adulthood, but can occur in the teen years and in old age. You are at higher risk for fibromyalgia if you have a rheumatic disease (health problem that affects the joints, muscles and bones). These include osteoarthritis, lupus, rheumatoid arthritis or ankylosing spondylitis. Although fibromyalgia is often considered an arthritis-related condition, it is not truly a form of arthritis (a disease of the joints) because it does not cause inflammation or damage to the joints, muscles, or other tissues. Like arthritis, however, fibromyalgia can cause significant pain and fatigue, and it can interfere with a person’s ability to carry on daily activities.

Scientists estimate that fibromyalgia affects 5 million Americans 18 or older. Between 80 and 90 percent of people diagnosed with fibromyalgia are women. However, men and children also can have the disorder. Most people are diagnosed during middle age.

Causes

The causes of fibromyalgia are unclear. They may be different in different people. Fibromyalgia may run in families. There likely are certain genes that can make people more prone to getting fibromyalgia and the other health problems that can occur with it. Genes alone, though, do not cause fibromyalgia.

There is most often some triggering factor that sets off fibromyalgia. It may be spine problems, arthritis, injury, or other type of physical stress. Emotional stress also may trigger this illness. The result is a change in the way the body “talks” with the spinal cord and brain. Levels of brain chemicals and proteins may change. For the person with fibromyalgia, it is as though the “volume control” is turned up too high in the brain’s pain processing centers.

Fibromyalgia has also been linked to –

  • Stressful or traumatic events, such as car accidents
  • Repetitive injuries
  • Illness
  • Certain diseases.

Fibromyalgia can also occur on its own.

Symptoms

The main symptoms of fibromyalgia are:

  • Widespread pain in your muscles
  • Tiredness (fatigue)
  • Sleep disturbance

The severity of symptoms varies from person to person and from day to day. Many people have flare-ups from time to time when their symptoms become suddenly worse. People with fibromyalgia often say that the fatigue is the worst part of the condition and that they can’t seem to think clearly or remember things properly (this is sometimes called ‘fibrofog’).

The pain may feel as though it affects your whole body, or it may be particularly bad in just a few areas. Some people find that their pain feels worse in very hot, cold or damp weather.

Less frequent symptoms of fibromyalgia include –

  • Poor circulation – tingling, numbness or swelling in your hands and feet
  • Headaches
  • Irritability or feeling miserable
  • Feeling an urgent need to urinate, especially at night
  • Irritable or uncomfortable bowels (diarrhoea or constipation and abdominal pain)

Treatment

Medication

  • Painkillers like paracetamol can help to ease pain. Where paracetamol isn’t strong enough, some people find drugs like co-codamol or co-dydramol useful. These contain paracetamol plus a stronger painkiller such as codeine, but they can cause side-effects such as constipation.
  • Opiate drugs include tramadol, codeine and buprenorphine or fentanyl patches. They’re very strong painkillers with many side-effects and it can be difficult to stop taking them once they’re started. Doctors, especially in pain clinics, may offer these if the pain is seriously affecting your quality of life but they don’t always work in fibromyalgia and should be used as sparingly as possible due to the risk of long-term side-effects.
  • Capsaicin gel or non-steroidal anti-inflammatory gels rubbed into the painful areas may help you, but there’s no convincing evidence that they’re effective in most people with fibromyalgia, especially as many different areas of your body can be affected at the same time.
  • Drugs such as low-dose amitriptyline and dosulepin can reduce muscle pain and improve your sleep pattern. These drugs need to be taken 2–3 hours before you settle at night. They may not work straight away, so you may need to try them for a few months to see whether they help. Your doctor will gradually increase the dose to an effective level.
  • Antidepressants, such as fluoxetine or paroxetine, can help with both pain and low mood. Drugs such as pregabalin and gabapentin have been used to treat pain. You’ll need to take them for a period of 6 weeks to assess whether they’re helpful. These can cause side-effects such as dizziness and weight gain.
  • Duloxetine can help with pain and sleep disturbance. 

Alternative Treatment

Omega-3 fatty acids, such as fish oil helps to reduce inflammation and improve immunity.

A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.

Alpha-lipoic acid for antioxidant support. Alpha-lipoic acid may decrease thiamine levels.

L-carnitine for muscular support. L-carnitine may make symptoms of hypothyroidism worse, and can potentially increase the likelihood of seizure in people with a history of seizures.

Magnesium for symptoms of fibromyalgia. Magnesium can potentially interact with certain medications, including high blood pressure medicines and some antibiotics.

S-adenosylmethionine or SAMe for mental and immune support. People who have manic or bipolar disorder should not take SAMe.

Probiotic supplement (containing Lactobacillus acidophilus) for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration.

Calcium/vitamin D supplement, for support of muscle and skeletal weakness.

Coenzyme Q10 for antioxidant, immune, and muscular support. Coenzyme Q10 can interfere with the actions of some blood-thining medications, such as warfarin (Coumadin) and others

Chlorella (Chlorella pyrenoidosa), a blue-green algae, may help lessen symptoms. Chlorella contains large amounts of vitamin K, a nutrient that helps the body’s clotting function and may interfere with blood-clotting effects of certain medications, such as warfarin (Coumadin) and others.

Melatonin for sleep and immune support.

Green tea (Camelia sinensis) for antioxidant and immune effects. Use caffeine-free products.

Cat’s claw (Uncaria tomentosa) for inflammation, immune, and antifungal activity. Cat’s claw can interfere with a variety of medications, and may worsen certain conditions, such as leukemia and some autoimmune disorders.

Bromelain (Ananus comosus) for pain and inflammation. Bromelain can have a blood thinning effect and increase the effectiveness of blood-thinning medications, such as aspirin and warfarin.

Turmeric (Curcuma lon ga) for inflammation. Turmeric can have a blood-thinning effect and can increase the effectiveness of blood-thinning medications, such as aspirin and warfarin (Coumadin).

Rhodiola (Rhodiola rosea), for antioxidant, anti-stress, and immune activity.

