Shoulder Problems

Shoulder pain is one of the commoner complaints seen by GPs. The shoulder girdle itself comprises five separate joints: the sternoclavicular, acromioclavicular, subacromial, glenohumeral and scapulothoracic joints. Problems in any of these can cause shoulder pain.

Patients may also experience shoulder pain referred from distant areas such as the cervical spine, thoracic inlet, mediastinum and lungs, the diaphragm and even sub-diaphragmatic problems such as hepatic problems. So the clinician needs to keep an open mind as to the cause of shoulder symptoms, although here l will focus on problems within the shoulder girdle.

The sternoclavicular joint
This is a synovial joint with a small meniscus, and is between the manubrium of the sternum and the medial end of the clavicle. Problems with this joint are rare, which is just as well because solutions for sternoclavicular pain tend not to be effective. Degenerative change in this joint is usually post-traumatic and can be treated usually by a series of up to three hydrocortisone injections into the sternoclavicular joint. An excision arthroplasty of the joint can be done in severe cases. Sternoclavicular dislocations are rare and are usually treated conservatively with the patients being managed symptomatically.

If the patient continues to have pain and instability from a long-standing sternoclavicular dislocation or subluxation surgical options include either stabilising the dislocated joint or an excision arthroplasty, but only about half the patients see a significant improvement.

Problems affecting the glenohumeral joint
The glenohumeral joint is the main joint of the shoulder girdle and can be involved in a number of problems.

Glenohumeral osteoarthritis
This presents with a painful, stiff shoulder and is confirmed radiologically with the expected signs of loss of joint space, subchondral sclerosis, cysts and osteophyte formation. Management is usually conservative with analgesics, NSAIDs and intra-articular steroid injections. Joint replacement is rarely required.

Adhesive capsulitis
This is a poorly understood condition, presenting with spontaneous onset of increasing pain and stiffness in the shoulder girdle. The condition affects the normally lax lining of the glenohumeral joint.

Marked inflammation of the lining of the joint leads to the joint capsule tending to glue itself together, producing a marked, restriction in range of movement at the glenohumeral joint. Patients have restricted internal and external rotation compared with the normal side, with a lesser degree of restricted elevation.

The natural history is typically eight months of pain, followed by eight months of pain and stiffness, followed by eight months of stiffness before resolution. Therefore after 24 months, the majority of patients with this condition will settle. The diagnosis is made from the history, examination and normal X-rays.

Management consists of informing the patient about the natural history of the condition, and ,symptoms are managed according to their severity. A few patients are so disabled by this condition that they need a manipulation under anaesthetic and intra-articular steroids.

Glenohumeral instability
The extreme mobility of the glenohumeral joint is achieved because the socket is only one-third of the area of the ball of the humeral head. This architectural arrangement allows great mobility at the expense of stability. Shoulder instability is a therefore a frequent problem.

In 90 to 95 per cent of cases there is an anteroinferior dislocation. Patients who suffer three or more dislocations, that is have become recurrent dislocators, should be referred for consideration of surgical repair. This usually means a Bankart repair, in which the glenoid Iabrum is reattached to the anterior aspect of the glenoid.

An arthroscopic approach is replacing open surgery, although patients should be aware that success rates for arthroscopic surgery are about 70 per cent, whereas open surgery is up to 95 per cent successful. Arthroscopic repair rates continue to improve, however. Patients are managed postoperatively in a sling for six weeks, and this is followed by a six-week rehabilitation programme.

Problems with the subacromial joint
The subacromial joint is the articulation between the top surface of the rotator cuff and the under surface of the acromion, and presents two main problems.

Subacromial impingement syndrome
This is probably the commonest problem affecting the shoulder. Patients report pain in the rcgion of the lateral deltoid or deltoid insertion. It can disturb sleep, be aggravated by lying on the affected shoulder, and typically causes pain whenever the arm is used at or around shoulder height.The patient usually points vaguely to the latcral deltoid area as being the source of the pain. There is often evidence of wasting of supraspinatus and secondary wasting of the deltoid muscle. There are usually no particular tender areas.

Positive findings are of a mid-range painful arc when the arm is elevated through abduction and flexion.The patient may also show an abnormal rhythm of movement when the arm is raised and lowered. This trick is subconsciously learnt by the patient and takes the traumatised part of the rotator cuff away from the under surface of the acromion. A specific test consists of asking the patient to abduct the arm to 30¡ while resisting the movement. This should cause a reproduction of the pain.

Treating impingement syndrome
Conservative treatments include physiotherapy to strengthen the subscapularis and infraspinatus muscles, thereby pulling the inflamed and irritated top surface of the rotator cuff away from the undersurface of the acrimony. Other conservative measures include steroid injections into the subacromial joint. A diagnostic local anaesthetic injection is made into the subacromial joint to help confirm the diagnosis, and this is effective at relieving pain. Up to three hydrocortisone injections can be given at four- to six-week intervals. A combination of physiotherapy and a series of steroid injections will resolve symptoms in about 80 per cent of cases.

If patients fail to respond, referral is indicated as they may need an arthroscopic subacromial decompression to relieve symptoms and prevent rotator cuff rupture. This generates more space in the subacromial joint to stop the inflamed and swollen tendons from being further rubbed. This 40-minute procedure is successful in about 80 per cent of cases, but full recovery takes about 12 weeks.

Rotator cuff rupture
Rupture of the rotator cuff can be either partial or complete.The rotator cuff is a tube of muscle emanating from the shoulder blade and encircling the humeral head. Its function is to pull the humeral head firmly on to the socket of the glenoid as the arm is elevated. Even with a tear, the rotator cuff may still be able to stabilise the humeral head and the glenoid. In these cases the rotator cuff is defined as functionally intact.

