Leading Orthopaedic Hospital in India 

Symptoms 

Initially, mild pain is presented in the back of the leg immediately after activities like running or jumping. The pain becomes more severe with prolonged running or climbing stairs. 

Tenderness or stiffness may be present in the early hours of the day which may improve with mild activity. 

If you have heard a sudden pop sound in the back of your calf, then it might be due to the rupture of your Achilles tendon. This requires immediate medical attention. 

Achilles tendon rupture requires immediate surgical treatment. It is characterised by a sharp pain as if someone is hitting on the back of your heel with a stick. 

Causes 

Achilles tendonitis is caused by straining the calf muscles by repeated physical activity or a sudden increase in the speed or amount of any activities such as running or jumping. This can cause inflammation of the tendons and is termed Achilles tendinosis. 

In middle-aged people, Achilles tendonitis due to tendon injury can occur if they play games such as tennis or basketball rarely and not every day of the week. This is due to an abrupt increase in the intensity of their leg movement. 

In some instances, rheumatoid arthritis is also associated with this condition. 

Risk factors 

The risk of developing Achilles tendinitis is high in elderly males; people with a family history; and patients, who are obese, have psoriasis or high blood pressure, and tight calf muscles. The risk also increases with certain antibiotics (e.g. fluoroquinolones) and is high during cold weather. Running in hilly terrains can also increase the risk of getting an Achilles tendon. 

When to seek medical advice? 

You need medical attention when the pain is severe or mild but persistent, as it can lead to tendon rupture or tendon tear. 

Before consulting a doctor get prepared with questions such as: 

• How is the progress of pain?
• What is the quality of your footwear?
• Is the severity of the symptoms associated with the time or activities you perform?
• Are you taking any medications or supplements?
• Did you switch to a different exercise schedule?
• Are you following any pain relief strategies? 

Diagnosis 

As a part of the physical examination, your physician will gently press the affected area to locate the pain, tenderness, and swelling. Additionally, the flexibility, range of motion, alignment and reflexes of the affected area are observed. For further evaluation, any one of the below tests may be ordered:

Treatment 

By taking certain measures at home, most of the people with tendinitis improve. However, patients with severe symptoms need other treatment options which may include: 

Medications: You may be given strong pain relievers and anti-inflammatory agents to relieve the associated pain and inflammation. 

Physical therapy: You may be suggested to perform certain exercises and stretches to strengthen the Achilles tendon, or to use orthotic devices to reduce the pressure on the Achilles tendon. 

Surgery: If you do not improve with the above treatments then you may have to undergo surgery to repair the Achilles tendon. 

Self-management 

You can take certain measures to overcome the Achilles tendinitis problem. They include: 

Rest: The first step is to rest the damaged foot. Do not perform activities which put pressure on the Achilles tendon. Instead, you can go for activities such as swimming, biking, etc. If your condition is more severe, then you may have to use crutches or wear boots. 

Ice: Placing ice on the painful area for about 15-20 minutes can reduce the pain as well as swelling. You may do this all through the day as needed. 

Compression: Compressive elastic bandages can be wrapped around the affected tendon to reduce swelling and prevent excessive movement of the tendon. 

Elevation: Raise your foot above the level of your heart to reduce circulation, thereby reducing swelling. While sleeping at night, keep the foot elevated. 

Complications 

Over time, Achilles tendinitis can make the weakened tendon rupture which can be repaired only with surgery. 

Excessive immobility can lead to tendon stiffness and DVT (deep vein thrombosis, i.e. blood clots in the legs). 

Prevention 

By taking some proactive measures, you can reduce your risk of developing Achilles tendinitis. They include: 

Be slow and steady: Do not suddenly increase the intensity of your exercises, instead adopt a gradual progress. 

Switch between high and low: Perform high-impact activities followed by low-impact activities alternatively. 

Be cautious: Do not perform vigorous exercises which cause strain on the tendon. If you have to, then initially do warm-ups followed by strenuous exercises. If you have pain with any exercise, stop doing it and rest your leg. 

Choose cushioning shoes: Pick the shoes which support your Achilles tendon while exercising and provide the cushioning effect to prevent strain on the tendon. 

Stretch every day: Before and after performing exercises, stretching your calf muscles is important. This strengthens your calf muscles to handle the stress during exercises. 

Who is at risk for ACL injury? 