 

Reference –

http://sacfs.asn.au/download/consensus_overview_fms.pdf\

http://www.awmf.org/fileadmin/user_upload/Leitlinien/041_D_Interdisziplinaere_V_fuer_Schmerztherapie/041-004le_S3_Fibromyalgiesyndrom_2012-04.pdf

http://www.niams.nih.gov/health_info/fibromyalgia/#b

http://www.medicinenet.com/fibromyalgia_facts/article.htm

http://www.mayoclinic.org/diseases-conditions/fibromyalgia/basics/risk-factors/con-20019243

http://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf

http://www.healthline.com/health/fibromyalgia-causes#Overview1

http://www.nhs.uk/Conditions/Fibromyalgia/Pages/Causes.aspx

http://www.everydayhealth.com/fibromyalgia-pictures/8-natural-fibromyalgia-treatments.aspx

 

 

 

 

 

Posted in MUSCULOSKELETAL
February 8, 2017

Dystonia is the term used to describe uncontrollable and sometimes painful muscle spasms caused by incorrect signals from the brain. Dystonia is not a single disease but a syndrome – a set of symptoms that cannot be attributed to a single cause but share common elements. Some forms of Dystonia may affect a specific body area, such as the neck, face, jaw, eyes, limbs or vocal cords.

It is caused by abnormal signals from the basal ganglia part of the brain to the muscles. These wrong messages result in sustained muscle contractions. Dystonia is made worse with voluntary movement. Dystonia can vary in severity from mild to severe. It can be focal, involving just one muscle group or body part; or it can be generalised, involving the whole body. It can be present alongside other motor problems such as spasticity, and its presence may not always be readily recognised.

This particular motor disorder can have a delayed onset, e.g. weeks or even months after the brain injury occurred. Dystonia may sometimes become more obvious over time, and this may lead to a loss of motor skills. Severe dystonia can lead to pain, joint damage and deformity.

Dystonia affects men, women and children of all ages and backgrounds. It can develop in childhood and is often particularly disabling for children. Dystonia may be genetic or caused by factors such as physical trauma, exposure to certain medications, or other neurological conditions.

Types of Dystonia

Dystonia can be classified according to the age of onset (childhood, adolescent or adult) by body distribution (focal, multifocal, segmental, generalised or hemidystonia) or by the cause (primary, secondary, ‘dystonia plus’ syndromes or combinations of hereditary and degenerative causes) –

  • Focal dystonias affect one part of the body such as eyes, neck, arm or vocal cords and are the most common type.
  • Multifocal dystonias affect several different unrelated body parts, such as eyes, hands and vocal cords. Segmental dystonias involve two or more adjacent body parts, such as the arm and neck.
  • Hemidystonias affect only one side of the body, and commonly result from a stroke. Generalised dystonia is more severe and can affect the entire body.
  • Primary dystonia refers to the situation where dystonia is the only sign and there is no identifiable cause or structural abnormality in the central nervous system.
  • Secondary dystonia implies there is a clear cause, such as a change in the structure of the brain, an environmental cause, as part of an inherited or acquired neurological disease or due to drugs or toxins.
  • ‘Dystonia-plus’ syndromes occur when dystonia is combined with other pathological changes. It includes dopa-responsive dystonia and myoclonic dystonia.

Causes

The causes of dystonia are not fully known, but it is currently thought that the condition results from a malfunction in a part of the brain called the basal ganglia.

The basal ganglia are structures situated deep in the brain. They help to regulate voluntary and involuntary movement by controlling muscle contractions in the body.

The problem may mainly lie in an area of the basal ganglia called the globus pallidus. If this area of the brain is not functioning correctly then the control of another structure in the brain called the thalamus is affected.

The thalamus controls the planning and execution of movement and sends nerves to muscles via the spinal cord. The end result is that muscle co-ordination is not regulated properly. The wrong muscles will contract on movement or all muscles will contract unnecessarily causing abnormal movement and posture.

Muscles positioned around joints usually work in pairs opposite each other, eg the biceps and triceps muscles of the upper arm bend or straighten the elbow respectively.

Usually if one muscle of a pair is contracted the other is relaxed. However, in dystonia both muscles in the pair contract at the same time leading to the abnormal movement or posture.

It is thought that in some cases there may be a chemical imbalance or ‘wiring fault’ in the basal ganglia. Chemical transmitters, such as dopamine, convey messages from one nerve cell to another within the basal ganglia. If this balance is upset then incorrect signals will be sent out resulting in loss of regulation of co-ordinated movements.

The fault in the basal ganglia may be caused by an inherited factor or be secondary to another problem such as drugs or toxins, or a separate neurological disease. Secondary dystonia is particularly common in children.

Other contributing factors

  • Brain tumors
  • Carbon monoxide or heavy metal poisoning
  • Oxygen deprivation
  • Cerebral palsy
  • Huntington’s disease
  • MS (multiple sclerosis)
  • Parkinson’s disease
  • Some infections, such as encephalitis, TB (tuberculosis) or HIV
  • Some medications, such as those taken by patients with epilepsy
  • Stroke
  • Traumatic brain or spine injury
  • Wilson’s disease.

Symptoms

Dystonia affects different people in varying ways. Muscle contractions might –

  • Begin in a single area, such as your leg, neck or arm. Focal dystonia that begins after age 21 usually starts in the neck, arm or face and tends to remain focal or segmental.
  • Occur during a specific action, such as handwriting.
  • Worsen with stress, fatigue or anxiety.
  • Become more noticeable over time.

Areas of the body that can be affected include

  • Neck (cervical dystonia) – Contractions cause the head to twist and turn to one side, or pull forward or backward, sometimes causing pain.
  • Eyelids – Rapid blinking or involuntary spasms causing the eyes to close (blepharospasms) can make some people functionally blind. Spasms usually aren’t painful, but might increase when in bright light, under stress or interacting with people. The eyes might feel dry.
  • Jaw or tongue (oromandibular dystonia) – People might experience slurred speech, drooling, and difficulty chewing or swallowing. Oromandibular dystonia can be painful and often occurs in combination with cervical dystonia or blepharospasms.
  • Voice box and vocal cords (spasmodic dystonia) – People might have a tight or whispering voice.
  • Hand and forearm – Some types of dystonia occur only while doing repetitive activity, such as writing (writer’s dystonia) or playing a specific musical instrument (musician’s dystonia).

Complications

Depending on the type of dystonia, complications can include –

  • Physical disabilities that affect your performance of daily activities or specific tasks
  • Functional blindness from dystonia that affects your eyelids
  • Difficulty with jaw movement, swallowing or speech
  • Pain and fatigue, due to constant contraction of your muscles
  • Depression, anxiety and social withdrawal

Treatment

Therapy – Dystonia is not a well-understood problem, and it can be very difficult and frustrating to treat. This is despite the skill of the therapist or the frequency of therapy or excercising. Therapy techniques that can work well for other movement problems such as spasticity and weakness often do not work for individuals with dystonia.

