Signs and Symptoms of Lupus

Lupus is a disease that in many cases is characterized by the distinctive rash that once was thought to resemble a wolf bite. That’s why the disease got the name lupus, the latin word for wolf. However, there are cases when the distinctive rash does not occur, and it was seen that there are not two cases of lupus exactly alike. Signs and symptoms can be permanent or temporary, mild or severe, or they can develop slowly or come suddenly.
Many of the persons with lupus have periods when the disease is getting worse- the so-called flares-, and after that, the disease improves, or even disappears for a while.

Usually, the most common signs and symptoms of lupus develop at intervals, rather than all at once.A skin problem often associated with the disease is a butterfly-shaped rash that develops across the cheeks and bridge of the nose, and this rash can be flat or raised and may be blotchy or completely red in the affected areas.

Some people develop a crusty, red, raised rash which is also called discoid rash on the face, neck, chest or scalp, is usually thick and scaly, may last for days or years and often leaves hypopigmented or hyperpigmented scars. There are other people that develop skin lesions which look at first like small pimples and can turn scaly and itchy and others have large, flat, itchy lesions with clear centers.

A lot of types of glomerulonephritis can appear because of lupus. Glomerulonephritis is a condition that affects the kidneys’ ability to filter toxins, leading to kidney failure. In many cases kidney damage can appear without any warning signs or symptoms, but some of those with kidney problems may develop frothy or tea-colored urine, swelling in their ankles or lower legs, or high blood pressure.Arthritis is another sign of lupus. A lot of patients with lupus can develop joint pain, stiffness and swelling, mainly in their fingers, hands, wrists and knees. Lupus-associated arthritis usually isn’t deforming, comes and goes quickly, and the pain can be severe during a flare.Lupus patients are very sensitive to sunlight, they develop rashes on sun-exposed skin. It was seen that lupus can cause also brain or central nervous system problems, like headaches, seizures, vision problems, dizziness, behavior changes or stroke.Lupus can also cause lung problems, like pleurisy, which is an inflammation of the chest cavity lining that can produce sharp stabbing chest pain, and also heart problems, mucosal ulcers, and blood vessels disorders.

There are also other signs and symptoms that can appear and are not specific to lupus.
Fatigue, which is an ongoing, extreme exhaustion that’s usually not relieved by rest can appear, also there can show up an unexplained fever, Raynaud’s phenomenon- a condition in which your fingers, toes, nose and ears turn pale and numb when exposed to cold temperatures-, digestive problems- like abdominal pain, weight loss nausea and vomiting-, hair loss, depression and swelling.

So if you want to find more about Lupus or more details about systemic lupus please follow this link

Acute Respiratory Case Study" a Cute Exacerbation in Copd"

Evidence based case study in management of acute Exacerbations of COPD.


Chronic pulmonary diseases have become increasingly one of the most common chronic lung diseases and a major cause of morbidity and mortality in modern world. It is characterized by airflow limitation that is not fully reversible.

聽Chronic Obstructive Disease is a leading cause of the death in the worldwide (Calverley et al, 2003). The condition can result in loss of work quality and quality of the life can be significantly effected (Barnes, 1999). In UK 27,478 men and woman die because of the chronic obstructive lung diseases and most of the death ( more than 90%) was in聽 the age of above 60 years old(British Thoracic Society. 2006).

Rehabilitation for patients with chronic lung diseases is well established and widely accepted as means of enhancing standard therapy in order to improve symptoms and maximise the patients function (Siafakas et al, 1995; Ries, 1990; Casaburi, 1993; Fishman, 1996). In 1974, the American College of Chest Physicians (ACCP) focused in there definition of Pulmonary rehabilitation on three important features and they suggested that Successful pulmonary rehabilitation depends on three importance features, Individuality of each case, Multidisciplinary team approach and attention to physiopathology and psychopathology of each case.

One of the main problems with COPD patient is the increase in the pulmonary secretions leading to increase in shortness of breath. These two factors affect the patient’s function and quality of life.聽 For exacerbation, Physiotherapy is often required to help clear secretions and reduce WOB, including non-invasive ventilation to prevent intubation (Alexandera, 2001).

There are various techniques, which can be used in physiotherapy to improve patient’s condition. The research suggests that the postural drainage is beneficial in clearing聽 the chest from secretions (Clarke,1989;Faling,1986), respiratory muscle relaxation manoeuvre is effective for improving the pulmonary function of pulmonary emphysema patients (Fujimoto et al, 1996), relaxation can help reduce dyspnoea and anxiety in chronic obstructive pulmonary disease (COPD) patients (Louie, 2004).

Case description 馃檨 case history, physical examination, and intervention)

Patient is a 67-years-old woman with acute exacerbation in Chronic Obstructive Pulmonary Disease (COPD). She complained of increased shortness of breath with loose, non-productive cough. A febrile on auscultation, bilateral rales, rhonchus, and expiratory wheezing. Patient said she is on bronchodilators and low-dose steroid. Patient said she has been suffering from this problem since 10yrs and has been on medication since. She does not do any exercises and her general practitioner who she usually sees has never mentioned about seeing any physiotherapist. Recently during this episode of acute exacerbation, she was advised by the hospital doctor to see a physiotherapist.

The strategy in this case study used was the problem-solving model, which included following six steps;

Step 1: Patient assessment,

Step 2: defining the problem,

step3: determining the goals,

step4: identifying appropriate techniques,

Step 5: applying the techniques,

step6: re-evaluation of the patients situation(Donna,1987).聽聽聽聽聽

Evaluation and assessment:

Accurate assessment is the key player of physiotherapy and forms the bases of rational practice. A Problem based assessment leads to reasoning in the pulmonary rehabilitation. As result, a thoughtful evaluation will guide to both effectiveness and efficiency聽 because time will be saved by avoiding unnecessary treatment (Physiotherapy in Respiratory Care An evidence-based approach to respiratory and cardiac management).

Ward reports and medical notes of the patient were evaluated to know about;

路聽聽聽聽聽聽聽聽 The past and present relevant history.

路聽聽聽聽聽聽聽聽 聽social history , accommodation

路聽聽聽聽聽聽聽聽 Conditions required precautions in relation to certain treatments e.g. light-headedness ,bleeding disorders or swallowing disorders

路聽聽聽聽聽聽聽聽 Recent cardiopulmonary聽 resuscitation to examine the X-ray in case of gastric aspiration or fracture

路聽聽聽聽聽聽聽聽 Checking for possibly of bony metastases, long-standing steroid therapy that this leads to risk of osteoporosis and checking for the history of radiotherapy over the chest. These all findings contraindicate percussion or vibration over the ribs.聽聽

路聽聽聽聽聽聽聽聽 The patient’s experience increased shortness of breath and the assessment indicate airway secretion.

A part of the patient evaluation was subjective assessment and that was by listening to patient’s problem in her own words. Following symptoms were checked:

Respiratory symptoms by looking for the how long the symptoms been troublesome.

路聽聽聽聽聽聽聽聽 Frequency, duration, and the severity.

路聽聽聽聽聽聽聽聽 Any pain, chest pain, musculoskeletal pain or cardiac pain.

路聽聽聽聽聽聽聽聽 Checking functional limitations including the daily living.

路聽聽聽聽聽聽聽聽 Observation to check the breathing rate and pattern before the patient a ware of the physiotherapist’s presence to avoid any role-play.

路聽聽聽聽聽聽聽聽 General appearance , colour, hand checked which is a good and rich source of information like cold hand indicate a poor cardiac output, oedema, jugular venous pressure, chest shape.

Objective measurement:

Exercise testing was used to monitor the progress of the patient due following few reasons:

路聽聽聽聽聽聽聽聽 Lung function tests are not a good predictor of exercise capacity (Bradley et al, 1999).

路聽聽聽聽聽聽聽聽 The laboratory tests are for physiological measurement rather than monitoring of patients progress.

路聽聽聽聽聽聽聽聽 The patients own estimate of exercise tolerance is not objective (Hough, 2001).

Exercise testing:

As long as the patient was not suffering from acute breath illness, exercise testing was used as an objective measure to monitor the progress. Oximetry on exercise testing was used which is advisable to measure the level of oxygen during the exercise (Martine et al, 1992). Because the patient was in acute exacerbation condition, only simple stair climbing testing was used and count the number of steps can be climbed up and down in 2 minute and rest allowed but included within the 2 minutes.聽 Each minute was passed the patient was informed about the time. The result of the test was only 10 steps per 2 minutes. Exercise testing revealed increased shortness of breath and from assessment of patient, it was clear that she had airway secretions.

Defining the problem:

Shortness of breath was probably due to increased secretions with the patient and so physiotherapy was planned after the use of bronchodilators. Percussion can trigger bronchospasm in patients with asthma and in this case would benefit to have maximum bronchodilator prior to treatment. (Donna 1987)

Determining the Goals:

Promote airway clearance; encourage relaxation and breathing exercise; encourage exercise to promote airway clearance.