If you are engaged in activities that involve:

• Jumping
• Running
• Skiing
• Abrupt stopping while running
• Landing on knees 

You could be a prospective candidate for ACL injury. The twisting of knees and impact on the knees sideways are common causes of ACL injury. These activities may put undue pressure on the ligaments, tearing them apart. Once injured, the ligaments take a long time to heal. 

Even though strange, the fact is that females are more prone to ACL injuries, more so if they are into sports. The incidence of ACL injury in female athletes is higher as compared to their male counterparts. The reason behind it is not well understood, but the anatomical and physiological factors seem to contribute. 

Signs and Symptoms of an ACL Injury 

If you have injured your ACL, you are likely to have pain and swelling in the knee. The swelling may increase over 6-8 hours, which could make the diagnosis difficult. An injured ACL makes a ‘pop’ sound during movement and you could have the strange feeling of the knees ‘giving way’. Straightening the knees could be extremely painful and walking is a tedious task. 

These symptoms should drive you to the nearest orthopaedic centre for confirmation of diagnosis. 

Diagnosis of ACL 

Diagnosis of ACL injury can be done by certain manoeuvres performed by the doctor. For example, the Lachman test and Pivot Shift Maneuver are performed to test the function of ACL. 

The doctor may advise X-rays of the knee to rule out any fractures. MRI is also found helpful to rule out other soft tissue injury. In most cases, physical examination and history of injury are adequate for diagnosing a torn ACL, and no further investigations are required. 

Managing an injured ACL 

Treatment of ACL injury entirely depends upon the individual’s age, lifestyle, and level of activity. The ACL can be managed either non-surgically, or through surgical interventions. 

Non-surgical treatment or rehabilitation

The non-surgical treatment or rehabilitation involves strengthening the joints and muscles around the knees to compensate for an unstable knee. Modification of activities and change of hobbies may be needed for best results. Bracing may be needed to keep the knee stable. The individual can walk using crutches to prevent weight-bearing in the affected knee. With this method, the individual can resume his daily activities in a month but has to say goodbye to those activities, which could have deleterious effects on ACL. 

Non-surgical methods are suitable for people with low activity levels and older adults. 

Surgery 

Individuals who are young, active, want to resume the same lifestyle, and intend to return to sports, are ideal candidates for surgery. The surgery is done through an arthroscope, thus, involving less tissue injury, early recovery, and less pain. The surgery involves reconstruction of the ACL followed by physical therapy. A tissue graft is placed inside the knee, and the new ligament grows over the graft 

The rehabilitation may take longer time as compared to non-surgical management. It involves restoring motion in the joints with the help of surrounding muscles and then strengthening the joint to help adapt to the stress in the ligament. The individual can return to normal activities within 6 months, following a gradual training. 

Prevention of ACL injuries 

People engaged in sports activities should undergo proper physical training to tune up their muscles to the offending task. Old people should try not to engage in high-impact sports. 

If you don’t care about your knee, you could be heading for trouble! 

Symptoms and signs of a broken ankle include: 

• Throbbing pain and ankle swelling
• Blisters and bruising over the fractured area
• Difficulty or abnormality in motion
• A crack sound during the injury
• Visible bones through the skin (in case of open fracture)
• Dislocated joint 

Complications 

Complications due to ankle fractures are rarely seen. If there is an open fracture, the risk of bone infections (osteomyelitis) increases. Due to fracture, the adjacent nerves and blood vessels get damaged. 

Causes and risk factors 

Ankle fracture is a common injury and it can occur due to accidents, falls, twisting or rotating the ankle, or applying force on the joint while jumping from heights. 

Participating in high-impact sports such as running and jumping is a risk factor as the bone is overused. Due to this, stress fractures can occur. Wearing improper shoes, and conditions such as osteoporosis and neuropathy also increase the risk of ankle fractures. 

Diagnosis 

The diagnosis begins with a review of medical history and a physical examination. During physical examination, your doctor checks the areas of tenderness to determine the precise location, range of motion and gait, skin sensation, and other symptoms such as swelling and deformity. 

Your doctor may recommend imaging tests to determine the condition of the bone, the type of bone fracture, and the extent of dislocation. 

X-ray: Mostly, ankle and foot fractures are diagnosed through X-ray. The test is performed to determine whether the bone is broken or displaced, and if the bone is broken, how many broken pieces are present. 