Techniques – Dystonia makes it difficult for a person to control his or her own body movements and posture, and efforts to do so often make the problem worse. Often, the more a person tries to control their posture the more locked in they may become, or the more out of control the affected limb gets. Some individuals are able to develop their own techniques (triggers) for managing their dystonic posturing.  Therefore, it is possible for some individuals to gain some control.

Orthoses, splints and lycra – The presence of dystonia can cause difficulties with the fitting, making and wearing of splints or orthoses, and creative solutions are often needed. Protective splints to minimise pain, joint damage and for functional benefits can be useful and important in the management of dystonia. Lycra garment splinting may be worth trialing as it can work well for some individuals, especially in the upper limbs and trunk.

Medications –

  • Focal dystonias can sometimes be relieved by botulinum toxin injections.
  • Generalised dystonia may respond to oral drug treatments such as L-dopa, baclofen, benztropine, benhexol and others.
  • Generalised dystonias are best treated with oral or intrathecal medications. Intrathecal medications are delivered directly to the space surrounding the spinal cord. Intrathecal baclofen is a relatively new, expensive but effective treatment for severe generalised spasticity and dystonia.

Alternative Treatment

Magnesium is an important nutrient for bodily function. This nutrient regulates blood pressure, supports strong bones and muscles and controls heart rhythm. The nutrient also controls the movement of calcium and vitamin C, which are important factors in maintaining effective nerve function.

Lysine is an important amino acid that functions in a variety of ways to treat spasmodic torticollis. The compound has been shown to reduce anxiety by increasing serotonin levels in individuals, which helps reduce the strain of the condition. The nutrient also helps rebuild and repair damaged muscular and skeletal tissue, which also contributes to treatment of the condition.

Iodine is a vital trace element that is a component of normal growth and development. Iodine aids in the removal of toxins from the body that may be contributing to the condition. This nutrient also aids the body in the utilization of important minerals like calcium and silicon, which also contribute to effective nerve function.

Omega 3 fatty acids, B12 and Vitamin D

Acupuncture – Traditional Chinese acupuncture is a part of traditional Chinese medicine, a system of healing which has been practised in China and other Eastern countries for thousands of years. It involves insertion of fine needles. Some patients feel a little sharpness during needle insertion, while others feel nothing at all. It is used as a means of pain relief and also to treat stress, anxiety and depression.

Hypnosis is a psychological technique used in medicine as a tool to bring about positive changes to both the mind and the body. The hypnotic state is produced either by oneself (self-hypnosis) or by responding to a therapist.

Reflexology involves applying pressure to the feet and hands. The application of pressure to parts of the feet or the hands effect corresponding parts of the body through reflex zones and meridian points. Tensions can be felt though this is usually a pleasant sensation for the client. It can be used for general aches and pains, stress-related problems and anxiety and depression.

Autogenic Training is a structured meditative-style practice. It is a sequence of simple mental exercises which bring about profound mental and physical relaxation.

Craniosacral Therapy is a gentle ‘hands-on’ therapy that aims to release tensions, restrictions and misalignments in the body. It can be used alongside conventional treatments. It can be offered for muscular pains as well as stress and anxiety.

 

Reference –

http://brainfoundation.org.au/disorders/dystonia

http://www.rch.org.au/kidsinfo/fact_sheets/Brain_injury_Dystonia/

http://www.springer.com/in/book/9783709115152

http://rarediseases.org/rare-diseases/dystonia/

http://www.nejm.org/doi/full/10.1056/NEJMicm1412207

http://www.disabled-world.com/artman/publish/dystonia.shtml

http://www.medicalnewstoday.com/articles/171354.php

http://www.medicinenet.com/dystonia/article.htm

http://www.mayoclinic.org/diseases-conditions/dystonia/symptoms-causes/dxc-20163695

http://www.nhs.uk/conditions/Dystonia/Pages/Introduction.aspx

http://www.dystonia.org.uk/index.php/living-with-dystonia/coping-with-dystonia/complementary-medicine

https://www.multiplesystematrophy.org/about-msa/dystonia-non-pharm

 

Posted in MUSCULOSKELETAL
February 8, 2017

Dizziness is a term which is used to describe a variety of sensations. It is defined as feelings of unsteadiness, wooziness, and lightheadedness; and sensations of moving, spinning, floating, swaying, tilting, or whirling (sensations known as vertigo). These sensations occur even when standing still or lying down.

Many people who experience dizziness find it difficult to explain exactly how it makes them feel. For example, some people who feel dizzy, light-headed, giddy or off-balance describe the feeling as if they, or their surroundings, are spinning around. Doctors use the term vertigo (see below) to describe this spinning, revolving form of dizziness. Others describe feeling “wobbly”, as if they were on a merry-go-round or on a boat on choppy water.

Dizziness can range from fleeting faintness to a severe balance disorder that makes normal functioning impossible. Among adults over 60, about 20 percent have had a dizziness episode that affected their usual activities.

Dizziness may feel like:

  • Lightheadedness, as though you might pass out
  • Unsteadiness or a loss of balance
  • A false sense that you or your surroundings are spinning or moving (vertigo)
  • Floating, swimming or heavy-headedness

Dizziness is often temporary and goes away without treatment. As you talk with your doctor about your condition, try to describe your specific symptoms, how the dizziness makes you feel as it is coming on and after it has passed, what triggers it, and how long it lasts. This will help your doctor diagnose the cause and treat it.

Causes

For the body to feel balanced, the brain requires input from the inner ear, eyes, muscles and joints. Since mechanisms for maintaining balance are so complex, finding the exact cause of dizziness is often difficult and requires input from several medical specialties. Dizziness is generally not serious. However, it may be the result from problems associated with the inner ear, brain, or heart. It can also be the result of medications.

A wide range of conditions and diseases can cause dizziness, including –

Inner ear problems – Disorders of the inner ear account for about half of all cases of persistent (ongoing) dizziness. Disorders include Meniere’s disease, benign paroxysmal positional vertigo (BPPV) and vestibular neuritis.

Anxiety disorders – Stress or anxiety may play a role in causing dizziness or, more commonly, may be a contributing factor in dizziness from other causes, such as inner ear disease.