A large rupture will not allow the rotator cuff to stabilise the head of the humerus in its socket, and the patient will be unable to abduct the arm at all. This is because when the deltoid contracts, the humeral head is pulled up through the rent in the rotator cuff. Patients with suspected rotator cuff ruptures require referral to an orthopaedic surgeon with an interest in shoulder problems for investigation and possible repair. Rotator cuff repairs are a major undertaking and require extensive rehabilitation programmes.

The acromioclavicular joint
Problems with the acromioclavicular joint (ACJ) are common, and usually involve osteoarthritis or ACJ dislocation.

Osteoarthritis
Patients localise tile pain extremely well to the area of a degenerate joint, usually pointing with one finger at the ACJ. Using the arm when it is raised typically aggravates the pain. Often there is a history of trauma. When examined, the ACJ is tender and pain is reproduced when stressing the ACJ by fully adducting and internally rotating the shoulder.

The patient also complains of pain when the arm is in full elevation in either flexion or abduction. Physiotherapy or oral anti-inflammatory drugs are used initially, but if there is no response a GP can give a series of up to three hydrocortisone acetate injections to the joint.

Injection technique
Injecting a degenerate ACJ can be quite difficult as the joint space is often narrowed. Infiltration around the joint with local anaesthetic is followed by an injection of I-2m1 of lignocaine into the joint. After a minute or so, test movements to ensure that the local anaesthetic block to the ACJ has resolved the patient’s symptoms. It is then usually fairly easy to inject hydrocortisone into the joint without causing undue discomfort. About 70 to 80 per cent of patients will be cured by a series of up to three such procedures at four- to six-week intervals. If the response is unsatisfactory then refer to an orthopaedic surgeon to consider an arthroscopic ACJ arthroplasty or an open ACJ arthroplasty. I prefer the former operation as this preserves the superior joint capsule and is cosmetically more acceptable.

ACJ dislocation
This is a common injury, particularly on the rugby field when players typically fall onto the point of their shoulder. Most patients will have been seen in a casualty department and may have been referred to a fracture clinic. The jury among orthopaedic surgeons is still out regarding the best treatment for ACJ dislocations.

Most patients can be treated conservatively, because even with a dislocated ACJ most patients are able to compensate well and have a normal range of movement and function of the shoulder. Patients with a marked cosmetic deformity, or those engaged in upper-limb sports or work should be counselled concerning the pros and cons of conservative management versus reconstructive surgery.

An ACJ reconstruction is easy to perform if done in the first few weeks. However, by the time an ACJ dislocation has become chronic – that is, after six weeks – then reconstruction becomes more difficult, requiring ligament or coracoid process transfer. Patients who may justify ACJ reconstruction should therefore be referred to a specialist early.

The scapulothoracic joint
Fortunately, problems in the scapulothoracic joint are rare. The commonest complaint is a painful or snapping scapula. In many of these patients no obvious cause for their symptoms can be found, although a small proportion of patients will have pain arising from the supramedial border of the scapula as it moves over the posterior chest wall.

Usually they are investigated with a CT scan. This investigation can provide a three dimensional picture of the architecture of the shoulder girdle.

Management
A physiotherapy programme is the first route to try and improve their Scapulothoracic control, but if patients fail to respond a small proportion of them may be offered excision of the abnormally angled supra-medial border of their scapula. This procedure may help alleviate their symptoms.

Patients likely to benefit from this operation represent only a small proportion of patients with scapulothoracic pain, however. All patients with scapulothoracic pain and clicking should be referred initially for a physiotherapy programme in the first instance to look at their scapulothoracic control.

Only if this fails to alleviate their symptoms is referral to an orthopaedic surgeon with an interest in shoulder problems recommended.

From an original article published in GP, 18TH MAY 2001

Patellar Luxation – Kneecap Disease on Dogs

Patellar luxation is usually a congenital condition in which the kneecap, or patella, dislocates outside of its normal trochlear groove. The dislocation clinically referred to as luxation, can occur on either the medial, or inside surface, or the lateral, or outside surface, of the knee. There are varying degrees of patellar luxation that are graded depending on whether the patella is intermittently or constantly luxated. This abnormal displacement of the kneecap results in pain, cartilage damage, and arthritis. There are varying degrees of severity of this disease, and surgery may be needed. This condition is common occurs on cats, dogs and humans. On dogs, this condition typically affects small and miniature breeds such as the poodle, Pomeranian, Chihuahua, Schipperke, Bichon Frise, and pug so they need proper petsafe. It is also seen in the cocker spaniel, golden retriever, Labrador retriever, and mixed breeds. On the rare occasions, this condition on larger dog breeds, the kneecap is as likely to move to the outside (lateral) side of the legs as to the inside.

Clinical signs of medial patellar luxation are lameness that is often intermittent, and may be unilateral or bilateral; thick, swollen stifles; pain on range-of-motion; crepitus; palpable luxation; inability to jump or walk normally; medial displacement of quadriceps muscle group; lateral bowing of the distal third of the femur. Common symptoms are intermittent or consistent lameness; bowlegged stance; reluctance to walk or jump; occasionally holding a rear leg out to the side when walking.

Medial patellar luxation, or MPL, is a very common disease of small or toy and miniature breeds in which the kneecap occasionally rides on the inside of its normal groove. Primarily congenital, although occasionally acquired through trauma, MPL causes lameness in one or both rear limbs. The degree of lameness is determined by the severity and duration of the disease, as well as the extent of existing arthritis. Patellar luxation is graded on a scale from I to IV, with IV being the most severe. The disease can progress from the less severe to more severe grades over time. The more severe forms are often accompanied by malformation of the femur and tibia, as well as varying amounts of arthritis and requiring enough rest on dog crates.