Identifying Appropriate Techniques:

聽聽 Due to short shortness of breath, modified positioning was used for postural drainage as per the patients comfort, turning the patient side to side to prevent any shortness of breathiness (Hough 1991). Trendelenberg position was also used with percussion and vibration was gently applied due to consideration that the patient was on long-term steroid therapy. Emphasis was placed on both lower lobes as no specific area of pathology was described. Relaxation exercises were done for upper chest and neck to increase the ventilation, abdominal areas. Patient was also taught home postural drainage to help in early recovery.

Walking and cycling was encouraged, as it is most widely used modalities of exercise training in chronic obstructive pulmonary disease rehabilitation (Vallet et al, 1997). Patient was given endurance (aerobic) training program for 4-12 weeks (Casaburi et al, 1997; Wijkstra et al, 1996), and she attended supervised training sessions 2-5 times a week. Each session duration was 20-30 minute.聽聽聽

Applying techniques:

聽Techniques for vibration and postural drainage (Gumery et al 2001) were applied with consideration to the contraindications and patients condition and motivation. As the patient was on long term of cortico- steroid treatment, possibility of osteoporosis was considered which may led to fracture while doing tapping in postural drainage.


The patient was re-evaluated after the secretions were mobilised and on observation, patients breathing was found to be more effective. The progress was slow as the patient was reconditioned. Patient was encouraged to remain active to help in early recovery. Patient and family was given education about restoration and maintenance of exercise tolerance and basic self-management. Home visits were made to check for adequate heating, and health or safety hazards. In addition, this visit was also supportive for the family.

The exercise was prescript for the patient to keep the patient fit and increase the vital capacity. The mode of the exercise was related to the patient’s life style and the patient was encouraged to use stationary bike. The bike was suggested as it supports 85% of the body weight, and large muscle groups can be exercised with less strain than walking (Bach and Haas, 1996, p.309). Furthermore, exercise programs for the muscles of ambulation were prescribed as they are a part of virtually every program of pulmonary rehabilitation (Ries, 1990; Casaburi, 1993; Carter et al, 1992; Olopado et al, 1992). Over the period of rehabilitation, the patient also said that her functional capabilities improved and this helped her to great extent in her ambulation. Exercises were also given for muscles of the shoulder girdle as these muscles can help provide support to pull on the ribcage (Criner et al, 1988). Patient was encouraged to resume her sports hobbies 鈥 bowling to combine exercise and recreation.

聽Patient was scheduled for a follow up appointment after 6 weeks of rehab and treatment to monitor the patient’s progress. (Broussard 1979; Fujimoto et al. 1996; Gift, Moore, and Soeken, 1992; Louie, 2004). Patient was also provided with breathlessness rating scale to check her breathlessness after each session of exercise.

On the follow up appointment subjective and objective re assessment was done. Patient as observed to check the breathing pattern and frequencies, auscultation was done to check the chest for any signs of secretion and obstructions. The patient was sent to take x-ray to check the clarity of the chest. Stair climb test was done and there was a good progress in the patient’s condition as the result was increased significantly from 10 steps in 2 minute before 6 week to 25 step.

Improvement was also seen on the self reported and measured breathlessness rating scale where the patient scored 2 whereas she scored 4 during initial assessment and also the recovery rate post exercises reduced from 5-10mins to 2-5mins and the patient also reported that she was doing fine the day and was comfortable.


From the above case study, it can be derived that patients suffering with similar conditions can benefit from appropriate exercise and active lifestyle. It is very important to keep encouraging the patients and educating them regarding the condition and help those to self manage.

Although suggestions for appropriate management can be made based on available evidence, the supporting literature is spotty.


聽聽 1. 聽 Alexandra Hough 2001, Physiotherapy in Respiratory Care An evidence-based approach to respiratory and cardiac management, third edn, Nelson Thomas Ltd, United Kingdom.

聽聽 2. 聽 Back, J. R. & Haas, F. pulmonary rehabilitation. Phys.Med.Clin.North Am [7], 205-406. 1996.

聽聽 3. 聽 Barnes PJ 1999, Managing chronic obstructive pulmonary disease Science Press, London.

聽聽 4. 聽 Bradley, J., Howard, J., & Wallace, E. 1999, “Validity of a modified shuttle test in adult cystic fibrosis”, Thorax, vol. 54, pp. 437-439.

聽聽 5. 聽 British Thoracic Society 2006, The Burden of Lung Disease, Second edn.

聽聽 6. 聽 Broussard, R. 1979, “Using relaxation for COPD”, Am.J.Nurs, vol. 79, no. 11, pp. 1962-1963.

聽聽 7. 聽 Calverley PM & Walker P 2003, “Chronic obstructive pulmonary disease”, Lancet, vol. 362, pp. 1053-1061.

聽聽 8. 聽 Carter R, Coast JR, & Idell S 1992, “Exercise training in patients with chronic obstructive pulmonary disease”, Med Sci Sports Exerc, vol. 24, pp. 281-291.

聽聽 9. 聽 Casaburi R & Petty TL 1993, Principles and practice of pulmonary rehabilitation WB Saunders, Philadelphia.

10. 聽 Clarke, S. W. Rationale of airway clearance. Eur.Respir.J.Suppl 7, 599-603. 1989.

11. 聽 Criner GJ & Celli BR. Effect of unsupported arm exercise on ventilatory muscle recruitment in patients with severe chronic airflow obstruction. Am Rev Respir Dis 138, 856-861. 1988.

12. 聽 Donna L & Frownfelter 1987, Chest Physical Therapy and Pulmonary Rehabilitation an Interdisciplinary Approach. 聽2 edn, Year Book Medical, INC, Chicago.

13. 聽 Faling, L. J. 1986, “Pulmonary rehabilitation–physical modalities”, Clin.Chest Med, vol. 7, no. 4, pp. 599-618.

14. 聽 Fujimoto, K. e. a. 1996, “Effects of muscle relaxation therapy using specially designed plates in patients with pulmonary emphysema”, Intern.Med, vol. 35, no. 10, pp. 756-763.

15. 聽 Gift, A., Moore, T., & Soeken, K. 1992, “Relaxation to reduce dyspnea and anxiety in COPD patients”, Nurs.Res, vol. 41, no. 4, pp. 242-246.

16. 聽 Gumery, L., Proyer, J., Prasad, S. A., & Dodd, M. clinical guidelines for Physiotherapy Management of Cystic Fibrosis.聽 2001. CSP.

17. 聽 Louie, S. W. 2004, “The effects of guided imagery relaxation in people with COPD”, Occup.Ther.Int, vol. 11, no. 3, pp. 145-159.

18. 聽 Martin D, Powers S, Cicale M, Collop N, Huang D, & Criswell D 1992, “Validity of pulse oximetry during exercise in elite endurance athletes”, J Appl Physiol, vol. 72, no. 2, pp. 455-458.

19. 聽 Olopade CO, Beck KC, & Viggiano RW 1992, “Exercise limitation and pulmonary rehabilitation in chronic obstructive pulmonary disease”, Mayo Clin Proc, vol. 67, pp. 144-157.

20. 聽 Ries AL 1990, “Position paper of the American Association of Cardiovascular and Pulmonary Rehabilitation: scientific basis of pulmonary rehabilitation”, J Cardiopulmonary Rehabilitation, vol. 10, pp. 418-414.

21. 聽 Siafakas NM, Vermeire P, & Pride NB 1995, “Optimal assessment and management of chronic obstructive pulmonary disease (COPD):聽 the European Respiratory Society Task Force”, Eur Respir J, vol. 8, pp. 1398-1420.

22. 聽 Vallet G, Ahmaidi S, & Serres I 1997, “Comparison of two training programmes in chronic airway limitation patients: standardized versus individualized protocols”, Eur Respir J, vol. 10, pp. 114-122.

23. 聽 Wijkstra PJ, van der Mark TW, & Kraan J 1996, “Effects of home rehabilitation on physical performance in patients with chronic obstructive pulmonary disease (COPD)”, Eur Respir J, vol. 9, pp. 104-110.

Bronchitis: the Respiratory Problem

Bronchitis is the medical condition of Inflammation of bronchi of lungs. Microbes or bacteria and foreign substances that entered the respiratory tract lead to the bronchi inflammation stimulating surplus mucus secretion. Thus bronchitis is also defined as a disease of acute or chronic inflammation in the mucous film of the bronchial pipes. The root cause of bronchitis may also be allergic responses to irritants like tobacco smoke.
The Symptoms of acute Bronchitis includes a profound chest cold, insignificant fever; inflammation, feeble voice, imperfect speech, squatness of breath, annoyance, nausea, lung and body pain; dry or mucous comprising cough. On the basis of the degree of seriousness bronchitis is divided into two categories as acute and chronic bronchitis. Acute bronchitis is a type of the terrible bronchitis disease due to the soreness of bronchial tree and is generally self limiting. Acute bronchitis is quite similar to an awful chest cold along with ultimate subsiding to undetectable levels. The symptoms of acute bronchitis is consider to be undetectable because of the fact that the shrinkage or the contractions of breathing system be inclined to invite auxiliary episodes. Acute bronchitis if left unchecked and untreated lead to more fatal chronic stages or even asthmatic bronchitis and can be more dangerous in newborns, children, and adults with causal respiratory diseases, particularly emphysema.
Long-term persistent injury, as due to smoking, may direct to chronic bronchitis, where severe, irretrievable harm leaves the lungs unwrap to illness and fibrosis. Smoking-associated chronic bronchitis frequently occurs in connection with emphysema and this is known as chronic disruptive pulmonary disease. Treatment of bronchitis includes drugs to widen the bronchi plus endorse coughing, antibiotics, and existence adaptations like giving up smoking.
Smoking is a leading causal factor of bronchitis and therefore it is extremely advisable to give up. Renouncing smoking can overturn the consequences of chronic bronchitis plus permit the patients to direct to a more vigorous life. Drinking large amount of fluids resolve to help acute victims of bronchitis. Although acute bronchitis is virtually not as stern as chronic, it is capable of leading to impediments if kept untreated.