Brain disorders – A common cause of dizziness is migraine, even without the headache that most people associate with a migraine. Very rarely, other causes of dizziness can include stroke or other brain diseases.

Other conditions – Some cases of dizziness are due to underlying medical conditions such as low blood pressure, infection, some heart problems (such as cardiac arrhythmias) and hypoglycaemia (low blood sugar). Drugs that are used to treat conditions such as epilepsy, coronary heart disease and high blood pressure can also cause dizziness in some people.

Unknown causes – Although a cause may not be found in some people, it does not necessarily mean that these people cannot be helped by the appropriate treatment.

Medications are a common source of dizziness. The medicines can include drugs to treat seizure disorders (eg, carbamazepine, phenytoin), drugs to help calm or sleep (sedating drugs/antidepressants), and even drugs used to treat inner ear infections (eg, gentamicin, streptomycin).

Alcohol consumption is another cause of dizziness.

Dizziness caused by aging –

  • Reduced capacity for exercise or activity, weakness, and deconditioning
  • Reduced ability for the blood circulation to compensate for quickly assuming an upright position (orthostatic hypotension)
  • Hardening of the arteries (arteriosclerosis)
  • Neuropathy (a progressive dysfunction of the nerves that is caused by different illnesses, especially diabetes)
  • Menopause
  • Poor eyesight and coordination
  • Dementia

Symptoms

Descriptions of dizziness may include:

  • A sensation of movement (including spinning), either of yourself or the external environment
  • Unsteadiness, including finding it difficult to walk in a straight line
  • Light-headedness
  • Feeling faint.

Other symptoms that may accompany dizziness include:

  • Headache
  • Nausea and vomiting
  • Ringing or other sounds in the ears (tinnitus)
  • Difficulty hearing
  • Staggering gait and loss of coordination (ataxia)
  • Unusual eye movements, such as flitting of the eyes (nystagmus)
  • Finding it difficult to see clearly when moving, for example, when reading a sign while walking or driving.

Treatment

Vestibular rehabilitation – The key treatment for almost all of the conditions that can cause dizziness is vestibular rehabilitation. The aim of vestibular rehabilitation is to help the development of vestibular compensation.

Cawthorne-Cooksey Exercise  – The aims of the Cawthorne-Cooksey exercises include relaxing the neck and shoulder muscles, training the eyes to move independently of the head, practising good balance in everyday situations, practising the head movements that cause dizziness, improving general co-ordination, and encouraging natural spontaneous movement.

Gaze stabilization exercises  – The aim of gaze stabilization exercises is to improve vision and the ability to focus on a stationary object while the head is moving.

Canalith repositioning procedures (CRP) – Canalith repositioning procedures (CRP) are the key treatment for benign paroxysmal positional vertigo (BPPV). Although most people with BPPV will recover within a few weeks or months, CRP can bring about a rapid recovery after just one or two sessions.

Medications – Medications such as meclizine (Antivert) or benzodiazepines (such as diazepam [Valium], lorazepam [Ativan]) are used to control the spinning feeling associated with dizziness, when vertigo is a possible cause. 

Alternative Treatment

Vitamin B6 – This vitamin is essential for the brain and the nervous system to function normally; getting enough is vital for avoiding dizziness.

Vitamin D – The inner ear is partly responsible for your sense of balance, so any ear problems may cause dizziness. Getting enough vitamin D is vital for your ear health.

Vitamin B12 – This is the usual vitamin deficiency suspect if you’re experiencing dizziness. Vitamin B-12’s primary functions are in the formation of red blood cells and the maintenance of a healthy nervous system.

Antioxidants—Antioxidants mitigate the damaging effects of free radicals on tissues, cell membranes, and DNA. Vitamin C, vitamin E, lipoic acid, and glutathione are among the most important antioxidants. Vitamin C has been shown to have a beneficial effect on patients with Ménière’s disease when given in combination with glutathione.

Ginkgo biloba—Researchers have found that dizziness induced by vestibular receptor impairment can be reduced by Ginkgo biloba extract.

Ginger – Ginger, or Zingiber officinale, is a perennial used in cooking and herbal medicine. It’s a traditional remedy for stomach problems, nausea, fever, coughs and diarrhea. The rhizomes are rich in volatile oil, and have antibacterial, cholesterol-lowering, hypoglycemic and anti-ulcer action.

 

Reference –

https://my.clevelandclinic.org/services/head-neck/diseases-conditions/hic-what-is-dizziness

http://www.dizziness-and-balance.com/disorders/

http://www.aafp.org/afp/2010/0815/p361.pdf

http://vestibular.org/node/2

http://www.brainandspine.org.uk/sites/default/files/documents/dizziness_and_balance_problems.pdf

 

Posted in MUSCULOSKELETAL
February 8, 2017

DISH (sometimes called Forestier’s disease) is considered a form of degenerative arthritis and is characterized by excessive bone growth along the sides of the vertebrae of the spine. It is also associated with inflammation and calcification (bone growth) at other areas of the body where tendons and ligaments attach to bone, such as at the elbow, knee and the heel of the foot. These can lead to bone spurs. Heel spurs, for example, are common among people with DISH.

The spine, or vertebral column, is made up of bones that stack on top of one another. These bones are calledvertebrae. There are five sections of the spine. At the top is the neck, or cervical spine, which connects with the skull. Below the neck is the thoracic spine or mid-back, which has the ribs attached. The ribs form the chest. Below the thoracic spine is the lumbar spine or low back. The lumbar spine attaches to the sacrum which is part of the pelvis. The last section of the spine is the coccyx, also know as the tail bone.

There are ligaments that help stabilized the spine. The ligament along the front of the spine is called the anterior longitudinal ligament. There is another ligament that attaches to the back of the spine called the posterior longitudinal ligament. These are the spinal ligaments that can turn into bone in Diffuse Idiopathic Skeletal Hyperostosis (DISH).

DISH is thought to be the second most common form of arthritis after osteoarthritis. It affects between six and 12 percent of North Americans, almost always occurring among people older than 50. Unlike most types of arthritis, DISH occurs more often among men (65%) than women (35 %), and affects 28 percent of men over the age of 80.

DISH can occur with other types of arthritis, such as osteoarthritis, and can also sometimes be confused with ankylosing spondylitis because they both affect the spine and entheses.

Who is at risk?