Some veterinarians and medical experts can identify dogs with this condition as early as eight weeks of age. They explain that the problem is a genetic defect so they are not advisable to be bred. On treating this condition, when the problem occurs only due to my manipulation or only occasionally on its own, no surgery is necessary and no medicines need to be administered. When the knee locks up frequently or the dog exhibits pain it its knee surgery is required. There are a number of surgical techniques that attempt to fix this problem. Some veterinarians relocate the patellar ligament and a small portion of bone (the tibial tuberosity) where it attaches to the tibia or shinbone. Others remove a portion of the medial patellar ligament and reinforce the lateral patellar ligament with suture. Often, the groove in which the patella rides is deepened. Because it is impossible to cleans and maintain an animal as aseptically as a human being, the vet begin all orthopedic cases on a broad-spectrum antibiotic several days prior to surgery. They continue this medicine for a week following the surgery. The affected leg or legs are bandaged for three days following the surgery and the pet is limited to short leashed walks for an additional two weeks. Because the surgery is relatively straight forward, few post surgical complications occur. Vet will try to do both legs at the same time even if the current problem is confined to a single leg. This is because left unattended, problems with the lesser-affected knee or sub clinical problems will lead to arthritis of that knee.

Stress Fractures – garyhill

Stress fractures usually start out as a minor discomfort in the foot or leg, that occurs near the end of a long run. Usually the pain goes away as soon as the athlete stops running.

Stress fractures are small cracks in the bone caused by repetitive stresses or overuse, such as the repetitive impact on the bones of the lower leg and foot during running and jumping activities.

When the human body is subjected to a slight increase in workload it will adapt by getting stronger. The bones, tendons and muscles will all change to handle the increase.

The risk of hip stress fractures may increase for a number of reasons. While some of these reasons are out of our control, others can be avoided or at least mitigated.

Fortunately, if you use the right techniques you can quickly get over your shin splint stress fracture and it will be like the problem never existed in the first place.

Consider stress fracture as a diagnosis in adolescent athletes complaining of worsening vague pain without a clear mechanism of injury.

Calcium is carried from bones by cells called osteoclasts and carried into bones by cells called osteoblasts. Bisphosphonates such as pamidronate prevent osteoclasts from carrying calcium from bones.

Increasing levels of pain reported in the part during activities or exercise is the typical pattern of presentation, with a recent upturn in the intensity or frequency of training often reported.

Fracture of the fifth is the most common injury. This results from the twisting of the ankle. This kind of fracture doesn’t need to be surgically repaired. Walking immediately in a removable plastic cast is usually advised.

Massage therapy is a treatment option which can reduce pain and discomfort in the soft tissue surrounding a fracture injury, and it can also assist in reducing edema and muscle tension.

Most Hallux fractures involve the distal aspect or the tip of the Great Toe. These stubbing type of injuries usually are diagnosed with x-ray and treated according to the severity of the fracture.

Stress can come from the everyday pressures of life. Traffic, money problems, and time constraints may not cause stress damage immediately but long periods of exposure to minor problems can cause mini fissures.

Reducing your stress is one great factor in osteoporosis. Why? It is because stress can deplete your body of necessary nutrients for your bones such as calcium.

Osteomyelitis is a disease that affects the bones and causes inflammation of the marrow as well as the bone itself. This problem is often a result of an infection.

You can immediately tell if you have a bone fracture by just examining the affected area. Usually on the impact itself you may hear a crack or a snap, telling you that the bone was broken.

A special category of bone fractures is related to sports and sport athletes. Sport athletes are prone to bone fractures because of the higher level of stress and force applied often on the bones.

The femur, or thigh bone, is one of the strongest and largest bones in the body. It usually takes a tremendous force to fracture a femur through the center.

Cerebral Palsy and Erb’s Palsy

The birth of a child is one of life’s most treasured and joyous events. That joy can be tainted or destroyed when the child suffers a debilitating or fatal birth injury due to a medical error.

Most birth injuries are preventable by proper monitoring of both the mother and the fetus during pregnancy and delivery. Children who suffer birth injuries can be disabled for life, require extensive medical care immediately after delivery, and may require life-long care.

The physical, emotional, and financial hardships that families experience can be overwhelming and life-altering. In some cases one or both parents will have to quit their jobs to care for the child, sometimes for the rest of that child’s life.

Cerebral palsy

Cerebral palsy is caused by brain injury to a baby during pregnancy, delivery, or shortly after delivery. It affects muscle control and it can cause learning disabilities. Proper medical care and therapy are your child’s best hope of leading a normal life, but most children with cerebral palsy require life-long care.

Cerebral palsy will affect each child differently but some of the problems it can cause include speech impairment, visual impairment, hearing impairment, difficulty walking, difficulty eating, limited motor skills, paralysis, drooling, seizures, and incontinence.

Cerebral palsy causes include:

  • Lack of oxygen
  • Umbilical cord strangulation
  • Unreasonable delay in performing a c-section
  • Rh incompatibility
  • Bleeding in the brain
  • Infection in mother or baby during pregnancy
  • Inappropriate medications during pregnancy
  • Kidney and urinary tract infections in the mother
  • Severe jaundice
  • Stroke
  • Failure to respond to fetal distress
  • Inappropriate use of forceps
  • Failure to treat infant seizures

Erb’s palsy

Another common birth injury is Erb’s palsy. Erb’s palsy does not affect the brain. It affects the shoulder, arm, and hand. In most cases, Erb’s palsy can be treated with therapy and exercise. In about 20% of cases, surgery is required. Most children can make a full recovery, but some are permanently disabled.

Erb’s palsy is caused by an injury to the brachial plexus during delivery. It is entirely preventable. The brachial plexus is a nerve bundle between the neck and shoulder. This nerve bundle can be damaged by too much force during delivery when the baby’s should is wedged behind the mother’s pubic bone. This is called shoulder dystocia.

Caesarian section is the best way to prevent Erb’s palsy, but when shoulder dystocia is not detected early enough to perform a C-section, there are several delivery methods that doctors can used to help prevent the trauma.