Bone Scan: A radioactive material is injected into the vein during the bone scan. Damaged areas appear as spots on the image obtained after the scan. Stress fractures are diagnosed using this test. 

Stress Test: a special x-ray, called a stress test is taken by your doctor by keeping pressure on the injured ankle. This test helps to determine the requirement of surgery. 

Computed Tomography (CT) Scan: This scan helps in further evaluation of injury such as the extension of fracture into the ankle joint 

Magnetic resonance imaging (MRI) Scan: This scan uses a strong magnetic field to give images of bones and ligaments with high resolution. The scan identifies fractures that are not visible in an X-ray image. 

Treatment 

If you suspect that your bone is fractured, immediately consult your doctor. You may be referred to an orthopaedic doctor. You can try a few measures before you reach the doctor’s office or emergency department. Apply cold packs and keep the ankle elevated to reduce swelling and pain. 

Medications: Over-the-counter medications such as ibuprofen, naproxen, or acetaminophen can be prescribed by your doctor to treat pain. 

Reduction: If the fracture is displaced, your doctor realigns the bone through the process called reduction. A muscle relaxant or local anaesthetic will be given during the process to manipulate the pieces into proper positions. 

Use of splints of casts: The broken bone is immobilized with the help of a cast to protect and support the bone until it heals. Pressure sores may occur sometimes due to the use of a cast. If there is swelling and the fracture is minor, your doctor prefers a splint as it provides space to accommodate swelling. 

If your doctor uses a cast, you need to follow some measures to avoid complications: 

• Keep the cast clean and dry.
• Wrap the cast with a plastic bag before taking a shower.
• Don’t scratch the skin under the cast.
• Don’t remove the cast by yourself. 

Surgery: Your doctor prefers surgery in some cases to maintain the proper position of the bone until it heals. During surgery, the surgeon uses pins, plates, or screws and these are removed when the bone completely heals. 

Physical Therapy: After healing, your doctor recommends a physical therapist to teach exercises for improving flexibility and strength of the joint and restoring normal range of motion. 

Prevention 

The following few measures can prevent ankle fractures: 

• Wear proper shoes and replace athletic shoes regularly.
• Consume calcium-rich foods such as milk and yoghurt to improve bone strength.
• Exercise regularly to strengthen the ankle muscles. 

The right way to use an ice pack 

Ice has to be placed not more than 20 minutes at a time on the affected part of the ankle. The minute the person feels numb, the ice has to be removed. Ice should be used once every 2 to 4 hours for the first 3 days after a sprain. The ice pack can be made by crushing ice and placing it in a plastic bag. After placing the ice pack one must wrap an elastic band around it to hold it in place. For a good ice massage, ice should be first frozen in a Styrofoam cup (4 to 8 ounces). The top part of the cup is torn to expose the ice and then it is massaged onto the affected area for not more than 30 seconds. For an ice slush bath, one must fill the bucket with ice and water, and then place the ankle in it till it gets numb. 

Returning to sports 

Returning to sports activities depends on the severity of the injury. For activities like swimming and bicycling, one can return to it immediately, if there is no pain. For participating in other sports one should always wear an ankle brace support. 

To avoid an ankle sprain one must always wear shoes that fit properly. Warm up before any sports activity is important and one should take care not to exercise on uneven ground. By taking necessary precautions one can avoid a serious ankle sprain. 

Diagnosis 

• For diagnosing an ankle sprain, an X-ray may be taken to capture images of the internal structure of the ankle.
• A bone scan may be conducted in which a radioactive substance is injected intravenously into the bone. This radioactive substance gets attached to the damaged bone which is seen in the scan as bright spots.
• The Magnetic resonance imaging (MRI) scan is done in which radio waves and a magnetic field are used to produce good images of the internal structure of the ankle.
• To get cross-sectional images of the ankle, a computerized tomography (CT scan) is done. 

 Treatment 

According to the RICE approach, one must rest the ankle sufficiently and use crutches, if needed. To decrease swelling, muscle spasms, bruising and pain, ice packs should be applied for at least 3 days after injury. Compressing the ankle with an ankle wrap helps prevent bruising and swelling. A horseshoe-shaped thick pad (1x4 to 3x8 inch) is placed on both sides of the ankle with an open end facing upwards. An elastic bandage is wrapped around the foot in a figure ‘8’ pattern leaving the ankle exposed. One must make sure that it is not wrapped so tightly that the blood flow is stopped. With adhesive strips, one can attach the elastic bandage firmly. The ankle wrap can be kept in place for up to a week. To prevent the swelling from getting worse, one must raise the ankle above heart level and keep it that way for 2 to 3 hours every day. 