Diffuse Idiopathic Skeletal Hyperostosis generally occurs in people between the ages of 50 and 60. It appears more often in men than women. While the cause is unknown, there seems to be a connection with having diabetes, high blood pressure, coronary artery disease, and being over weight.

Some researchers feel that the extra bone is made because of extra blood supply near the spine. Growth factors that effect the formation of calcium likely play a role.

Symptoms

  • Ysphagia (caused by compression of osteophytes) – Dysphagia is often related to DISH. It can Occur because of mechanical obstruction or impingment of the osteophytes at the larynx or pharynx.
  • Oesophagal obstruction
  • Hoarseness
  • Cervical myelopathy
  • Atlantoaxial subluxation
  • Spinal stenosis
  • Ossification of the posterior longitudinal ligament
  • Spinal cord injury
  • Dyspnea
  • Foreign body sensation
  • Neurologic manifestations duo to compression of the spinal cord
  • Hypercholesterinemia (resulting in cardiovacular comorbidities)
  • Peripheral joint affection

Treatment

Medications – While there is no cure for DISH, there are treatments that can help the symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) may help manage pain or tendonitis-like inflammation. Tylenol® which is also called acetaminophenmay also help relieve pain. More severe pain may be treated with corticosteroid injections.

Surgery – Rarely is surgery necessary. However, if the extra bone growth compresses the spinal cord or nerve roots, surgery may be needed. Surgery is done to relieve pressure on the spinal cord or nerve roots. Surgery to take out the extra bone growth (spurs) in the neck may help with symptoms of difficulty swallowing.

Physical therapy may also be recommended for stiffness.

Heat Therapy stimulates the widening of blood vessels to promote increased blood to a specific area. Hot and cold therapy is usually done in combination. This way it allows for the activation of the blood flow by bringing circulation to an inflamed and painful area with heat and sends it out of the blood with cold. When done in office it is usually ten minutes hot then ten cold and ten hot again.

Acupuncture has also been used to decrease muscle tension to provide pain relief. It has been used especially when DISH has affected the neck area causing cervical muscle strain. Many studies done were insufficient for any conclusions to be determined. Some patients have noted significant pain relief.

Cryotherapy (Ice Therapy) – This may be used in order to activate the narrowing of blood vessels in order to slow down circulation in a specific area.

Magnesium – Healthy cells contain high levels of magnesium and lower levels of calcium, so the calcium deposits are likely a result of an imbalance.

 

Reference –

http://www.physio-pedia.com/Forestier_Disease

http://www.ajronline.org/doi/full/10.2214/AJR.07.7102

http://patient.info/doctor/diffuse-idiopathic-skeletal-hyperostosis

http://www.emedicinehealth.com/diffuse_idiopathic_skeletal_hyperostosis_dish/article_em.htm

http://www.arthritisresearchuk.org/arthritis-information/conditions/diffuse-idiopathic-skeletal-hyperostosis.aspx

http://www.arthritisresearchuk.org/arthritis-information/conditions/diffuse-idiopathic-skeletal-hyperostosis.aspx

http://www.orthobullets.com/spine/2045/dish-diffuse-idiopathic-skeletal-hyperostosis

 

 

 

Posted in MUSCULOSKELETAL
February 8, 2017

Desmoid tumors are tumors that arise from cells called fibroblasts. Fibroblasts are found throughout our body and their main function is to provide structural support and protection to the vital organs such as lung, liver, blood vessels, heart, kidneys, skin, intestines etc. and they also play a critical role in wound healing. When fibroblast cells undergo mutations they can become cancerous and become desmoid tumors (also known as “aggressive fibromatosis”). Desmoid tumors can arise in virtually any part of the body. These tumors often occur in women in their 30’s, but can occur in anyone at any age.

Desmoid tumors can be slow growing or extremely aggressive. They do not metastasize (move from one body part to another), and if slow growing they can be carefully watched by your physician. However, when they are aggressive they can cause life threatening problems or even death when they compress vital organs such as intestines, kidney, lungs, blood vessels, nerves etc.

The most common symptom of desmoid tumors is pain. Other signs and symptoms, which are often caused by growth of the tumor into surrounding tissue, vary based on the size and location of the tumor. Intra-abdominal desmoid tumors can block the bowel, causing constipation. Extra-abdominal desmoid tumors can restrict the movement of affected joints and cause limping or difficulty moving the arms or legs.

Desmoid tumors are rare, affecting an estimated 1 to 2 per 500,000 people worldwide. In the United States, 900 to 1,500 new cases are diagnosed per year. Sporadic desmoid tumors are more common than those associated with familial adenomatous polyposis.

Desmoid tumors are usually named for the areas where they grow –

  • Abdominal desmoid tumors—in the walls of the abdomen (belly)
  • Intra-abdominal desmoid tumors—in tissue connecting abdominal organs
  • Extra-abdominal desmoid tumors—anywhere else in the body

Causes

The exact cause of desmoid tumors is not known.Typically, tumors develop in just one area, although sometimes they may appear in several locations. Multiple locations of disease can be associated with familial adenomatous polyposis, a genetic abnormality in which potentially malignant polyps develop in the intestinal lining.

In some rare cases, desmoid tumors can occur in women who are pregnant. This happens during pregnancy or after a surgical delivery. Many believe that this is caused by a combination of elevated hormones and surgery, however, these is no strong scientific evidence to support this claim. The relationship between pregnancy and desmoid tumors is very rare and consists of mostly anecdotes in the scientific literature.

This supports the theory that desmoids may have a genetic cause. Other theories have been explored, as well—including hormonal and traumatic causes—with no definitive conclusions.

Symptoms

Desmoid tumors can develop at virtually any site in the body.  Superficial desmoids tend to be less aggressive than desmoids found deep inside the body (i.e., abdominal, extra-abdominal, mesenteric). Superficial desmoid tumors usually manifest themselves as a painless or slightly painful lump.  Desmoids inside the abdomen can cause severe pain, rupture of intestines, compression of the kidneys or ureters or rectal bleeding. They can compress critical blood vessels such as the mesenteric vessels and the vena cava. Desmoid tumors may have multiple sites of origin on chest, arms or legs.

Because Desmoid tumors affect tissue that is elastic and easily moved, a tumor may exist for a long time before being discovered, growing large and pushing aside surrounding tissue.