There are many warning signs doctors should look for that indicate a high risk of shoulder dystocia including:

  • Obesity in the mother
  • Advanced age of mother
  • Short or small mother
  • Diabetes in the mother
  • Flat, contracted or exceptionally small pelvis in the mother
  • Above-normal weight gain during pregnancy
  • High pre-birth weight of the baby
  • Abnormally long gestation period
  • Prolonged labor
  • Breech position

Sleep Paralysis Symptoms – How to Cope

Sleep paralysis symptoms are frightening conditions that cause you to be paralyzed while still conscious. It can happen when you are about to sleep or as you are waking up. As if that is not scary enough, it can also include hallucinations. A person may see an eerie figure, hear a strange sound or feel suffocated. All of these add to the overall feeling of danger for the person. The experiences can be downright scary, leading to panic or a feeling of impending death.

Though there is no known cure yet for this disorder, there are ways to manage its symptoms. These are some of the ways to cope with sleep paralysis;

Learn to recognize the symptoms.

The key to effectively manage sleep paralysis is knowledge. Learn as much as you can about the disorder. Understanding sleep paralysis can ease the sufferer’s mind from stress and fear when it’s time to sleep. Knowing what causes the disorder, its symptoms, and how to treat it can somehow diminish its effect on you.

Find out what triggers your sleep paralysis and avoid it.

Try to observe your sleeping pattern, positions, and your mental or emotional condition before an attack occurred. This will help you identify the factors that can trigger your sleep paralysis and be able to avoid them in the future. If you observe that your sleep paralysis attacks happen when you’re sleeping on your back, then try to sleep on your side. Identify also if the paralysis happens as you were falling asleep or upon waking up. All of this information will come in handy especially if you decide to see a doctor about your problem.

Get enough sleep.

Sleep deprivation or irregular sleeping pattern can increase the frequency of paralysis attacks. That is why it is important to maintain healthy sleep. Try to get as much as 6-8 hours of sleep.

Just Relax.

Sleep paralysis can be truly scary, especially when coupled with hallucinations. However, just try to relax during an episode. Keep in mind that it will all go away soon and will not harm you.

Focus on body movement.

One of the best ways to regain consciousness is by moving even just a small part of your body. You can try blinking your eye, batting your eyelashes or roaming your eye around the room. You may also try to wiggle your toes or your fingers. Just concentrate on continuing the movement as fast you can. It can help rid the paralysis in no time.

Monitor your heart rate.

You heart rate normally increases when experiencing sleep paralysis. Take advantage of this. Wear a heart rate monitor that is set to vibrate. The vibration is enough stimuli to nudge you awake.

Tell your partner about your condition.

If someone is sleeping beside you, tell him about your condition. You can try moaning to catch his attention and help you in waking you up.

It is very important to bear in mind that while sleep paralysis is frightening, it is not harmful. You are not alone with your symptoms since a lot of people have experienced it too. You are not dying or losing your mind. But if you feel that it affects you profoundly and you can’t control it through the measures mentioned above, talk to your doctor and see what other things can be done.

We’ve also compiled a comprehensive information on sleep paralysis symptoms,its causes and treatments in our sleep paralysis page. You may not know it but sleep paralysis can also be a direct complication of a sleep disorder called narcolepsy. Find out if you are suffering from this condition too. Go straight to my Narcolepsy website to know more about this disorder. See you there!

Hernia – Causes of Hernia

A hernia occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity. Although the term hernia can be used for bulges in other areas, it most often is used to describe hernias of the lower torso (abdominal wall hernias).

There are many different kinds of hernias. The most familiar are those that occur in the abdomen. In this type of hernia, a part of the intestines protrudes (sticks out) through the wall of the abdomen. An abdominal hernia can occur in different areas. The name given to the hernia depends on the location in which it occurs.

What causes a hernia?

Expect marked obesity to be a major factor in developing hernias. Weakened muscle tissue and poor circulation are present due to lack of exercise. Excessive weight and pressure on weak muscles is a likely source for hernias.

Recognize heavy lifting as a major contributor to the development of hernias. Those who lift heavy materials must learn good body mechanics and wear proper support to avoid putting undue stress on weak internal muscles.

Hiatal Hernia Causes: The causes of a hiatal hernia are speculative and unique to each individual. However, there are a number causes. First of all there may be a mechanical cause. Improper lifting, hard coughing bouts heavy lifting, sharp blows to the abdomen (the kind that “knock the wind out of you”), tight clothing and poor posture may contribute to the development of this problem. Improper lifting may be the biggest mechanical cause of this disorder. If the air is not expelled out of a person’s lungs while lifting, it will force the stomach into the esophagus.

Inguinal Hernia: Inguinal hernias are caused by a weakness in the abdominal wall. In some people, this weakness is congenital, which means it is present at birth. In others, it develops over time, as a result of excessive weight gain or loss, physical activity that places pressure on the abdomen, pregnancy, straining during bowel movements because of constipation, straining during urination because of an enlarged prostate, or chronic and intense coughing. Because the abdominal wall is weak, the hernia occurs during abdominal strain.

Some inguinal hernias have no apparent cause. But many occur as a result of increased pressure within the abdomen, a pre-existing weak spot in the abdominal wall or a combination of the two. In men, the weak spot usually occurs along the inguinal canal. This is the area where the spermatic cord, which contains the vas deferens, the tube that carries sperm, enters the scrotum.

SPINAL INJURIES CAUSES,COMPLICATIONS AND TREATMENT

Usually the result of trauma to the head or neck, spinal injuries (other than spinal cord damage) include fractures, contusions, and compressions of the vertebralcolumn. Spinal injuries most commonly occur in the twelfth thoracic, first lumbar, and fifth, sixth, and seventh cervical areas. The real danger from such injuries isassociated damage to the spinal cord.

Causes

Most serious spinal injuries result from motor vehicle crashes, falls, diving into shallow water, and gunshot and related wounds. Less serious spinal injuries typicallyare caused by improper lifting of heavy objects and by minor fails. Spinal dysfunction may also result from hyperparathyroidism and neoplastic lesions.