Premature diagnosis and management is dangerous in successfully plunging the symptoms of bronchitis. Antibiotics are frequently stipulated to help eradicate infection. Moreover, inhalers are usually used to assist provisional flair-ups for instance wheezing and coughing thus assisting the patient to respire more contentedly. In severe cases oxygen therapy is accepted where the patient is provided oxygen tank to assist breathing and respiration.
A vigorous diet with exercise courses are also suggested for lessening symptom associated with bronchitis. Ordinary aerobic exercise is courteous in intensifying lung capability and supporting in breathing. Walking has an immense low blow exercise for those with bronchitis disease. Besides, breathing cardiovascular exercises can be supportive as well as learning how to get deliberate, cavernous breathing to fortify the muscles and calm down the patient.
For acute bronchitis the patient should avoid dairy foodstuffs as it will enhance the quantity of sputum produced, complicating the symptoms. As an alternative, cayenne pepper, chicken stock and garlic are suggested as these assist in clearing the mucous. Aromatherapy utilizing eucalyptus facilitates to pacify the irritated lungs and regulate clearer inhalation or respiration. Hot showers or a warm compress too clears the mucus and help in stable breathing. The best solution to bronchitis is quitting smoking as well as being conscious of the second hand smokers.

Physiotherapy of Your Shoulder

The function of the human arm is to allow placement of the hand in useful positions so the hands can perform activities where the eyes can see them. Because of the huge range of positions required the shoulder is very flexible with a large motion range, but this is at the expense of some reduced strength and greatly reduced stability. A “soft tissue joint” is often a description of the shoulder, indicating it is the tendons, muscles and ligaments which are important to the joint’s function. Shoulder treatment and rehabilitation is a core physiotherapy skill.

The shoulder joint is constructed from the socket of the scapula and the humeral head, the ball at the top of the upper arm bone. The head of the upper arm is a large ball and important tendons insert onto it to move and stabilise the shoulder, but the shoulder socket, the glenoid, is small in comparison and very shallow. A cartilage rim, the labrum of the glenoid, deepens the socket and adds to stability. The acromio-clavicular joint lies above the shoulder joint proper and provides dynamic stability during arm movements, being made up from part of the scapula and the outer end of the clavicle.

The major stability and flexibility joints of the upper limb shoulder girdle are the scapulothoracic and glenohumeral joints and these joints are held steady and moved by large and powerful muscles. The pectoralis major and latissimus dorsi muscles stabilise and perform strong movements, the serratus anterior stabilises the scapula on the thorax, the rotator cuff stabilises the humeral head on the socket and the deltoid and other muscles perform movements. The shoulder blade and thorax need to be kept in a stable relationship for the glenohumeral joint to perform precise and controlled movements.

Around the shoulder all the muscles narrow down into flat, fibrous tendons, some larger and stronger, some thinner and weaker. All these tendons are anchoring themselves to the humeral head, allowing their muscles to act on the shoulder. The rotator cuff includes a group of relatively small shoulder muscles, the subscapularis, the supraspinatus, the infraspinatus and the teres minor. The tendons form a wide sheet over the ball, allowing muscle forces to act on it. The rotator cuff, despite its name, acts to hold the humeral head down on the socket and allow the more powerful muscles to perform shoulder movements.聽

With age, small degenerative tears occur in the tendons of the cuff, in some cases painful and in others not, causing loss of movement and strength. As tears progress they can become massive, cutting off the cuff muscle power from the humeral head and severely reducing function. Rotator cuff strengthening work is performed by physiotherapists and if the tears are severe they concentrate on anterior deltoid strength to improve functional ability in the absence of cuff power. Shoulder surgeons can repair many rotator cuff tears and physiotherapists rehabilitate patients following the shoulder protocols.

Osteoarthritis (OA) more commonly affects the hips and the knees, however the shoulder can be severely affected in which cases physiotherapy can help with advice, mobilisation of the joints and work on strength and joint motion. Once physiotherapy treatment has been tried then total shoulder replacement is the only remaining treatment option, surgical replacement occurring of the head of the arm bone and the socket of the shoulder blade. As the shoulder is referred to as a “soft-tissue joint” it is the balance and strength of the tendons, muscles and ligaments that determines a good outcome for the replacement. Physiotherapists closely follow the surgical protocols to get the optimal results.

Physiotherapists treat many other types of shoulder problems such as impingement, tendinitis, hypermobility, abnormal muscle patterning, fractures and dislocations. Impingement is treated by strengthening the rotator cuff or by subacromial injection or acromioplasty operation, where the end of the acromion can be excised. Tendinitis is treated by direct treatment of the tendon and graded strengthening and hypermobility by stability work and accepting the limitations dictated by the condition. Abnormal muscle patterning is managed by teaching normal patterns functionally and fractures and dislocations by the protocols laid down by the surgeons and trauma physiotherapists.

Upper-limb Dystonia Secondary to Atlantoaxial Dislocation – a Rare Case Report


The Atlantoaxial dislocation (AAD) is a fracture of the odontoid process, in such a way that the end that forms a joint with the atlas is separated from its base and kept in position only by the ligaments, which are not strong, joining it to the atlas. Usually AAD presents with occipital pain, others develop vertigo, brainstem signs, lower cranial nerve palsies. The brainstem findings occur with either basilar invaginations or with the alteration of the path of the vertebral artery with changing of normal anatomy.

Though Idiopathic Cervical Dystonia as a sequel to AAD has been reported in literature. [1] Upper limb dystonia is unusual in such cases and has never been reported from India as well as from any part of world and we report a 19-year-old male with AAD who presented with limb dystonia and hemiparesis

Case History:

A 19-year-old boy born of a non-consanguineous marriage, following a trivial trauma to the nape of neck before 2 years developed progressive spastic right hemiparesis. Three months prior to admission, he developed urinary urgency, precipitancy and constipation, and abnormal posturing of right upper limb predominantly of the hand.There was history of right hemiparesis when he was four years old, which improved spontaneously over two months. He denied history of fever, accident or vaccination prior to the present illness.

His neurological examination revealed short neck, low hairline and spastic right-sided hemiparesis. There was marked hyper-reflexia and clonus with posterior column impairment without signs of spinothalamic tract involvement. This was associated with restriction of neck movements and neck spasm. There were abnormal movements of right upper limb predominantly distal, in form of repetitive sustained posturing suggestive of dystonia.

The clinical, biochemical and radiological examination revealed neither evidence of rheumatoid arthritis nor any inflammatory, connective tissue disorder. Magnetic Resonance Imaging (MRI) of craniovertebral junction showed a mobile Atlantoaxial dislocation with a well-developed posterior arch of atlas and the absence of the lamina of the axis.The MRI of brain was normal.


Atlantoaxial dislocation (AAD) constitutes an important group of Cranio-Vertebral Junction anomalies frequently requiring emergency decompression and stabilization of joints to prevent morbidity and mortality resulting from compression of neurovascular bundles. Although present since birth, patients become symptomatic at a later age (often in third decade) usually following a trauma. The trauma may be so trivial, so as to be forgotten by the patient himself. When present, the severity of symptoms and its progression bears no relationship to the injury sustained. It is suggested that chronic recurrent trauma during neck movements and daily activities is an important factor for making the illness symptomatic and its sudden aggravation. Because of its varied clinical presentation and an unpredictable course the AAD is often misdiagnosed. Its usual manifestations include nuchal pain and rigidity, progressive cervical myelopathy, foramen magnum syndrome and sudden death due to compression of vital structures at cervico- medullary junction.

Dystonia is a rare neurological disorder characterized by sustained muscle contraction with resultant bizarre muscle movements and hence bizarre posturing. Broadly dystonia can be classified as focal, generalized, early onset or late onset. [2] Though dystonia due to diverse etiologies like drugs, degenerative diseases like progressive supra nuclear palsy and even cortical oligoastrocytoma have been described. [3] There has been a frequently reported association between peripheral injuries or pain and subsequent development of dystonia. Although this has been noted for many years, the mechanism is unclear and causative link is speculative. Most cases have been in patients who develop various forms of focal adult onset primary torsion dystonia after local injuries. Some patients may have pre-existing genetic liability to dystonia but this has been unproven. Occasionally Dystonia have been described in surprising clinical settings like spinal cord lesions and brainstem hemorrhage. [4,5] In the contrary, cervical dystonia itself may result in orthopedics and neurological complications including cervical spine degeneration, spondylosis, disk herniation, vertebral subluxation and fractures, radiculopathies and myelopathy. [6] AAD leading to dystonia could be due to multiple factors like limb pain and cervical cord lesion. Our case report is exceptional and AAD leading to limb dystonia has probably never been described in literature.