Each child may experience symptoms differently, but here’s a list of the most common symptoms of Desmoid tumors –

  • A painless swelling or lump
  • Pain or soreness caused by compressed nerves or muscles
  • Pain and obstruction of the bowels
  • Limping or other difficulty using the legs, feet, arms or hands

Treatment

Radiation – Radiation therapy can destroy cancer cells and shrink tumors. In some cases, desmoid tumors may be treated successfully with radiation therapy alone. In other cases, radiation therapy is used in conjunction with surgery. Radiation treatments usually begin two weeks after the surgical procedure.

Hormone therapy – Desmoids are known to have estrogen receptors. This means that their growth may be stimulated by the hormone estrogen. Drugs that block the hormonal stimulation of the tumor are sometimes effective at controlling the tumor growth.

Nonsteroidal anti-inflammatory drugs (NSAIDs) – Medications such as ibuprofen and naproxen, as well as a special kind of NSAID called a COX-II inhibitor, can be effective in treating desmoid tumors.

Chemotherapy – Low doses of chemotherapy drugs are effective in management of desmoids. Long-term use of these drugs is difficult, however, due to their cumulative effects in the body.

Other nonsurgical treatments – Radiofrequency ablation, in which the tumor is heated with a high-frequency electrical current, and direct injection of the tumor with irritating chemicals such as acetic acid have also shown some promise in treating desmoid tumors.

Surgery to remove the tumor is the preferred method of treatment. However, it can be difficult during surgery to determine the outer extent of the tumor. This is because desmoids are not well encapsulated and they often intertwine with other tissues. A tumor may recur after surgery with local rates of recurrence ranging from 25% to 68%.

Alternative Treatment

 

Reference –

http://www.webmd.com/cancer/desmoid-tumor

http://www.orpha.net/consor4.01/www/cgi-bin/OC_Exp.php?lng=EN&Expert=873

http://radiopaedia.org/articles/desmoid-tumour

http://atlasgeneticsoncology.org/Tumors/DesmoidFibromatosisID5179.html

http://atlasgeneticsoncology.org/Tumors/DesmoidFibromatosisID5179.html

http://ghr.nlm.nih.gov/condition/desmoid-tumor

 

http://jco.ascopubs.org/content/17/1/158.full

http://www2.mdanderson.org/depts/oncolog/articles/10/11-12-novdec/11-12-10-1.html

http://www.dtrf.org/index.php/about-br-desmoid-tumors/about-desmoid-tumors.html

http://emedicine.medscape.com/article/1060887-overview

http://ghr.nlm.nih.gov/condition/desmoid-tumor

https://senmagazine.co.uk/articles/1104-can-ideas-from-complementary-and-alternative-medicine-help-those-struggling-with-dyslexia.html

 

Posted in MUSCULOSKELETAL
February 8, 2017

DeQuervain’s tenosynovitis, also called stenosing tenosynovitis, occurs when tendons around the base of the thumb are irritated or constricted. This is typically caused by overuse especially from activities that require forceful gripping while flexing and extending the wrist.

More specifically, the condition involves inflammation of the lining of the sheath (synovium) that surrounds two tendons of the thumb: Abductor Pollicis Longus and Extensor Pollicis Brevis. The inflammation prevents the tendons from gliding smoothly through a tunnel located on the thumb side of the wrist. When the synovium of these tendons becomes inflamed friction occurs with certain thumb and wrist movements, which ultimately causes pain and discomfort.

De Quervain’s is more common in women than in men, and almost 50% of new mothers experience this condition. It has a tendency to develop during pregnancy, when fluid may be retained. It may also develop during menopause.

This condition is also common to people who use their hands in repetitive motions, such as constant gripping, forcefully bending the wrist, placing the wrist in awkward positions, or engaging in lifting or pinching activities. It can also be caused by direct trauma or sudden incorrect lifting, and it is sometimes associated with conditions such as diabetes, rheumatoid arthritis and hypothyroidism.

De Quervain’s was named after the Swiss surgeon who first described the condition in 1895. It is one of the most common types of tendon lining inflammation (also called tenosynovitis).

Causes

De Quervain tenosynovitis is basically a combination of overuse and poor hand on wrist posture.

  • Repeated hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovitis.
  • Holding the hand at an angle to the wrist creates a compression point that excessively rubs the tendon.
  • This inflammation can lead to swelling, which restricts the smooth gliding action of the tendons within the tunnel.
  • Scar tissue from a previous injury can make it difficult for the tendons to slide easily through the tunnel.
  • Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb.

Risk Factors

The cause of de Quervain’s tenosynovitis is idiopathic or unknown. However, there are certain risk factors that may increase the chance of developing the condition. These can include the following –

  • Gender – The condition is more common in females than males.
  • Age – It occurs more frequently around ages 30-50.
  • Social Habits – The condition may be caused by overuse such as with frequent texting or typing on mobile devices with your thumbs.
  • Work Habits – Occupations that require repetitive hand and wrist movements such as with construction or playing music may increase your risk of developing the condition.
  • Medical Conditions – Patients with diabetes, alcoholism, cirrhosis of the liver, and seizure disorders appear to be at increased risk of developing the condition.

Symptoms

The main symptom of de Quervain’s tenosynovitis is pain or tenderness at the base of the thumb. Some might also feel pain going up your forearm. The pain may come on suddenly or develop slowly. It may get worse when using hand and thumb.

Other symptoms of de Quervain’s tenosynovitis include the following –

  • Pain may be felt over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.
  • Swelling near the base of the thumb
  • A fluid-filled cyst in the affected area, which may or may not bulge through the skin
  • Numbness along the back of the thumb and index finger
  • A “catching” or “snapping” feeling when a person moves the thumb
  • A squeaking sound as the tendons move within the swollen sheaths

Treatment

Splints – Splints may be used to rest the thumb and wrist.

Anti-inflammatory medication (NSAIDs) – These medications can be taken by mouth or injected into a tendon compartment. This may help reduce swelling and relieve pain.

Avoiding activities that cause pain and swelling – This may allow the symptoms to go away on their own.

Corticosteroids – Injection of corticosteroids into the tendon sheath may help reduce swelling and pain.

Surgery – Surgery may be recommended if symptoms are severe or do not improve. The goal of surgery is to open the thumb compartment (covering) to make more room for the irritated tendons.