Complications

Spinal injuries can be complicated by spinal cord damage, resulting in paralysis and even death. The extent of cord damage depends on the level of injury to thespinal column. Autonomic dysreflexia, spinal shock, and neurogenic shock are complications of spinal injuries.

Assessment findings

The patient’s history may reveal trauma, a neoplastic lesion, an infection that could produce a spinal abscess, or an endocrine disorder. The patient typicallycomplains of muscle spasms and back or neck pain that worsens with movement.

In cervical fractures, point tenderness may be present; in dorsal and lumbarfractures, pain may radiate to other body areas, such as the legs.Physical assessment (including a neurologic assessment) helps locate the level of injury and detect any spinal cord damage.

General observation of the patient reveals that he limits movement and activities that cause pain. Inspection reveals any surface wounds that occurred with the spinalinjury. Palpation can identify pain location, loss of sensation, deformity, and the presence of areflexia.If the injury damages the spinal cord, note that clinical effects range from mild paresthesia to quadriplegia and shock.

Diagnostic tests

Spinal X-rays, myelography, and computed tomography scans and magnetic resonance imaging are used to locate the fracture and site of the compression.

Treatment

The primary treatment after spinal injury is immediate immobilization to stabilize the spine and prevent cord damage; other treatment is supportive.Cervical injuries require immobilization by application of a hard cervical collar, sandbags on both sides of the patient’s head, or skeletal traction with skull tongs or ahalo device. When a patient shows clinical evidence of spinal cord injury, high doses of I.V. methylprednisolone are started.

Treatment of stable lumbar and dorsal fractures consists of bed rest on a firm surface (such as a bed board), analgesics, and muscle relaxants until the fracturestabilizes (usually in 10 to 12 weeks).

Later treatment includes exercises to strengthen the back muscles and a back brace or corset to provide support while walking.An unstable dorsal or lumbar fracture requires a plaster cast, a turning frame and, in severe fracture, laminectomy and spinal fusion.When the damage results in compression of the spinal column, neurosurgery may relieve the pressure. If the cause of compression is a neoplastic lesion,chemotherapy and radiation may relieve the compression by shrinking the lesion. Surface wounds that accompany the spinal injury require wound care and tetanusprophylaxis unless the patient was recently immunized.

Gas Scooters – a Power Sports Fun

Gas scooters are two-wheeled transportation vehicles. Gas scooters are motor vehicle built over a particular frame. It has two small wheels, where the size of wheels varies from 10″ to 16″ in diameter. The engines of Gas scooters are placed in the rear side of the vehicle. These engines of Gas scooters are made for light duty only so they are not very powerful but enough for carrying two adult person easily. In Gas scooters, you will find large range of designs such as small or large wheels scooters, front fairing or floor boards scooters, manual or automatic transmission scooters and step-through or step-over frames scooters. The engine displacement of Gas scooters ranges from 50 cc to 799 cc.

In most part of the world like America, Asia and Europe, Gas scooters has become the basic form of urban transportation because they can be bought at very low cost and they also have easy driving position. Gas scooters are easy to ride and can be driven by both adults and children over the age of 16. But there are different traffic regulations in different parts of the world. If you live in a crowded city then Gas scooters are the best options for your transportation. There are many benefits of Gas scooters such as they are easy to drive, they gives good mileage, easily comes out of a traffic jam and can be afforded by middle class or lower class families also. The price ranges of a Gas scooter vary from $1000 to $4000.

You can buy a Gas scooter from a dealer or from any dealer on the web. But buying Gas scooters on the web is more profitable. If you go to a dealer or a showroom you may have to pay various types of taxes and other things. But if you buy a Gas scooter from the web dealer then these taxes or other expense gets lower. You will also have a wide variety of options to choose a Gas scooter. A normal Gas scooter has the following specifications:

  1. Engine – 150cc Air Cooled, 4 Strokes, Single Cylinder.
  2. Maximum Power – 11 HP.
  3. Maximum Torque – Feel it for yourself.
  4. Ignition – 12V / 7A CDI.
  5. Start – Electric w/Key Ignition & Kick Starter.
  6. Transmission – Dry-auto acentric.
  7. Dimensions LXWXH – 76X27X46 inches. (Depends on models)
  8. Seat Height – 29.5″
  9. Dry Weight – 265 lbs.
  10. Tires – Front/Rear 130/60 – 13
  11. Brakes – Front Hydraulic Disc, Rear Drum.
  12. Top Speed – Up To 55 inches.
  13. Wheel base – 53.5 inches.
  14. Fuel Capacity – 1.7 Gallons.
  15. Weight Capacity – 325 lbs.
  16. Colors – Red, Black, Yellow and Blue. (Depends on models)

Over the last few decades Gas scooters have gained large popularity. According to Motorcycle Industry Council, in United States the sales of Gas scooters have been doubled since 2000. These Gas scooters have become more popular because of various things such as weight, size, fuel efficiency and larger storage room in comparison to motorcycles. In some parts they also have fewer restrictions in comparison to motorcycle in the same area. There are some more benefits of Gas scooters such as it can go in those areas also where four wheeler or big vehicles cannot go.

You also have lots of options while buying a Gas scooter. There are wide ranges of manufacturer of Gas scooters and which produces several different models. You can choose the right one for you. All these Gas scooters come with complete paper work and warranty. So there is no risk involved. You can buy it for power sports fun or for low transportation. In both cases you are gaining something.

Shingles: Symptoms, Cause and Treatment

Shingles, also called Herpes Zoster, is an outbreak of rash or blisters on the skin that is caused by the same virus that causes chickenpox – the varicella-zoster virus (VZV). The varicella-zoster virus is now recognized as one of the eight herpes viruses that infect humans. The varicella-zoster virus is closely related to herpes simplex virus (HSV) types 1 and 2, however, it has become clear that the varicella-zoster virus is distinct from the herpes simplex virus both in its biology and in its clinical behavior.