The exact mechanism of movement disorders in cervical cord lesions is yet not clearly understood. However, various hypotheses have been proposed which includes altered sensory input, abnormal processing of both input and output signals in the spinal interneurons and increased excitability of the spinal motor neurons. Disruption of the somatosensory pathways or motor cortex to the striatum also may produce abnormal movements without sensory loss.

Hand dystonia in our patient was ascribed to AAD with cord compression because the abnormal movements of hand completely disappeared after the correction of AAD.


1.Kanekar S. Atlantoaxial dislocation in idiopathic cervical dystonia. Neurol India 2004 ;52:124-5.

2.Jowi JO, Musoke SS.Dystonia: case series of twenty two patients.East Afr Med J 2005 ;82:463-7.

3.Koch MW, Luijckx GJ, Leenders KL.Paroxysmal focal dystonia with sensory symptoms secondary to cortical oligoastrocytoma.J Neurol2006;253:1227-8.

4.Cammarota A, Gershanik OS, Garcia S, Lera G. Cervical dystonia due to spinal cord ependymoma: involvement of cervical cord segments in the pathogenesis of dystonia. Mov Disord1995;10:500-3.

5.Esteban Munoz J, Tolosa E, Saiz A, Vila N, Marti MJ, Blesa R. Upper-limb dystonia secondary to a midbrain hemorrhage. Mov Disord 1996;11:96-9.

6.Konrad C, Vollmer-Haase J, Anneken K, Knecht S. Orthopedic and neurological complications of cervical dystonia- review of the literature. Acta Neurol Scand 2004;109:369-73.

The Treatment of Wrist Fractures by Osteopaths

When the weather begins to get icy it gets less safe underfoot and people start to fall over and hurt themselves. A common injury is a fall on the outstretched hand (FOOSH) which often results in wrist fracture. When we say wrist fracture we are usually describing a fracture of the end of the radius and ulna, the two major bones of the forearm. Wrist fractures vary from very minor like a chip to major breaks which require operative fixation. Osteopaths work in fracture clinics and rehabilitate the hand, wrist and forearm after such injuries.

75 percent of wrist fractures involve the radius and ulna, with the wrist the most often injured part of the upper extremity. A fracture can be minor and be undisplaced or very severe with multiple fractures (comminuted) and badly displaced, which may need operation with plates and screws to fix the fracture securely. The type of fracture is related to the age of the sufferer: adolescents have wrist growth plate displacement, children bend their bones in a greenstick fracture and adults present with a fracture of the final inch of the forearm bones above the wrist.

Fractures of this type occur mostly in people from 60-69 years old and those from 6 to 10 years old.聽 Fractures can occur without joint involvement (older people) or with fractures extending into the joint (younger people due to higher trauma forces) which complicates the picture. Diagnosis of a fracture is straightforward as the area is often very painful and swollen and the patient resists moving it. It may have a typical postural deformity called a dinner fork and feeling over this area will confirm the presence of a fracture.

Orthopaedic Management of Wrist Fracture

The main principle of treatment is to immobilize the fracture in an anatomically correct position so it heals as closely as possible to the original shape. The fracture is assessed for its severity and whether it is displaced. Displacement can be manipulated and plastered to hold the position but if the displacement is too great or the plaster does not hold the position then operative intervention is pursued. Internal fixation can involve passing narrow wires into the bones to hold position (k wiring) or inserting a plate with screws to immobilize the fracture, after which plaster is again applied.

Osteopathy after Wrist Fracture

The typical time in plaster is five to six weeks and once it comes off the osteopath can assess and rehabilitate the wrist and hand. The condition of the wrist and hand is very variable on coming out of plaster and a skilled assessment of the problems and potential for improvement is vital. The osteo will look initially at the colour or swelling of the hand to get an indication of the severity of the problem. Excessive swelling, significant colour change or extreme reported pain might point to Complex Regional Pain Syndrome (CRPS), a severe and important condition which needs prompt treatment.

The shoulder ranges are assessed initially by the osteopath as the shoulder can be injured in the fall and suffer loss of movement. Loss of movement at the elbow can occur if the patient holds their arm stiff for the first few weeks but the rotatory forearm movements (supination & pronation) are much more commonly restricted and functionally important. The fracture is close to the lower rotatory forearm joint and restricts this and the wrist ranges of motion. The hand function, finger and thumb movements are also assessed by the physio.

The osteo will decide if the patients hand is normal for coming out of plaster and give range of motion exercises for the elbow, forearm, wrist and hand and perhaps the shoulder. A futura splint, a velcro fastening wrist splint, is useful to reduce the shock of coming out of plaster and allow patients to do functional activities without aggravating the pain too greatly. Attending a hand class for repeated exercise can be useful and osteos can use mobilizing techniques to restore the accessory movement between the joints. Once the wrist is settled and moving better the osteopath will work on strengthening exercise and encourage functional normality.

Multidisciplinary Pain Management for Cerebral Palsy

Cerebral palsy affects an estimated 800,000 people in the U.S, and 3 out of every 1,000 children. It’s a condition that affects every aspect of the human body, from movement, muscle tone to developmental brain abnormalities, vision and hearing problems, and seizures. According to the Centers for Disease Control, about 10,000 babies per years in the U.S. will develop cerebral palsy, and of these babies many of them will need specialized physical therapy and pain management doctors throughout their lives.

What is Cerebral Palsy?

Cerebral palsy (CP) is defined by the Mayo Clinic as a disorder of movement, muscle tone or posture that is cause by injury or abnormal development in the immature brain, most often before birth. Cerebral actually refers to the brain while Palsy refers to the physical aspects of the condition. Though most cases of cerebral palsy develop before birth, CP can be the direct result of a traumatic brain injury at any point in life.

Symptoms of CP occur in the first few years of life, or soon after a traumatic accident, and only worsen as time goes on. Although symptoms vary greatly, there is rarely a misdiagnosis issue with it comes to CP. The Cerebral or neurological symptoms can include difficulty with vision or hearing, seizures, abnormal pain perceptions, dental problems, and intellectual disabilities. On the Palsy, or physical, sides of things, symptoms include variations in muscle tone, 鈥榮pastic’ or 鈥榬igid’ muscles, tremors, motor skill delays, favoring one side of the body, difficulty swallowing, difficulty with sucking or eating, delayed speech, and difficulty with precise motions.

While there are many types cerebral palsy, the most common is Spastic CP which includes rigid, tight and spastic muscles, muscles only functioning properly on one side of the body, or severe muscle and movement difficulties so that a wheelchair is required. Other forms of cerebral palsy include Athetoid Dyskinetic, Ataxic, Hypotonic, Congenital, or Erb’s CP.

What Causes Cerebral Palsy?

The exact cause for many cases of cerebral palsy can be hard to pinpoint. If CP occurs in an adult, it’s easier to see that a traumatic event or accident has occurred to damage the brain, but before birth it’s hard for physicians to determine the exact cause for CP.

Cerebral Palsy is not one disease with a single origin, like chicken pox or measles. It is a group of disorders that are related but probably stem from a number of different causes. When physicians diagnose Cerebral Palsy in an individual child, they look at risk factors, the symptoms, the mother’s and child’s medical history, and the onset of the disorder. 鈥

There are, however, common factors that may lead to the type of brain development issues that can cause CP. These predictors include drugs and alcohol, infection such as rubella, toxoplasmosis, syphilis, or chickenpox, exposure to toxins such as methyl mercury, thyroid problems, lack of oxygen or blood supply, or premature birth. 聽

Pain Management for Cerebral Palsy

Pain management doctors who specialize in pediatrics and special needs have a supreme knowledge of the intricacies of cerebral palsy. With this condition comes a different reaction to pain, a different understanding of pain, and pain doctors must be able to communicate to parents and children the aspects of treatment.

Children with CP understand pain differently than children with normal brain function and physical movement. 聽Many times, this condition brings with is an extremely sensitive pain threshold. Pain is experienced in a different way and on different levels, so a pediatric pain doctor must use specific pain assessment to determine exactly where the child’s pain is coming from.

Children with CP often have prolonged experience of pain that can keep them in and out of the pain doctor’s office throughout their lives. Nerves and tendons become easily injured to do the 鈥榮pastic’ and 鈥榬igid’ nature of muscles, as well as spasms and seizures that can add extreme pressure to different areas of the body. Joints become easily inflamed and patterns of wear and tear appear quite frequently in areas that are repeatedly spasming.

Spasticity Pain

When muscles are tight for great lengths of time, or when the brain cannot control those muscles, spasticity occurs. Spasticity is an imbalance of signals from the central nervous system to the muscles, according to WebMD, and the most common symptom of cerebral palsy. Because the muscles are hard at work at all times of the day and night, there is a great deal of pain associated with spasticity.