Occupational therapy – A hand therapist will conduct a full evaluation and may then provide one or more the following –

  • A custom-fitted orthosis (brace) that will rest the thumb/wrist and help reduce the inflammation.
  • Deep tissue massage of the thumb/wrist.
  • Myofascial release techniques (gentle stretching).
  • Ultrasound massage.
  • As the pain decreases, therapeutic exercises to stretch and strengthen the area.
  • An ergonomic assessment and training to prevent further damage, along with recommendations for optimal ways for people to continue their activities of daily living.
  • Advice to new mothers on how to lift their babies, the baby carrier, or baby bottle to prevent this condition

Alternative Treatment

Bromelain – This enzyme that comes from pineapples reduces inflammation.

Vitamin C to aid in healing, increase immune function, and reduce inflammation.

Calcium helps to aid healing of connective tissues and muscles.

Vitamin A is used for immune function and healing. Do not use if you are or may become pregnant.

Vitamin E and essential fatty acids, such as fish oil or evening primrose oil helps to reduce inflammation. Vitamin E may interact with a number of medications.

Turmeric – Used for pain and inflammation. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger.

Willow bark helps to relieve pain. Willow acts similar to aspirin.

Licorice helps to reduce inflammation.

Complementary Treatment

Radial Deviation – Radial deviation exercises are designed to strengthen the wrist, which will alleviate pressure on the tendons and reduce symptoms.

Wrist Flexion and Extension Strengthening – This exercise is similar to the wrist flexion and extension stretches, except you will be holding a weight in the hand to provide resistance.

Finger Abduction With Rubber Band – Resisted finger abduction exercises such as this will also help strengthen the muscles in the hands, which will help alleviate the symptoms and prevent future cases of this condition.

Thumb adduction stretches will stretch the thumb and ameliorate stiffness.

 

Reference –

http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/de-quervains-disease

http://familydoctor.org/familydoctor/en/diseases-conditions/de-quervains-tenosynovitis.html

http://www.med.und.edu/users/jwhiting/dess.html

http://www.handsurgery.com.au/services/de-quervains-tenosynovitis/

http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/wrist/de-quervains-tenosynovitis/

http://www.wesleyhandcentre.com.au/pdf/de-quervains-tenosynovitis.pdf

http://www.mayoclinic.org/diseases-conditions/de-quervains-tenosynovitis/basics/definition/con-20027238

http://www.webmd.com/rheumatoid-arthritis/de-quervains-disease

http://emedicine.medscape.com/article/1243387-overview

https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000537.htm

http://orthoinfo.aaos.org/topic.cfm?topic=a00007

 

Posted in MUSCULOSKELETAL
February 8, 2017

Craniosynostosis is a birth defect in which the bones in a baby’s skull join together too early. This happens before the baby’s brain is fully formed. It is a congenital deformity of the infant skull that occurs when the fibrous joints between the bones of the skull (called cranial sutures) close prematurely.

In an infant, the skull is not a solid piece of bone, but it is several boney plates separated by fibrous flexible material called sutures. These sutures allow the skull to expand as the brain grows, and will eventually fuse to form a solid skull. Around two years of age, a child’s skull bones begin to join together because the sutures become bone. When this occurs, the suture is said to “close.” In a baby with craniosynostosis, one or more of the sutures closes too early. This can limit or slow the growth of the baby’s brain. The remaining open sutures have to grow faster to make up for the closed suture. This extra growth causes a change in head shape. In some cases, the remaining open sutures can’t grow fast enough to keep up with the brain’s growth causing an abnormally high pressure in the skull, which can have negative effects on brain health. These include learning delays, blindness, and, rarely, death, if untreated. Craniosynostosis can either be –

  • Syndromic – the condition is one of a number of birth defects to affect a child
  • Nonsyndromic – the condition develops in isolation and the child has no other birth defects

Types of Craniosynotosis

There are several types of craniosynostosis. They have a typical appearance depending on which suture, or sutures, are involved, and are named both according to the head shape (words that end in –cephaly), and by which suture is abnormally fused.

  • Sagittal synostosis– The sagittal suture runs along the top of the head, from the baby’s soft spot near the front of the head to the back of the head. When this suture closes too early, the baby’s head will grow long and narrow (scaphocephaly). It is the most common type of craniosynostosis.
  • Coronal synostosis – The right and left coronal sutures run from each ear to the sagittal suture at the top of the head. When one of these sutures closes too early, the baby may have a flattened forehead on the side of the skull that closed early (anterior plagiocephaly). The baby’s eye socket on that side might also be raised up and his or her nose could be pulled toward that side. This is the second most common type of craniosynostosis.
    • Bicoronal synostosis – This type of craniosynostosis occurs when the coronal sutures on both sides of the baby’s head close too early. In this case, the baby’s head will grow broad and short (brachycephaly).
  • Lambdoid synostosis – The lambdoid suture runs along the backside of the head. If this suture closes too early, the baby’s head may be flattened on the back side (posterior plagiocephaly). This is one of the rarest types of craniosynostosis.
  • Metopic synostosis – The metopic suture runs from the baby’s nose to the sagittal suture at the top of the head. If this suture closes too early, the top of the baby’s head shape may look triangular, meaning narrow in the front and broad in the back (trigonocephaly). This is one of the rarest types of craniosynostosis.

Craniosynostosis is a rare condition. It is estimated that one in every 1,800 to 3,000 children is born with the condition. Three out of every four cases affect boys. Nonsyndromic craniosynostosis is the most common form of the condition, accounting for 80%-95% of all cases. The cause of nonsyndromic craniosynostosis is unknown. There are more than 150 different syndromes that can cause syndromic craniosynostosis, all of which are very rare. A syndrome describes a range of different symptoms that are all related to a common cause, which is usually (but not always) genetic.

Causes

The causes of craniosynostosis in most infants are unknown. Some babies have a craniosynostosis because of changes in their genes. In some cases, craniosynostosis occurs because of an abnormality in a single gene, which can cause a genetic syndrome. However, in most cases, craniosynostosis is thought to be caused by a combination of genes and other factors, such as things the mother comes in contact with in her environment, or what the mother eats or drinks, or certain medications she uses during pregnancy.

Craniosynostosis is a feature of many different genetic syndromes that have a variety of inheritance patterns and chances for reoccurrence, depending on the specific syndrome present. It is important for the child as well as family members to be examined carefully for signs of a syndromic cause (inherited genetic disorder) of craniosynostosis such as limb defects, ear abnormalities, or cardiovascular malformations.

Risk Factors

Maternal thyroid disease ― Women with thyroid disease or who are treated for thyroid disease while they are pregnant have a higher chance of having an infant with craniosynostosis, compared to women who don’t have thyroid disease.