Causes

Shingles is a second eruption of the varicella-zoster virus — the same virus that causes chickenpox.

Varicella-zoster is part of a group of viruses called herpes viruses, which includes the viruses that cause cold sores and genital herpes. Many of these viruses can lie hidden in your nervous system after an initial infection and remain inactive for years before causing another infection.

Anyone who’s had chickenpox may develop shingles. If your immune system doesn’t destroy the entire virus during the initial infection, the remaining virus can enter your nervous system and lie hidden for years. Eventually, it may reactivate and travel along nerve pathways to your skin — producing the shingles. However, it’s most common in older adults: More than half the shingles cases occur in adults over 60.

Shingles is more common in older adults and those who have weak immune systems. The virus responsible for shingles is called Varicella zoster. Anyone who has previously had chickenpox may subsequently develop shingles. Blisters can occur in more than one area and the virus may affect internal organs, including the gastrointestinal tract, the lungs and the brain. If you have a weak immune system, it is best to avoid close contact with someone with shingles.

Treatment

Antiviral medications are also routinely prescribed in severe cases of shingles or when the eye is affected. Such treatment needs to begin within three days of getting the rash to be effective, so if you suspect you have shingles, see your doctor immediately. For reasons that are not completely understood, some PHN patients get no relief from pain medication, and what works in one case may not be effective in another.

If you have pain that persists longer than a month after your shingles rash heals, your health professional may diagnose postherpetic neuralgia, the most common complication of shingles. Postherpetic neuralgia can cause pain for months or years. It affects 10% to 15% of those who experience shingles.

Shingles symptoms generally disappear within three to five weeks. However, treatment is recommended to help encourage shingles pain relief. Your health care provider can offer you oral antiviral medications, including acyclovir, valacyclovir, and famciclovir, in order to speed up the course of the shingles disease. You may also be prescribed pain relieving medications, such as ibuprofen and acetaminophen.

Symptoms of Shingles

For people with intense symptoms, there are many medications your doctor can prescribe to treat shingles. Steroids (prednisone) and tricyclic antidepressants (amitriptyline) are also prescribed to lessen shingles symptoms, and the former might help prevent PHN. Zynoxin Topical Solution is one medication which works topically to help relieve shingles symptoms. Acyclovir also is used to treat the symptoms of chickenpox, shingles, herpes virus infections. Prescription antiviral medicines don’t cure shingles, but they can shorten the duration of symptoms. Treatment of the symptoms of shingles through compresses and pain relievers is typically recommended by doctors. Try oatmeal bath products, available at drugstores, to relieve symptoms of shingles. Oral drugs to treat shingles operate better if they are started within three days of the start of symptoms.

Pinched Sciatic Nerve Leg Pain

Pinched sciatic nerve leg pain can vary from a slight twinge to constant pain originating in the lower back and travelling all the way down through the buttock and down the leg to the foot. The sciatic nerve is the longest nerve in the human body and so the pain associated with this nerve can be any place from the lower back to the foot on either or both legs.

Some people may find walking difficult while others may not when experiencing pinched sciatic nerve leg pain . In my case I found walking no problem but standing almost impossible or driving for long distances as my leg would go numb. The pain would usually start in the buttock and the numbness would affect areas from the knee down to the foot which meant clutching to change gears would be very difficult as I had no feeling in the leg.

Pinched sciatic nerve leg pain may be as a result of an injury to the back in the form of for example, lifting objects incorrectly, sitting at a computer desk in the incorrect posture position, sport, car and gym accidents and many more. The term Pinched means the nerve may be compressed or constricted due to movement of a bulging disc. Other causes of a pinched sciatic nerve may include spinal arthritis and problems with the vertebral column.

If you are experiencing what you may think to be pinched sciatic nerve leg pain then the first place you should go is to your local GP as they are qualified to give you the best advice available. There are drugs available to help reduce the inflamed are of the nerve and thus reduce the pain. Sitting on soft or low surfaces should be avoided as trying to get up from them may cause severe discomfort.

There are many treatments and exercises available from yoga to surgery in some severe cases. Rest is a great way to alleviate this pinched sciatic nerve leg pain. Stay in bed on a firm mattress for up to 3 days if some possible. Some people apply heat packs to the back this could be in the form of a hot water bag while others prefer ice packs. Recently a friend was told to lie on his Tummy as this would put less pressure on the spine and allow the spine to rest in its normal curved position.

Use Of Physical Therapy Tables In Rehabilitative Therapy Programs

Physical therapy tables are necessary fixtures for every therapy program. Physical therapy tables are utilized to augment more than just physical therapy programs, but pediatric therapy programs, geriatric therapy programs, neurological therapy programs and others. The physical therapy tables in our inventory are designed to accommodate the needs of almost every patient, whether they’re in a wheelchair or require the use of walkers or other mobility aids. Each physical therapy table is easy to move, simple to adjust, and the crank handles on the physical therapy tables are retractable so they won’t present an obstacle or hazard to either patient or healthcare provider. The physical therapy tables we carry are simply vital for any rehabilitation program and physical therapy procedure.

The purpose of physical therapy is to help patients regain the use of their muscles, bones, and nervous system through the use of exercise equipment, heat therapy, cold therapy, massagers, whirlpool baths, among a myriad of other techniques. Every physical therapy treatment plan attempts to relieve pain, improve strength and mobility, and train patients to perform necessary tasks in order to resume their everyday lifestyles. Physical therapy is often prescribed to rehabilitate a patient after many injuries, illnesses, and disease such as:

– Amputations
– Arthritis
– Burns
– Cancer
– Cardiac Disease
– Cervical and Lumbar Dysfunction
– Neurological Problems
– Orthopedic Injuries
– Pulmonary Disease
– Spinal Cord Injuries
– Stroke
– Traumatic Brain Injuries

The duration of any physical therapy program varies depending on the severity of the injury or illness being treated as well as the patient’s response to therapy.