Spinal Pain

Another form of pain that is quite common to those living with CP is chronic back pain. Because of the many spinal deformities (scoliosis, kyphosis, lordosis) associated with cerebral palsy, upper and lower back pain is seen in many patients. These spinal deformities can make sitting, standing and walking incredibly uncomfortable and even painful.

CP Pain Managmenet

Pain doctors most commonly refer to physical therapists, behavioral therapists, prescription medications, and a neurologist when treating patients with cerebral palsy. By using a multidisciplinary team of medical experts, a pain doctor can treat all aspects of the child’s condition.

A physician, such as a pediatrician, pediatric neurologist, or pediatric physiatrist, who is trained to help developmentally disabled children. This doctor, who often acts as the leader of the treatment team, integrates the professional advice of all team members into a comprehensive treatment plan, makes sure the plan is implemented properly, and follows the child’s progress over a number of years. 聽鈥 The National Institute of Neurological Disorders and Stroke

For more information on cerebral palsy and pain management,聽visit 聽

The 3 P’s: Perfectionism, Procrastination, and Paralysis

Do you set your standards high, but always feel like you’ve failed?  Learn about the 3 “P’s” and end the vicious cycle that keeps you stuck and ineffective.

The Vicious Cycle

Perfectionism, procrastination, and paralysis – one often leads to the next, in a vicious cycle, especially on large, long-term projects with no clear deadlines.  Let’s look at each part of this cycle, and explore some concrete steps that you can take to disrupt the cycle.


Perfectionism can be defined as striving towards impossibly high goals.  Perfectionists are caught in a trap – they can never be good enough. They engage in rigid, black or white thinking about their own performance – if it isn’t perfect, it’s horrible.

Ironically, perfectionists often achieve a product that is far less than perfect.  At times, their performance is mediocre.  In contrast, those who aim at more realistic goals can outperform the perfectionists.  How can this be?  The procrastination and paralysis that results from overly high standards causes the perfectionist to wait until it’s too late, then rush to do something; anything.  The more relaxed realist, in the meantime, is able to put an effort in earlier, over a more prolonged period of time, with more chance to let time and subsequent changes or editing improve the final product.


When you believe that your next project should set the world on fire, you are setting yourself up for failure.  At some level you know that this level of achievement is unlikely.  You lose your energy and excitement for your project. 

On a football field, when the coach yells at the team that they are a bunch of @$#% for playing so poorly, the players may play better.  That is because they are enraged at being humiliated and they can use the rage to batter their opponents.  This doesn’t not work in other spheres!  Criticism, whether from your boss or your own inner critical audience slows you down, and interferes with your thinking process.

It is so easy to put off the next step of your project when thinking about it makes you experience unpleasant feelings.  So you procrastinate.  “I’ll get started tomorrow, and work twice as hard.”  But it’s hard for you to ignore the fact that you are not living up to your own high expectations for yourself.  “I’m lazy.”  ” I have no will power.”

As time goes on, you start to grind to a halt.  That leads to the third “P.”


You do absolutely nothing on the very project that is most important to you.  This is devastating for your self-esteem, and very discouraging.  It’s hard to plan your next project when you failed to complete your last one.

How to Avoid the 3 “P’s”

There are steps that you can take to avoid falling into the vicious cycle of the 3 “P’s.

* Become aware of the perfectionistic audience voices in your head (no, you’re not crazy.)  You can’t learn to ignore them if you don’t know that they’re talking to you.

* Learn how to answer them back (don’t do it out loud or people will think you’re crazy.)  An example would be, “OK it’s not my best work but at least I’m finishing it.”

* Look for role models who are satisfied with “good enough.”  Note how they get things done and are not looked down on by others.

* Set up realistic goals.  One way to tell if a goal is realistic is if you can actually do it.  For example, “Read two articles and write for 15 minutes before 5:00 tonight” is a realistic goal.  “Read two articles and write for 6 hours and write 10 pages before 5:00 tonight” is not a realistic goal.

* If you have reached the third “P,” drastic steps are needed.  Talk to a trusted friend, find a “project buddy,” or seek coaching. Do Not Give Up — it is very possible to get yourself out of the paralyzed state and back to productivity with just a little help.

A Final “P.”  Or Maybe Two.


Start with baby steps.  Do a little every day.  As you observe your own productivity, however small it may be, you will start to feel better about yourself.  You were capable all along – it’s just that your unrealistic expectations stopped you from functioning optimally.  Eventually your productivity will start to look like Progress.  And that’s the last “P” for today.

How to Treat Inguinal Hernias

An inguinal or groin hernia is caused when the intestines are protruding out of the abdominal wall. When this happens a lump will form on the upper thigh where it connects to the stomach. More often then not the pain that one can experience will vary depending on how far the intestines are sticking out. These intestines will protrude where there is a weak area in the abdominal wall.

Many times these hernias to not need any specific treatment. Doctors can easily push them back or reduce them without using drastic treatments. Many who are annoyed with them can strap them against the groin. But this is only temporary and will not offer much relief or correct the problem.

There are some cases in which a part of the intestine is caught in the lump – which squeezes off its blood flow. This is called the strangulated part of the intestine and it will not take long for it to die. When this happens the patient will begin to experience excruciating pain. Because a strangulated intestine can cause severe problems it is best to see a doctor immediately to prevent further complications. It will require surgery.

There are two types of surgery for a inguinal hernia; herniorrhaphy or hernioplasty. Herniorrhaphy is the most common and the oldest treatments. During this surgery the doctor will man an icision that will push the protrusion back into the abdomen. They will then tighten the weak muscles and the supportive tissues using stitches. Hernioplasty is a rather simple procedure in which a mesh of artificial fiber is used to repair the weakened muscles.

Surgeries for inguinal hernias usually take 45 to 90 minutes are most often performed in day surgery clinics. Patients are allowed to go home, move about, and eat whatever they want after the surgery. But they are still encouraged to take it easy. That is why it is best that they refrain from lifting anything that weighs more then 20 pounds.

Like with any operation there are risks involved and complications can occur. The risks include; a reappearance of the hernia and infections. Infections will require the removal of the mesh and will treated with antibiotics.聽

Types and Treatment of Bone Fractures

Did you know that each of us, on average, will have two bone fractures over the course of our lifetime?聽 Naturally, some people, on account of their vocations, avocations and lifestyles, will have more. Human activity can generate fractures of every bone in the body. Some bones, like the skull bones and ribs, form protective compartments for certain vital organs. Other bones provide the framework for muscles, tendons, and other locomotor structures that allow us to move about in our environment. This discussion will deal with the more common fractures which are sustained in day to day activities.

First of all, let’s discuss the kinds of fractures. One category involves whether the fracture is complete with separate bone fragments, or incomplete where bone fragments still partially joined. Another category is open fracture versus closed fracture. An open fracture is usually caused by a bone fragment puncturing the skin, so that the fracture is exposed to the outside. A closed fracture does not communicate directly with the outside, i.e., there is no broken skin. Other fractures, such as linear, spiral, or transverse, have to do with the fracture’s relationship to the long axis of the bone, that is, lengthwise, around, or across the bone. If the fracture has more than one fragment, it is called comminuted.

The basic principle in treating a fracture, both in first aid and in definitive care by a physician, is fracture immobilization. Applying a splint or other device to prevent movement of the fracture is of utmost importance. If a broken bone is moved, it can rupture nutrient blood vessels, cause further bleeding around the fracture, or even convert a closed fracture to an open one.聽

The second thing a physician has to address is whether there is nerve damage or blood vessel damage associated with the fracture. An entrapped nerve or artery would usually necessitate surgical treatment of the fracture.

The third thing that has to be assessed is fracture gap and angulations of the fracture deformity. If a fracture is too widely separated or angulated, surgery and internal fixation deices to repair the fracture may be needed.聽 The final determinant is whether the fracture is open or closed. An open fracture has to be treated surgically to ensure the maximal possibility of healing.

Most fractures can be treated by external splinting or casting. The rule is to cast one joint above and one joint below the fracture, so that the tendons and muscles won’t tug on the fracture site and prevent healing. The initial healing process involves the laying down of fibrocyte cells at the injury site which produce a rubbery substance called collagen. This collagen is gradually calcified over the next several weeks as the fracture heals. Calcification can usually be seen by x-ray at six to eight weeks, but total fracture healing may require several months.聽 One common place to sustain a fracture is the wrists and lower forearms. People tend to thrust their hands out in front of them to break a fall, and this often causes these fractures. A common fracture of the wrists of children and the elderly is the Colles Fracture, which produces a dinner-fork deformity of the wrist due to the angulated fracture of the radius bone. Most wrist and forearm fractures respond well to closed reduction (manipulation to reduce the angle and gap) and heal well with casting.

Another common fracture is the collar bone, or clavicle. This often occurs from a fall on the elbow or shoulder. It is treated with a sling and usually knits back together well, though there is often a temporary fracture deformity. Occasionally the fracture ends have to be surgically joined.