The medications used for reducing swelling include acetaminophen (Tylenol), Ibuprofen (Motrin, Advil), and naproxen (Aleve). 

Physical therapy is given after the swelling comes down. This increases the balance, flexibility, motion and strength of the ankle. A cast or a walking boot may be necessary for proper healing of the ankle joint. Surgery is needed for ligament tear. 

 Preventing re-injury 

To prevent re-injury one must exercise the ankle to make the muscles stronger. One needs to wear a semi-rigid brace on the ankle to prevent further sprains for 1 to 2 months. 

• To exercise the ankle, the person should make circles with the ankle while sitting on the floor with legs stretched. Around 5 to 10 circles can be done thrice a day moving the ankle up and down and side to side.
• One can try writing alphabets in the air with the toe which is a good exercise.
• Pulling toes towards oneself and pointing them away, holding in such a position for 15 seconds is another exercise that one can do around 10 times a day.
• The other exercises include stepping up; resisting in and out and sitting and standing heel raises.
• To improve balance one can try standing on the injured leg for 30 seconds and slowly increase the duration. Placing a chair in front will provide support. One can repeat this exercise thrice daily. 

Can Ankylosing Spondylitis affect other parts of my body? 

Yes, it does! Ankylosing spondylitis can also cause inflammation, stiffness, and pain in other parts of the body such as your shoulders, heels, ribs, hips and smaller joints of hands and feet. But very rarely your eyes may also be affected. 

Symptoms of Ankylosing Spondylitis 

The most common symptoms reported by the people with Ankylosing Spondylitis include: 

• Excessive coughing
• Forwardly stooped position
• Continuous lower back pain
• Fatigue and loss of appetite
• Inflammation near the tendons and ligament
• Pain in the joint after vigorous physical activity
• Shooting pain in the early morning after waking up 

Causes for Ankylosing Spondylitis 

There are no specific causes for Ankylosing Spondylitis. However, people who have a gene called HLA-B27 are at an increased risk of developing Ankylosing Spondylitis. 

Who is at risk? 

• If you have a family history of Ankylosing Spondylitis
• If you are positive for HLA-B27 marker
• If you have frequent infections related to the digestive tract 

Diagnosis of Ankylosing Spondylitis 

The diagnosis of Ankylosing Spondylitis is based on several factors which include your symptoms, physical examination, X-ray reports of back and pelvis, chest measurements while breathing, and the results of laboratory investigations. 

Dietary modifications 

A healthy diet is always a hit. In the case of Ankylosing Spondylitis a healthy diet improves the symptoms and reduces the disease progressing activity. Omega-3 fatty acids that are available in cold water fishes such as salmon, and tuna are beneficial. Flax seeds and walnuts also can reduce the disease activity. 

Treatment of Ankylosing Spondylitis 

There is no specific treatment for Ankylosing Spondylitis. However, the goals of the treatment include reducing stiffness, discomfort, and pain. 

Exercise: Performing regular exercises is an excellent remedy to treat the stiffness and strengthen the muscles. Regular exercises minimize the risk of disability. Your doctor would advise swimming that works well for people with Ankylosing Spondylitis. 

Physical therapy: To retain or maintain the physical function the best suitable early intervention would be physical therapy. It helps reduce the deformity. 

Drugs: Drugs provide relief from the pain and help you continue your daily activities without any discomfort. The drugs may include NSAIDs, disease-modifying anti-rheumatoid drugs, steroid injections, and antidepressants. 

Surgery: Surgery may be the last choice in the treatment of Ankylosing Spondylitis AS. However, your doctor would recommend surgery if you have severe discomfort due to joint damage. 

Lifestyle modifications for Ankylosing Spondylitis 

• Refrain from placing pillows beneath the neck while resting
• Try to sit on chairs that don’t let you steep your posture
• Smoking aggravates the condition, so you must refrain from using tobacco products
• You must get good support while sleeping, so sleep on a mattress that keeps your back straight 

Symptoms 

You would know immediately if your arm broke because there may be a loud cracking sound. The other symptoms of arm fracture include: 

• Extreme pain at the affected site
• Swelling and bruising
• Deformity when compared to another arm
• Inability to move the arm
• Numbness in the affected area 

Causes 

The causes of arm fractures include the following: 

• Falls: A fall can cause a fracture when you fall onto an outstretched hand. The extent of the fracture depends on the age and how much pressure you applied to the bone.
• Direct trauma: Any of your arm bones can break if there is a direct blow from objects such as a bat or during a car or bike accident.
• Stress fracture: A stress fracture may occur when your arm muscles become tired and weak from overuse. These fractures are most common in athletes. 