Physical therapy tables are commonly used in exercise regimens, the best known and most widely used form of physical therapy. Depending on the patient’s condition, exercises may be performed alone or with the assistance of a therapist. An exercise regimen will incorporate rehabilitation & exercise equipment including physical therapy tables, floor mats, stationary bicycles, walkers, wheelchairs, practice stairs, parallel bars, and pulley weights among others.

Physical therapy programs also incorporate hot & cold therapies. Heat therapy can be applied with compresses, paraffin wax therapy, or by soaking in a whirlpool. This strategy aims to stimulate a patient’s circulation, relax muscles, and relieve pain. Cold therapy can be applied with ice or soaking. As well, massagers can help improve circulation, relieve pain and muscle spasms, reduce swelling, and help the patient to simply relax. Electrotherapy may also be used to stimulate muscle and make them contract, helping weakened or paralyzed muscles respond again.

Geriatric physical therapy encompasses a broad area of issues that concern people as they age, but is typically focused on the elderly. There are conditions that affect many people as they grow older including arthritis, osteoporosis, cancer, Alzheimer’s disease, hip and joint replacement, balance disorders, and more. The use of physical therapy treatment tables in geriatric physical therapy will help restore dexterity, movement, cognizance, object recognition, and more.

Neurological physical therapy focuses on individuals with a neurological disorder or disease, including cerebral palsy, Alzheimer’s, multiple sclerosis, Parkinson’s, stroke, spinal cord injuries, and others. Common problems associated with neurological disorders include vision impairment, poor balance, paralysis, and loss of functional independence. Therapists use physical therapy treatment tables to work with patients to improve these areas of dysfunction.

Pediatric physical therapy uses a wide variety of modalities to treat disorders in children. Physical therapy tables will be utilized as work stations to improve motor skills, coordination, as well as cognitive and sensory processing. Children with developmental delays, cerebral palsy, spina bifida, and torticollis are a few of the patients treated by pediatric physical therapists.

Sore Throat Symptoms

Sore throat symptoms are not hard to pin point. They come with other problems as well. You will notice that you have a running nose. This means that you have a cold. Coughing can aggravate the sore throat if the cough is dry. One of the most outstanding symptoms is the itchy or painful feeling that you get on your throat. You feel like your throat has wounds. It becomes painful to swallow and you can see that you are swollen around the neck. You can feel the swelling if you touch around this area. Your body temperature is likely to go up more than usual. This can make you feel feverish. There are some over the counter drugs such as paracetamol that will relieve you from this. If possible, use a thermometer to ascertain that your temperature has actually gone up. This is a pointer that you require treatment for your sore throat.

If the problem persists on for the nest two weeks, you have to know that the sore throat needs some professional treatment. There could be an underlying problem. You should know that the kind of symptoms that you experience is determined by the cause of the sore throat. In a case where you have an allergic reaction, your nose might be blocked as well. You have to know what is causing you the reaction. The causes are many and they include the type of foods that you are eating as well the choice of mouth care products’ that you buy.

The problem you feel in swallowing food is due to the inflaming of the throat. It becomes swollen and constricted. You feel like you are struggling to get the food down your throat. You should go for easy foods that are not hard. When you feed the young ones and they refuse to eat for no apparent reason, you should have a doctor examine their throats. A baby who has a sore throat will neither breast feed nor eat. If you have a dry feeling in your throat that is not ordinary thirst, you should consider seeing a doctor. As a precaution, do no not yield to the temptation to drink a very cold drink. You should make sure that you take something warm. It would help to reduce the intensity of the symptoms.

Your voice will begin to diminish. This kind of a sore throat can be caused by shouting and straining your voice beyond limit. When you to go sports ground, no matter how supportive you are to your team, you have to make sure that you do not cheer too loudly. This can result to a painful sore throat accompanied by loss of voice. The voice feels raspy and you can hardly communicate. You should avoid conversations in noisy areas as well. If you will feel a metallic taste in your mouth, this means that you have a throat infection. Doctors say that there is a lot of mucus in you throat that accumulates and as a result you get this awkward taste in your mouth.

What Are Tonsil Stones, And Why Do I Have Them?

Tonsils can get inflamed and can cause significant problems, but the fact is, these so-called “useless” tonsils that were once removed as a matter of course are in fact not useless at all. In fact, they help protect us from illness, because they are among the first lines of defense that help protect our bodies from bacterial and viral onslaughts. In fact, they trap viruses and bacteria before they can go further. However, they’re not entirely without problems, and they don’t always work like they should. In some cases, mucous, bacteria, dead cells, or other debris can get caught in tonsil crevices, thus causing so-called “tonsil stones,” or tonsiliths, which are small white or yellow colored stones.

Tonsiliths are simply “garbage” that gathers around the tonsils, like postnasal drip, bacteria, and even food. They harden into small, yellow-colored stones that can look like small white spots at the back of the throat. They may also be caused by salivary glands that are overactive, or as a reaction to dairy products.

It wasn’t too long ago that people simply thought these tonsil stones were bits of food or small bits of plaque that got caught in the back of the throat. Many of these tonsiliths are very small indeed, such that they can often be overlooked in normal examinations, and often aren’t caught until they’re seen on something like a CT scan.

But how do you know if you have tonsiliths? The symptoms are unpleasant and can be extremely embarrassing. The most common is the feeling of having something stuck in the back of your throat or a feeling of your throat tightening up. You might have a metallic aftertaste you can’t get rid of and of course, foul breath.

There are a variety of treatments for tonsil stones. Some people develop a thorough routine of gargling and frequent brushing, as well as scraping the back of the throat with a toothbrush to manually remove them. You can also reach back with your finger or a cotton swab to gently squeeze them out by brushing from the bottom of the tonsil and pressing upwards. There are many websites with more tips and ideas on how to get rid of them.