Rib fractures usually occur from direct blows to the ribs. They are very painful, but there is not an adequate way to splint them. An elastic rib belt was once used, but was found to cause pneumonia on the affected side. So the main treatment is enough pain medicine for comfort until the ribs start to heal and the pain subsides.

Skull fractures usually occur from direct blows. Because of the proximity to the brain, cranial nerves, and facial structures, their evaluation and treatment usually fall to neurosurgeons, ENT surgeons, or oral surgeons.

Compression fractures of the spine can occur from bone aging, or from major decelerative injuries. If there is impingement on the spinal cord or nerve roots, neurosurgeons or specialized orthopedic surgeons assume their care. Hip fractures are, as we know, common in the elderly. This is because their bones are weakened and brittle by the osteoporosis of aging, and they are more prone to falls. Usually surgery is required to retain function of the hip, and the healing process is prolonged.

It takes a lot of force to fracture a healthy femur, the big bone of the upper leg. This usually occurs in a fall from height or a motor vehicle accident. The fracture is often treated with traction to reduce it, and may require open surgery.

Fractures of the ankle are common in sports, falls, and motor vehicle accidents. If angulation and gap distance are not excessive after reduction, and if there isn’t tendon separation, these are most often treated with cast applications.

That’s the topic of fractures in a nutshell. The physician treating a fracture has a lot of factors to consider. He needs to mentally calculate the strength and direction of forces which caused the fracture. He needs to study the exact nature of the fracture with x-rays or maybe a CT scan. He must determine if there is concomitant nerve, blood vessel, or tendon injury. Finally he must determine whether the fracture can be managed by reduction and splinting or casting, or if it will need surgical correction.

John Drew Laurusonis

Doctors Medical Center聽

Have You Been Involved in an Auto Accident?

First Shock.聽 Then Pain.聽 Now What?
There are more than 300 auto accidents each month in Contra Costa County.聽 In spite of the frustrations you may now be going through, if you are alive, the accident could have been worse.聽 First, let’s count our blessings!!!聽 Contra Costa County has experienced over 100 auto accident fatalities since 2000.聽 But now, you have other challenges to be concerned with.

Don’t Be Fooled…….
If your auto accident seemed minor because of slow speeds or little damage to your vehicle, that doesn’t mean injury did not occur.聽 It can be a time of great concern.聽 At just 10mph, the body can be subjected to a force of 5 to 10 G’s.聽 The force of 10 G’s is greater than a fighter pilot would experience during aerial combat.
Independent studies show that your body can violently move back and forth 6 to 10 times the speed your auto was going at time of impact.聽 In other words, a 5-10 mph crash, your neck can move at 50 to 100 miles per hour!聽 This is how G force can cause serious injuries at even low speeds.聽 Of course, high impact speeds are self-explanatory.

1.聽聽 Stop – do not obstruct traffic
2.聽聽 Assist the injured
3.聽聽 Protect the scene – to percent further injury
4.聽聽 Call an officer – local Police Department
5.聽聽 Keep notes – strictly to yourself
6.聽聽 Assist the officer – give basic facts
7.聽聽 Identify the other driver
8.聽聽 Obtain witnesses information
9.聽聽 Arrest does not indicate liability
10. Do not leave the scene until doing the past 9 things
11. Call Barton Chiropractic
12. Inform your insurance company
13. Obtain professional counsel (get an Attorney)

Two Types of Injuries
There are two types of injuries that happened to accident victims:聽 These include Hard Tissue and Soft Tissue Injuries.聽 Hard tissue injuries usually require emergency medical treatment.聽 Most soft tissue injuries respond best to chiropractic care.聽

Hard Tissue Injuries
Hard tissue injuries are those injuries which happen to the bones.聽 They include fractures, broken bones and dental problems.聽 These along with cuts, bruises and burns fall within the category of Emergency Medical Care.聽 Most of these have a set healing time.聽 Once you’ve been checked and treated for these types of injuries, the next thing to be concerned about are soft tissue injuries.

Soft Tissue Injuries
Soft tissue injuries are those injuries which happen to all the remaining tissues of the body.聽 These include sprains and strains of the musculoskeletal system, including the spine and neck.聽 The most prevalent soft tissue injury found in auto accidents in known as whiplash.聽

Whiplash is a term used to describe what happens to your head and neck in an automobile accident.聽 It can occur at any angle; head on collisions, rear-end impacts, from any corner, or from being T-Boned, which is impact from the side.聽聽
The ill effects of a whiplash injury can occur instantly or it could be weeks, months or even years before symptoms occur.聽 Injuries to the neck caused by a sudden movement (head forward, back, or sideways) is commonly referred to as “whiplash” or “acceleration/deceleration injuries”.聽 Literally thousands of pounds of force is exerted upon the neck and spine of the whiplash victim.聽 These forces result in tearing of muscles, ligaments, and tendons, and in turn, can result in a displacement of the vertebrae of the spine (subluxation) which is a dysfunctional joint causing nerve irritation (pinched spinal nerves).聽 The results of such injuries can cause neck pain, shoulder and arm pain or numbness, elbow and hand pain or numbness, mid back pain, headaches, dizziness, and blurred vision.聽 The injured areas lose the ability to function and loss of range of motion (stiffness) occurs. This is where whiplash pain comes from.聽 It’s most prevalent in the neck – but can happen to any area of the spine or body.

Symptoms of Whiplash
Whiplash symptoms can include neck pain and stiffness, shoulder pain, headaches, back pain, arm pain, numbness or tingling in your fingers, dizziness or lightheadedness, mid back pain, low back pain, numbness or tingling down your legs.聽 Whiplash may also produce facial pain, ringing in the ears or hearing loss, vertigo, blurred vision, or even hoarseness.聽 Whiplash is real and painful.聽聽 You may experience one or many of the above symptoms.聽 Each person is unique in their injuries.聽

The Problem With Whiplash
The problem with whiplash is that very few doctors truly understand it.聽 Well meaning emergency room physicians, general medical doctors and physical therapists do not appreciate the extent of the pain and injuries of whiplash accident victims.聽 The end result is these people are often provided inadequate treatment to care for their injuries.聽 Don’t let this happen to you.

Whiplash Injuries Can Remain Hidden For Weeks Or Months
Because of the body’s ability to adapt to injury, some whiplash injuries can remain hidden for weeks or months before pain or other symptoms surface.聽 By the time symptoms surface, many people have already signed their right s to treatment away.聽聽 Insurance companies know the facts and spend millions of dollars a year to hide them.聽聽 It is no secret that insurance companies may not have your best interest in mind and attempt to get you to prematurely settle your claim in order that they can avoid additional liability.聽 Insurance companies are controlled by stockholders whose primary aim is to make money.聽 Their concern is not your health.聽 Their concern is to get you to settle for as little as possible.聽 If you do, what happens when hidden challenges begin surfacing?聽 Don’t let this happen to you.聽 Preserve your rights to receive the treatment you need by not signing away your rights.


Chiropractic聽is the most appropriate approach to these types of injuries.聽 Chiropractic care utilizes specific bone manipulations (Adjustments) to help normalize spinal function.聽 This is crucial in the beginning phases of healing to bring back proper motion, but return of functional joint motion usually requires 2-3 months of chiropractic care.聽聽聽 Active care allows the soft tissue (muscles, ligaments, and tendons) to heal most effectively with minimal scar tissue and physical therapy can take from a few months up to a year to complete the healing process.聽

There are 3 phases of healing that our bodies must undergo in any type of injury and chiropractic combined with physiotherapy is the most effect approach to all soft tissue injuries.聽 The initial phase of healing (Acute Inflammatory Phase) usually lasts 24 to 72 hours and ice (Cryotherapy) and immobilization (Neck Brace) is essential during this phase.聽聽 The next phase of healing (Regeneration Phase) begins around 3 to 5 days post injury and can last up to 3-6 months.聽 Chiropractic care combined with passive modalities is crucial to achieve maximum improvement of joint function during this phase of healing.聽 This is when damaged tissue is replaced by new tissue (Collagen).聽聽 Mobilization to the injured joints (chiropractic care) is essential to proper healing during this phase of care.聽 The third and final phase of care (Remodeling Phase) begins about 2 to 4 weeks after the injury and can last longer than 1 year in very severe cases.聽 Remodeling overlaps the regeneration phase of healing and this is when chiropractic and physical therapy is combined.聽 Remodeling is when new tissue (Collagen) begins and continues to strengthens.聽 It is essential to be seeing a physical therapist 2 to 4 weeks post injury to reduce recovery time during the remodeling phase.聽 Always remember chiropractic first, medicine and physiotherapy second, and surgery last.

Pain is an indicator that a problem within are bodies exists.聽 Without pain our bodies could not tell us that there is an injury and that there is something wrong.聽 Usually the absence of pain and swelling after injury is an exceedingly poor indicator of healing tissue.聽 Most minor to moderate whiplash injuries are overlooked by the patient, the hospital, and even the patient’s family medical provider due to the lack of initial pain.聽 One week up to 2 months after the injury, the patient continues to have pain or the pain worsens, is when most people begin to realize that the injury is much worse then they had imagined.