Certain medications ― Women who report using clomiphene citrate (a fertility medication) just before or early in pregnancy are more likely to have a baby with craniosynostosis, compared to women who didn’t take this medicine.

Smoking – Studies have found that maternal smoking is associated with an increased risk of infant craniosynostosis. One study found this association only for heavy smokers who continued smoking after the first trimester and had delayed or no folic acid supplement use.

Drugs and Medication – Studies of maternal alcohol consumption have had mixed results. One study found no relationship between maternal alcohol consumption and craniosynostosis risk. There may be a connection between nitrosatable drugs (chlordiazepoxide, nitrofurantoin, and chlorpheniramine) and increased risk of craniosynostosis.

Maternal Health – Mothers who are overweight may be at an increased risk for delivering a child with isolated craniosynostosis, but another study failed to confirm this finding. Although maternal pre-gestational diabetes mellitus has not been found to be a risk factor for craniosynostosis, gestational diabetes mellitus may confer an increased risk for having a child with craniosynostosis and multiple additional defects. Maternal thyroid disease has been reported as a risk factor for craniosynostosis.

Fertility Treatments – Some evidence exists for a link between specific fertility treatments and greater risk of craniosynostosis. Clomiphene citrate, a drug used for ovulation stimulation, was associated with an increased craniosynostosis risk.

Vitamins and dietary nutrients have been studied for their associations with craniosynostosis risk. In one study, higher maternal intake of riboflavin, vitamin B6, vitamin E, and vitamin C before and during pregnancy was associated with a decreased risk for sagittal synostosis, and higher intake of methionine and vitamin C was associated with a decreased risk for coronal synostosis.

Parental Occupation – Occupation of the father in the agriculture and forestry or mechanics and repairman fields has been suggested as a risk factor for craniosynostosis.

Infant Sex – Most studies have reported higher craniosynostosis rates or ratios among male infants, particularly for sagittal and metopic synostosis. Coronal craniosynostosis seems to be more common in female infants.

Parental Age – Craniosynostosis risk appears to increase with increasing maternal age; however, some studies did not find a significant relationship between maternal age and craniosynostosis risk. The relationship between father’s age and craniosynostosis risk is less clear. One study identified older age of the father as a risk factor.

Signs & Symptoms

In infants with this condition, the most common signs are changes in the shape of the head and face. The appearance of the child’s face may not be the same when compared to the other side. Signs and symptoms of Craniosynostosis include the following –

  • Sagittal synostosis – This is when the head grows long but its width is restricted due to the sagittal suture (top of the head) fusing too early. It is the most widespread type of craniosynostosis and mostly occurs in boys.
  • Coronal craniosynostosis – This is due to early fusion of one or both of the sutures connecting the top of the head to the ears (coronal sutures). It results in the baby having a flat forehead and possibly a higher eye socket on the affected side. If both sutures fuse, both sides of the face are affected, this is known as Biconal synostosis. This kind of craniosynostosis occurs mostly in girls and is the second most common of the types.
  • Metopic synostosis – This is a much rarer form of craniosynostosis. This time the suture that fuses is located between the sagittal suture and the nose. Babies with this form develop a triangular scalp.
  • Lambdoid synostosis – This is when the suture that runs across the back of the head (lamdoid suture) fuses causing flatness in this area. Of all forms of craniosynostosis, this is the most rare.

General Symptoms include –

  • A full or bulging fontanelle (soft spot located on the top of the head)
  • Sleepiness (or less alert than usual)
  • Scalp veins may be very noticeable
  • Increased irritability
  • High-pitched cry
  • Poor feeding
  • Projectile vomiting
  • Increasing head circumference
  • Seizures
  • Bulging eyes and an inability of the child to look upward with the head facing forward
  • Developmental delays

Treatment

The primary treatment method of craniosynostosis is surgery, which is best done within the first year of the child’s life. The main goal of the surgery is to let the cranial vault develop normally. If surgery is not performed the condition can get worse and the skull deformity increase. There are two common types of surgery for craniosynostosis –

  • Traditional surgery, also called calvarial vault remodeling – Among the surgical options available, the more traditional surgery we offer is when the baby is older. During surgery, an incision is made in the infant’s scalp. The shape of the head is corrected by moving the area that is abnormally fused or prematurely fused and then reshaping the skull so it can take more of a round contour. Surgery can last up to eight hours. The baby will likely spend one night in the ICU plus an additional 3-5 days in the hospital for monitoring.
  • Minimally invasive endoscopic surger – This minimally invasive surgery is one that we perform when the baby is much younger (less than 3 months old).This type of surgery is followed by the use of a molding helmet. After the surgery is performed, we then prescribe the molding helmet. You can expect to follow up with your neurosurgeon every 3 months for the first year post-surgery to check progress of the helmet reshaping the skull.

Risks for any surgery are –

  • Breathing problems
  • Infection, including in the lungs and urinary tract
  • Blood loss (children having an open repair may need a transfusion)
  • Reactions to medicines

Possible risks of having this surgery are –

  • Infection in the brain
  • Bones connect together again, and more surgery is needed
  • Brain swelling
  • Damage to brain tissue

 

Reference –

http://www.craniokids.org/

https://www.childrens.com/specialties-services/specialty-centers-and-programs/plastic-craniofacial-surgery/programs-and-services/craniofacial-program/conditions-and-treatments/craniosynostosis

http://www.hse.ie/eng/health/az/C/Craniosynostosis/

https://www.cappskids.org/

http://www.sickkids.ca/Craniofacial/What-we-do/Craniofacial-Conditions/Craniosynostosis/

http://www.chw.org/medical-care/neuroscience/conditions/craniosynostosis/

http://www.gosh.nhs.uk/medical-information/search-medical-conditions/craniosynostosis

http://www.seattlechildrens.org/medical-conditions/bone-joint-muscle-conditions/craniosynostosis-treatment/

http://www.ninds.nih.gov/disorders/craniosynostosis/craniosynostosis.htm

http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/pediatric_neurosurgery/conditions/craniosynostosis/

http://emedicine.medscape.com/article/1175957-overview

http://www.nhs.uk/conditions/craniosynostosis/Pages/Introduction.aspx

http://www.mayoclinic.org/diseases-conditions/craniosynostosis/basics/definition/con-20032917

 

 

 

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