In some particularly severe cases, surgery may be recommended. Cryptolysis is a surgical procedure whereby a surgeon removes the tonsil stones with a laser, and then smoothes the surface of the tonsil so as to prevent regrowth of the tonsiliths. Even though that may seem like a good idea, remember that smoothing the surface of the tonsils may in fact negate some of the positive effects of those rough surfaces, because those rough surfaces do catch bacteria before they can do significant damage.

A last resort is that you can have your tonsils removed, of course, but this will take care of just the tonsiliths, not the bad breath. Tonsiliths can also reform even so. Surgery can be expensive and painful, and it can take you up to a month to completely recover from it.

Beyond that, it may simply be better to manage tonsiliths by practicing good oral hygiene and following a healthy diet. Cut down on your dairy intake if you have to and make sure you brush regularly, especially after meals and before bed. This will help keep food from accumulating in your throat such that tonsil stones could form. Gargling as part of oral hygiene is also a good way to keep stones at bay, as is drinking plenty of water. And all of these tips, of course, are good for your health in general — not just as preventatives for tonsiliths.

Metabolic Syndrome Risk

Metabolic syndrome is a very dangerous situation. It is a cluster of conditions such as high blood pressure and high blood levels of glucose. Because of that disorder heap, metabolic syndrome raises the risk of heart disease and diabetes.

The likelihood that adolescents will develop metabolic syndrome rises in cases of exposure to tobacco smoke, either through active or passive smoke.
This association is even stronger among teens who are overweight or at risk of being overweight.

According to statistics, the metabolic syndrome primarily strikes those teens who are overweight or at-risk for overweight, a group that has tripled during the last two decades. This makes a growing segment of the youth population uniquely vulnerable to the development of this syndrome and to subsequent premature cardiovascular disease and type II diabetes.

Causes

The common causes and risk factor’s of Metabolic syndrome include the following:

The exact cause of metabolic syndrome is not known.

Eating a diet that has too many calories and too much saturated fat, and not getting enough physical activity.

Smoking.

Have a history of type 2 diabetes are at risk for metabolic syndrome X.

A diagnosis of high blood pressure, cardiovascular disease or polycystic ovary syndrome- a similar type of metabolic problem that affects a woman’s hormones and reproductive system- also increases the risk of metabolic syndrome.

Symptoms of Metabolic syndrome

Some sign and symptoms related to metabolic syndrome are as follows:

High blood pressure.

Elevated uric acid levels.

Diagnosing Metabolic Syndrome

While academics attending the ADA’s 66th Scientific Sessions debate and question the importance of clustering certain risk factors under a diagnosis of metabolic syndrome, it’s unarguable value lies in its ability to single out those individuals at risk of developing type 2 diabetes and cardiovascular disease.

Translated into practical terms, this means that a person diagnosed as having metabolic syndrome has three times the normal risk of developing cardiovascular disease, as well as three times the normal risk of developing type 2 diabetes.

Add to this the recent reliable evidence that lifestyle interventions that result in weight loss can prevent or at least delay the onset of type 2 diabetes, and the importance of diagnosing metabolic syndrome becomes obvious. And there is a more subtle but no less significant reason for diagnosing metabolic syndrome – the fact that insulin resistance is the underlying cause. This is because insulin resistance, by its very nature, makes weight loss on conventional diets almost impossible. Anyone who tries to lose weight on a low fat / high carbohydrate diet in order to significantly increase their life expectancy, is more or less doomed to failure if they have insulin resistance.

Benefits Of Treadmill For Diabetics

Diabetes is a lifestyle disorder. It is a disease in which a body cannot properly control the amount of sugar in blood, and body does not produce sufficient amount of insulin or does not utilize it properly. It is very important for a diabetic patient to maintain sugar level in blood and to exercise regularly. A treadmill provides a good workout and is easy to use.

Benefits of a treadmill
A treadmill can be used for brisk walking or running indoors. In the case of patients with low blood sugar, treatment becomes easier as the patient is already at his destination on a treadmill, and would not run the risk of being hypoglycemic, while far from home. Moreover, treadmill exercising improves diabetes control by improving muscle insulin sensitivity for nearly 24 to 48 hours following exercise. The reason for this is an increased glucose uptake by muscle used for muscle glycogen repletion.

Also, when more glycogen is depleted during intense or prolonged exercise, insulin sensitivity increases and remains high for a longer period of time following exercise. Treadmill exercise enhances glucose control by increasing muscle mass and decreasing body fat at the same time. However, the benefits are lost rapidly if exercising is stopped. Treadmills can generally used by anyone, regardless of age, or fitness level.

As treadmill allows an individual to walk at home, it is the easy way of exercising. It occupies small space for storage. It can be easily movable from one place to another. It allows an individual to set his own speed and displays the reading on the monitor. While watching TV and listening to music also one can exercise over the treadmill. The belt system allows an individual to run or walk in the right direction. It is used in various places like home, gym, hospital, and other such places.

Precautions
It is highly advisable to talk with a medical practitioner, before starting or changing any exercise program. It should be made sure that walking is correctly done. Doctors prescribing treadmill exercise usually suggest starting with a 10 per cent maximum grade, and ultimately working up to a 15 per cent grade for a more intense workout. Moreover, cushioning is important with older people, or with people having joint or orthopedic problems.

And it is important to put on proper footwear. Working on a clean and smoothly running treadmill is necessary. It is very important to remember that if a diabetic patient takes insulin, he should wait an hour after an injection before doing any form of exercise. He should also check his blood sugar level before and after exercising.

Low blood sugar training is a good idea before starting any exercise program. To avoid boredom, try CDs or tapes with good music. Also, anyone can place a mirror in front of a treadmill. This will help him work on his posture and walking technique