Improper treatment of whiplash injuries and all soft tissue injuries is a factor in about 50% of the patient’s that finally present themselves to our clinic.聽 Some patients are given a soft cervical collar by there medical doctor.聽 If this collar is worn too long, the collar itself can further weaken supportive muscles and actually lengthen recovery time.聽 If a muscle, ligament, tendon, or joint is subject to prolonged immobilization after injury or surgery this can have significant and profound negative effects.聽 If a fracture is present the patient is to be first seen by Neuro-surgeon to rule out spinal cord injury and will more than likely have to where a special collar/halo until the fracture is healed.聽 Once the fractured vertebrae is healed the patient should be sent to a physical therapist to minimize the negative affects of the prolonged immobilization of the soft tissues.聽 Most MD’s and DO’s prescribe muscle relaxors, pain medications, and anti-inflammatory medications (NSAIDS) first and skip chiropractic and physical therapy all together.聽

Don’t Take Unnecessary Chances
In whiplash injuries, ligaments, muscles and joints are stretched and torn out of their original positions.聽 When this happens, the nerves become compressed and cause pain.聽 Without proper care, the injury can progressive grow worse, because the neck vertebrate are now unstable and disc decay can form.聽 Your ligaments and other soft tissues can heal with scar tissue, and your vertebrate may heal in the wrong positions, creating long-term instability and weakness.聽聽 This is a permanent condition known as fibrosis, the pain is real and can last a lifetime.聽 Don’t take unnecessary chances.

The Good News!
The good news is that qualified chiropractic care has proven to be very effective in helping most whiplash victims identify and treat their whiplash injuries – without drugs or surgery.聽
A study by Woodward, Cook, Gargan and Bannister found 93% of patients under chiropractic care for whiplash injuries had improved.聽 They further stated”…..”No conventional medical treatment has proven to be as effective as chiropractic.”
Call Us Today At Barton Chiropractic Center in ConcordFor Your Exam
Dr. Barton, Dr. Joe, and Dr.聽Jay have had the experience of helping thousands of auto accident victims in their careers, saving most of them from long-term drug addiction and years of future pain as a result of their soft tissue, whiplash injuries.
Call us for your comprehensive examination.聽 If you have challenges needing treatment, rest assured we will provide you with the most competent and comfortable care available.聽 We are willing to work with you regardless of whether you do or do not have an attorney.聽 Our primary concern is to help you move into your future without the painful effects of whiplash following you there.
Call us today at 925-685-2002.聽 We look forward to serving you.
We can refer you to several attorneys in the area that specialize in Personal Injury Claims and who have assisted our patients in the past.


Trigeminal Neuralgia Information

Trigeminal Neuralgia is a chronic pain that is felt on one side of the jaw or cheek. In simple words it is a disease of the facial nerves and is also known as tic douloureaux. The pain is sudden and excruciating producing a burning or a shocking sensation. Though each episode of the pain is not long-lasting the intensity. The attack is sudden and it can last days, weeks, or months or even disappear for years or months together. Although this nerve disorder is not life threatening, the pain is physically and mentally intolerable.

According to the data collected, it is seen that TN is more common in people over 50 and more women are affected than men. Patients suffering from this disease have complained of tingling or numbing sensation before the attacks. The intense and sporadic attacks of pain are often triggered by talking, brushing teeth, eating or even exposure to the wind. Any vibration can start an attack. Severe cases like these can be cured with trigeminal neuralgia surgery.

According to all the Trigeminal Neuralgia information, collected over the years the cause of this disease is unknown. However, there is some evidence that this disorder inherited and depends upon the pattern of blood vessel formation. The disease gets its name from the Trigeminal nerve. The attack happens when a blood vessel presses the Trigeminal nerve at the point where it exits the brain. The disease may occur as a normal aging process or sometimes in case of multiple sclerosis or damage of the myelin sheath that act as a protecting covering to the nerves.

Trigeminal Neuralgia information reveals that the disease is difficult to diagnose as facial pains may be due to various reasons. Treatments for this disease may differ depending on the cause and the intensity -of the pain. Medicines like anti-convulsants and tricyclic anti-depressants.聽 Surgeries and other complementary approaches like portable ultrasound are also considered to the viable treatment options for this disease. However, trigeminal neuralgia surgery is recommended only if medical treatment fails to relive the pain and produce intolerable side effects.

In combination with drugs Trigeminal Neuralgia patients have been known to use complementary techniques like acupuncture, nutritional therapy, vitamin therapy and sometimes electrical simulation of the nerves.

Traveling With Bad Back and Pinched Sciatic Nerve Symptoms? Read These Back Pain Relief Travel Tips First!

We all need a break. If you have back pain or pinched sciatic nerve symptoms, you probably need one more than most. Here is a back pain relief travel plan to help you cope. Holidays are great, a time to relax, be with the family, play with the kids, explore, romance your loved one鈥r are they? If you have back problems you may be thinking it is easier to stay at home…

For many of us with back pain and sciatica symptoms just the very thought of a long journey, a strange bed, a lot of sitting, standing and traveling just doesn’t seem worth it. However with a few back pain relief travel tips you may reconsider鈥

With the onset of a ruptured disc and back pain I gave up holidays, and so did my family. That was just a miserable time for us all. Then I thought there must be a way. Whether it is a short trip or a long haul flight here are some hot tips for back pain relief during travel. For more detail feel free to visit

1. Before you travel.

鈥 First it is very important you contact your doctor to see if you are safe to travel with your back condition and that it will not compromise any back pain relief program you are undertaking.

鈥 Check you can get proper travel insurance and do shop around and make sure you are well covered.

鈥 If you require medication for you to get back pain relief make sure you carry enough for the duration of your travels and take some extra in case of delays. Ensure you carry your medications in your hand luggage and in their original labeled containers. Check with airline before booking your flights for the latest regulations.

鈥 Try to book an aisle seat.

鈥 Pack as lightly as possible, especially if you are carrying your luggage. If possible use suitcases with wheels; they are great if you have a bad back and sciatica symptoms.

鈥 Check your destination. Is it easy for you to get around with your bad back and pinched sciatic nerve symptoms? You need to know what you can handle comfortably with your back problems and book accordingly.

2. During a flight.

鈥 Drink lots of water on the flight. Particularly if you are taking back pain medication and as you are at altitude your body will easily get dehydrated which is not good for anyone and especially not if you have back pain, disc problems and pinched sciatic nerves.

鈥 At least once an hour get out of your seat and walk up and down the aisles. If you are following a back care stretching and strengthening back pain exercise system then try to do some of these. Do be courteous to other passengers but it is possible to do especially the standing ones in the aisles or in the galley part if you request politely of the cabin crew at times when it is not too busy.

鈥 Try not to fall asleep. This can be difficult but it is better to stay awake and move than to fall asleep and be in an uncomfortable position which may aggravate your back pain.

鈥 When in your seat, use the pillows and take a lumbar support if you need to help you get in the most comfortable position you can for your back.

鈥 Use a heat pad if that works for you to warm the muscles of your back and ease pain.

鈥 Do ask for assistance; do not try to struggle or risk back strain putting luggage in the overhead bins.

3. Traveling by coach/ train/car.

鈥 In a car whether you are the driver or passenger try to stop every hour. Get out and walk around, stretch and get the circulation going again.

鈥 On a coach or train try to get an aisle seat and take every opportunity to stand up, get off, walk around and do your back pain relief exercises.

鈥 Use a lumbar support or small towel or pillow behind your back and neck so you feel more comfortable.

鈥 Use a heat pad if that works for you to warm your back muscles and ease pain.

4. At your destination

鈥 If your destination is a long drive from the airport do consider staying in a nearby hotel/motel for one night so you can relax.

鈥 Pace yourself. Treat your back well; build in rest times and times to do your back care stretches. No one knows your back like you do and it is your job to be aware of its needs. Listen to your body!

鈥 If there is a pool and it is safe for you to do so, use it. Water therapy helps many people with back pain and pinched sciatic nerve symptoms and it is a good opportunity to do your back care stretches in the water.

鈥 When on holiday do keep up with any back pain relief exercises you need to do. This is not the time to cut back on what you need to keep your back healthy. Continue to drink more water, have good nutrition, do your back care stretches and exercise regularly.

And finally鈥

Have a great time and enjoy yourself, you so deserve it!
It is vital if you have back pain and pinched sciatic nerve symptoms that you ask questions, do your research and learn as much as you can. Feel free to visit my website at for more back pain articles, hints and tips on dealing with back pain in everyday life, information, back pain solutions and inspiration. No one cares about your back like you do.

Child Surgery In India At Affordable Low Cost鈥揅hild Surgery India Cost

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Child Surgery In India

Children aren’t simply miniature people who suffer the same diseases adults do, but on a smaller scale. Rather, they have their own specific afflictions and abnormalities.

Diagnosing and treating children’s heart diseases requires specialized knowledge and a dedicated approach to care…..