Types of arm fracture 

There are three different types of arm fracture and include the following: 

Nondisplaced: In the case of a nondisplaced arm fracture, the bones break but remain in the same place. 

Displaced: The displaced arm fracture may occur when the bone breaks and the pieces move from the original position. 

Open fracture: The open fracture is a severe condition where the bone breaks through the skin exposing the fractured bone. 

Risk factors 

The factors that increase your risk of fractures include certain medical conditions and physical activities. Medical conditions such as weakened bones, osteoporosis, and bone cancers can lead to fractures, and these are considered pathological fractures. The physical activities or certain sports in which there is an increased risk of falling such as playing football, skateboarding, or skiing. 

Diagnosis 

The initial evaluation begins with a thorough history and physical examination. Your doctor may suggest an X-ray to determine the type and extent of the fracture. Sometimes, magnetic resonance imaging (MRI) may be recommended for more detailed images. 

Complications 

Most often, the fractures heal with appropriate treatment. However, certain complications may occur including: 

• Nerve Injury: The nerve, which controls the movement of your hand, may be damaged causing numbness or weakness in your hand.
• Bone infection: If the arm fracture involves bone protruding through the skin, it may cause infection.
• Osteoarthritis: If the fractures involve the joint, then you may have osteoarthritis in the future. 

 Treatment 

Brace, cast, or splint: A brace or splint restricts the movement of your arm and holds it in place. 

Medications: You may be given pain medications to reduce the pain. Your doctor also prescribes certain antibiotics to prevent infection. 

Physical therapy: Your doctor may refer you to a physical therapist. Physical therapy involves performing minor exercises which help to improve your bone strength and reduce the risk of loss of function. 

Surgery: If you have an open fracture, then you may require debridement of the injured tissue and fixing the pins or screws to hold the bones straight. 

Self-management and prevention 

To promote healing, you must take adequate rest. Rest is often used to treat stress fractures. Elevating the arm above the level of your heart helps to decrease the pain and swelling. You can also use ice to reduce pain and swelling. 

A bone fracture can be prevented to a certain extent by the following tips: 

• Increase the intake of vitamin D and calcium.
• Perform weight-bearing exercises to strengthen your bones.
• Prevent falls by wearing sensible shoes, removing home hazards, or lighting up your living space.
• Use protective gear such as wrist guards while performing high-risk activities. 

Symptoms 

Arthritis symptoms may appear either suddenly or may develop over some time. Symptoms involve only the joints and include: 

• Pain
• Stiffness and tenderness
• Warm skin, redness, and swelling of the skin at the joint
• Weakness and muscle wasting
• Decreased range of motion 

Causes 

Wear and tear of the cartilage (connective tissue in the joints which absorbs shock and pressure during joint use) causes osteoarthritis (OA). Infection or injury to the joint enhances this wear and tear process of the cartilage. 

Another type of arthritis is due to an autoimmune infection which leads to rheumatoid arthritis (RA). In this condition, the immune cells attack our body cells in the fluid of the joint thereby causing inflammation of the joint. Genetic markers are responsible for these autoimmune disorders. 

Risk factors 

Age: It is common in people aged above 65 years. However, occasionally even children and adults can also develop the condition. 

Gender: Women are more likely to develop arthritis compared to men. 

Obesity: In overweight people, the joints bear the excess weight of the body which increases their risk for arthritis. 

Family history: The risk of developing OA is higher in people with a family history of the disease. 

Joint injury: People who had an injury in a joint while playing sports may develop arthritis in that joint. 

Complications 

• Severe arthritis of the arms and legs can make it difficult to carry out daily activities. It becomes very difficult to sit or walk if the knee and hip joint are affected.
• In some patients, arthritis can lead to twisting and deformation of the affected joint.
• Osteoporosis is the loss of bone density which makes it more likely for fractures to occur as seen in arthritis patients.
• Sleep disturbances are common due to the severe pain associated with arthritis.
• Psychological problems such as loss of self-esteem, depression, anxiety, etc. are seen in such patients. 

Diagnosis 

Diagnosis of arthritis involves careful evaluation of symptoms followed by physical examination. 

Treatment 

Treatment of arthritis is aimed to alleviate the symptoms and delay the progression of the condition but it cannot cure the disease. Osteoarthritis treatment may differ from rheumatoid arthritis treatment. 

Treatment of Osteoarthritis 

In minor and initial stages, drugs such as painkillers, non-steroidal anti-inflammatory agents and corticosteroids are used. 

If the condition is severe, then surgical therapy is necessary. The below surgical therapies are available for osteoarthritis: 

• Osteotomy (the affected bone is cut and re-aligned)
• Arthroplasty (joint replacement)
• Arthrodesis (joint fusion) 

Treatment of Rheumatoid arthritis 

Treatment involves the use of painkillers, disease-modifying anti-rheumatic drugs (DMARDs), physiotherapy and regular exercises. 

Self-management 

There are some promising alternative medicines for treating arthritis as detailed below: 

Massage: Kneading of muscles by putting slight pressure helps to increase blood flow causing warmth and relieving pain temporarily. 

Acupuncture: Using fine needles at specific points on the skin can help to reduce pain associated with arthritis. 

Yoga and Tai Chi: Slow stretching movements caused during yoga and tai chi improve the joint's flexibility and range of motion. 

Signs and symptoms 

Pain is the most common symptom and the first sign of thumb arthritis. Your thumb base may feel stiff and tender, especially while trying to grip or catch something. Other signs and symptoms include: 

• Decreased strength while pinching or grasping objects
• Decreased range of motion
• Bony protuberance or bump at the base of your thumb 

Causes 

Thumb arthritis commonly occurs with ageing. 

The ends of the bone are covered with cartilage, which acts as a cushion and allows the bones to glide smoothly against each other. However, with thumb arthritis, the cartilage deteriorates and roughens the smooth surface. The roughened bones rub against each other, resulting in friction and joint damage. 

If you have had an injury or trauma to the joint, the inflammation at the site results in osteoarthritis. If you have osteoarthritis in other joints such as knees, hips or elbows, there are chances that you may get thumb arthritis as well. 

Risk factors 

Several factors may increase your risk of thumb arthritis. 

• Gender – Females are at increased risk. -However, the reason is unknown
• Old age- above 40 years
• Obesity
• Hereditary conditions like joint ligament laxity and malformed joints
• Thumb fractures and sprains
• Rheumatoid arthritis
• Osteoarthritis 

Diagnosis 

Your doctor may question you about the symptoms, previous injury pain patterns or activities that increase the pain. The doctor may hold the joint while moving your thumb and put pressure on it to determine the severity of the pain. If the movement has a grinding sound, and if you have pain or a gritty feeling, the doctor may conclude that the cartilage has worn down, and the bones are rubbing against each other. 

After that, he or she would suggest you go for further tests such as an X-ray to check the symptoms of thumb arthritis such as deterioration of the joint, bone spurs or calcium deposits, and joint spaces that have developed. 

There are chances that you may develop carpel tunnel syndrome, and hence your doctor may suggest you go for that test also. 

Treatment 

Your doctor may recommend non-surgical treatment if the condition is diagnosed in the early stages which includes: 

• Apply ice for five to fifteen minutes on the most swollen and tender area
• Wear a supportive splint to limit your thumb movement, reduce pain and allow the joint to rest and heal. You can wear the splint just at night or for the whole day. 

Medications 

Your doctor prescribes OTC drugs such as acetaminophen, ibuprofen or naproxen. Celecoxib and tramadol are prescribed to manage severe pain. 

If the pain relievers are ineffective, the doctor may give a long-lasting corticosteroid injection to your thumb joint. The injection gives you temporary but immediate pain relief and reduces inflammation. 

Surgery 

If you do not respond to non-surgical treatment, surgery would be an option. There are several different surgical procedures which are usually performed on an outpatient basis. 

Joint fusion: The bones of the affected joint are permanently fused. The fused joint can bear weight, but the movement is limited. 

Osteotomy: The bones of the affected joint are repositioned to correct deformities. 

Trapeziectomy: one of the bones of your thumb joint (trapezium) is removed. 