Understanding Child Surgery

Child / Pediatric Surgeons are medical doctors who specialize in the surgical treatment of conditions affecting children. Pediatric surgeons operate on children whose development ranges from the newborn stage through the teenage years. In addition to completing training and achieving board certification, pediatric surgeons complete two additional years of training exclusively in children’s surgery. They then receive special certification in the subspecialty of child surgery….

Variety of Surgical Procedures

A ] Trauma

The ChildSurgery service is consulted immediately for any pediatric trauma victim with serious and/or multiple injuries. The service will coordinate the trauma work-up, consult the appropriate subspecialty services, perform any necessary general surgical procedures, and coordinate care in the hospital. The service maintains a constant presence and therefore, an easily recognizable source of information for families and caretakers……

B ] Tumors/Oncology

The Child Surgery service is intimately involved with the management and performs surgery for surgical childhood malignancies. These include Wilms’ tumor, neuroblastoma, hepatoblastoma, hepatocellular carcinoma, rhabdomyosarcoma, teratomas, adrenal tumors, ovarian tumors, and testicular tumors. In addition, the service is involved in performing biopsies….

C ] Transplantation

The Child Surgery service, in conjunction with Pediatric Urology, performs kidney transplants and participates in the comprehensive care of these pediatric patients. The service provides necessary vascular access for children requiring bone marrow transplantation…..

D ] Airway

The Child Surgery service utilizes laryngoscopy, bronchoscopy, and appropriate surgical techniques to evaluate and treat a variety of congenital and acquired airway disorders. These include stridor, laryngomalacia, tracheomalacia, subglottic stenosis, tracheal stenosis, laryngeal or tracheal clefts, and aspirated foreign bodies…..

E ] Head and Neck

The Child Surgery service addresses a variety of conditions in the head and neck including branchial cleft anomalies and remnants, thyroglossal duct cysts, cystic hygroma/lymphangioma, abnormal/enlarged lymph nodes, neck masses, dermoid and sebaceous cysts, torticollis, disorders of the thyroid and parathyroid glands, and “tongue-tie”……

F ] Lymph Node

The Child Surgery service evaluates and surgically treats enlarged and infected lymph nodes when appropriate from a variety of conditions which include infections (cat scratch, atypical mycobacteria, tuberculosis, staphylococcus, streptococcus, and a variety of other bacteria) , tumors (Hodgkin and non-Hodgkin lymphoma, metastases from other primary tumors), and idiopathic enlargement…..

G ] Endocrine

The Child Surgery service evaluates and treats disorders of the thyroid gland, parathyroid glands, adrenal glands (adrenal tumors, hyperfunctioning and hypofunctioning gland, pheochromacytoma), pancreas (cysts and pseudocysts, hyperinsulinism, islet cell adenoma, tumors)…..

H ] Breast

The Child Surgery service evaluates and treats benign lesions of the breast in males (gynecomastia, breast enlargement, infection, congenital anomalies) and females (fibroadenoma, infection, inflammation, cysts, congenital anomalies). Endocrine evaluation is obtained when needed……

I ] Chest Wall

The Child Surgery service evaluates and treats disorders of the chest wall including pectus excavatum, pectus carinatum, sternal defects, Poland’s syndrome, and other congenital and acquired deformities. Cardiac and pulmonary evaluation is obtained when appropriate…..

J ] Thoracic

The Child Surgery service evaluates and treats a variety of congenital and acquired thoracic disorders. These include congenital diaphragmatic hernia, diaphragmatic eventration, mediastinal cysts and tumors, bronchogenic cysts, enlarged lymph nodes, pulmonary sequestration, cystic adenomatoid malformation……

K ] Abdominal Wall

The Child Surgery service evaluates and treats a variety of congenital abdominal wall defects including gastroschisis, omphalocele, and Prune Belly syndrome……

L ] Hernias

The Child Surgery service evaluates and treats a variety of hernias including inguinal, umbilical, epigastric, ventral, and epiploceles…..

M ] Gastrointestinal

The Child Surgery service evaluates and treats a wide variety of congenital and acquired gastrointestinal disorders. Conditions include pyloric stenosis, esophageal reflux, peptic ulcer, congenital duodenal obstruction (duodenal atresia, stenosis, web, annular pancreas), atresia and stenosis of small and large intestine, meconium ileus, Meckel diverticulum, intussusception, malrotation, intestinal obstruction…..

N ] Liver and Biliary Tract

The Child Surgery service evaluates and treats conditions of the biliary tract including jaundice of the newborn, biliary atresia, choledochal cyst, diseases of the gallbladder (gallstones, cholecystitis), common bile duct obstruction, liver cysts and tumors, liver hemangioma, portal hypertension…..

O ] Pancreas

The Child Surgery service evaluates and treats conditions of the pancreas including cysts, pseudocysts, pancreatitis, neoplasms, hyperinsulinemia, islet cell adenoma…..

P ] Spleen

The Child Surgery service evaluates and treats conditions of the spleen including splenomegaly and hypersplenism from a variety of hematologic disorders (sickle cell anemia, hereditary spherocytosis, Gaucher’s disease, idiopathic thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), thalessemias, autoimmune hemolytic anemias), cysts, tumors, and abscesses….

Q ] Genitourinary

The Child Surgery service evaluates and treats undescended testicles, testicular torsion, epididymitis, phimosis, cloacal extrophy, cloacal anomalies, labial fusion, clitoral hypertrophy, ambiguous genitalia, Prune Belly syndrome. The service regularly performs circumcision procedures as well…..

R ] Soft Tissue

The Child Surgery service treats and evaluates congenital and acquired defects of the skin and soft tissue including cysts, nodules, pigmented lesions/nevi, hemangioma, lymphangioma/cystic hygroma…..

S ] Vascular

The Child Surgery service treats and evaluates congenital and acquired vascular anomalies. These include vascular rings and slings, and vascular injuries. The service also regularly provides vascular access for nutrition, chemotherapy….

T ] Minimally Invasive Surgery (Laparoscopy, Thoracoscopy, Endoscopy)

The Child Surgery regularly uses a variety of endoscopic techniques to evaluate and treat conditions of the airway (laryngoscopy, bronchoscopy), the chest (thoracoscopy), abdomen (laparoscopy) and urinary tract (cystoscopy)…..


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Having the industry’s most elaborate and exclusive Patient Care and Clinical Coordination teams stationed at each partner hospital, we provide you the smoothest and seamless care ever imagined. With a ratio of one Patient Care Manager to five patients our patient care standards are unmatched across the sub continent.

Symptoms Of Throat Cancer – Is My Chronic Sore Throat A Sign?

Although there are lots of kinds and types of cancer, cancer of the throat is really a hazardous kind of cancer impacting many people all over the world these days. Cancer of the throat can impact any kind of individual; however particular groups tend to be more vulnerable to this type of cancer.

Cancer of the throat is more common within smokers frequently or those who are exposed to lots of passive smoking. Individuals with persistent acid reflux disorder will also be at a greater risk of getting this kind of cancer.

Additional groups that are much more vulnerable to getting cancer of the throat are the ones with a family history of the disease. The cancer that impacts the pharynx (the region that links the mouth area and the sinus cavity), the vocal cords and/or the larynx (the voice box) in an individual is called cancer of the throat. Every year some 6000 to 8000 individuals pass away from throat cancer in the USA.

Black males are most vulnerable to getting cancer of the throat. Individuals with cancer of the throat tend to be far more prone to have cancer within their pharynx compared to the larynx. Males are a lot more vulnerable to getting the cancer of the throat then ladies, and approximately 25000 new instances of throat cancer are identified every year.

There are several signs and symptoms that will point to cancer of the throat and when you have these symptoms you need to seek advice from a physician as quickly as possible. Like every illness an earlier prognosis and therapy can help to save your life. Particularly with most cancers if it’s identified well in time treatment could be a lot more efficient.

Sadly the first signs and symptoms for throat cancer are very common and may end up being mistaken for some additional conditions such as a sore throat, influenza and common cold, these types of signs and symptoms shouldn’t be overlooked and a through check-up ought to be done to identify the issue properly.

Persistent earaches really are a typical characteristic of throat cancer; these pains can often be mistaken for an ear infection brought on by influenza. Persistent sore throat is yet another main characteristic of throat cancer and it can end up being persistent and never disappear.

A dry throat and trouble talking, sometimes it can seem to be such as there’s a lump in the back of the mouth, neck or even throat, this particular sign may also make one seem hoarse. Occasionally someone struggling with cancer of the throat may really feel pins and needles all around the face. The throat cancer individual can show noticeable blisters on the tongue and mouth area.

Discomfort or even trouble swallowing, sometimes trouble even swallowing fluids really are a characteristic of throat cancer and really should not be overlooked. Unexpected unexplained weight reduction in a person is an indication of concern and it is an indicator of throat cancer or even another kind of cancer. Blood loss from the throat and blood in the sputum is yet another characteristic of cancer of the throat.

Should you suffer these signs and symptoms or perhaps a mixture of the signs and symptoms get yourself correctly examined, it’s not needed that you’re struggling with throat cancer simply because you have a few signs and symptoms but it’s vital that you eliminate the presence of this dangerous illness in a timely manner.