Joint replacement or arthroplasty: The affected part of the joint is removed and replaced with a graft taken from one of the tendons. 

Self-management 

There are special exercises for joint pains that improve the range of motion and other symptoms of arthritis. The doctors usually recommend doing these exercises that give the best results: 

• Thumb stretch, in which you should touch the tip of your thumb with the last finger.
• Try to hold your thumb stable with the other hand and bend only the upper part of your thumb.
• Simply touch the tips of your fingers with the tip of your thumb. 

Do not forget to apply ice to your joint for five to 15 minutes if you have severe swelling and pain. 

Symptoms 

In most people, the condition causes no signs or symptoms. The symptoms of cervical spondylosis primarily include neck stiffness and severe pain. Rarely, the condition may result from the narrowing of the vertebral canal through which the nerve roots are passed to the rest of your body. If compression of these nerve roots occurs, then you may experience the following: 

• Numbness and weakness in your arms, legs, hands, or feet
• Difficulty walking
• Loss of bowel or bladder control 

Consult your doctor immediately when you observe the above symptoms. 

Causes 

The causes of vertebral degeneration in cervical spondylosis include the following: 

Dehydrated spinal disks: The spinal discs serve as cushions between the vertebrae of the spine. It consists of a gel-like substance that absorbs shock from twisting or any other activities. In older adults, these disks dry out and shrink which allows your vertebrae to rub on each other causing pain. 

Herniated discs: Sometimes, cracks appear on the spinal discs leading to leakage of gel-like substance. This causes bulging of your discs and compresses the spinal cord and nerve roots. 

Ligament stiffness: The cords that connect your spinal bones, called ligaments, become stiffer gradually affecting the movement of your neck. 

Risk factors and complications 

The factors that increase your risk of developing cervical spondylosis are listed below: 

• Increasing age: Often, cervical spondylosis develops due to structural changes in the neck that occur as you age.
• Trauma: A history of injuries to your neck increases the risk of cervical spondylosis.
• Type of occupation: If your occupation involves frequent neck motions, lifting of heavy weights or awkward positioning may cause stress on your neck, resulting in degeneration of cervical bones.
• Genetics: Certain genetic factors or family history of cervical spondylosis may cause cervical spondylosis.
• Smoking: According to research studies, smoking has been linked to an increased risk of cervical spondylosis. 

If the condition is left untreated, the nerve roots are compressed severely, causing permanent damage. 

Diagnosis 

The initial diagnosis includes a physical examination, where your doctor assesses the range of motion in your neck, and the way you walk, and also tests your reflexes and muscle strength. To confirm the diagnosis, your doctor might order the following tests. 

Imaging tests 

• Neck X-ray: An X-ray of your neck and vertebrae is obtained to identify the abnormalities. It is also helpful to rule out other serious conditions causing neck pain.
• Computed tomography scan: The computed tomography scan provides a complete view of your bones and helps to diagnose cervical spondylosis.
• Magnetic resonance imaging (MRI): An MRI scan will help to identify the areas where the nerve roots are compressed.
• Myelography: Myelography is a minimally invasive diagnostic procedure that involves injecting a dye into your spinal canal and X-rays were taken to obtain the detailed spinal structure. 

Nerve function tests 

Your doctor might recommend a nerve function test to detect the abnormalities while transmitting the nerve signals to your muscles. These tests include: 

• Electromyography: The test is used to detect the electrical activity of your spinal nerves. As the spinal nerves transmit the electrical impulses to your muscles, the test examines the muscle during contraction and at rest.
• Nerve conduction study: This involves placing the electrodes on the nerve that is to be studied. The test measures the strength and intensity of the nerve impulse by passing a small shock through the nerve. 

Treatment 

Your doctor recommends the treatment based on the severity of the signs and symptoms. The therapeutic goal is to relieve pain and prevent permanent damage to your spinal cord. Your doctor might recommend any of the following therapies. 

Medication: Your doctor might prescribe nonsteroidal anti-inflammatory drugs such as ibuprofen and aspirin; corticosteroids such as prednisone; muscle relaxants such as cyclobenzaprine; anti-seizure medications such as gabapentin and pregabalin; antidepressants; or pain relievers such as oxycodone. All these drugs help to relieve pain caused due to nerve damage. 

Physical therapy: Your doctor might refer you to a physical therapist who instructs you on the type of exercises that contribute to strengthening your muscles. 

Surgical therapy: If you do not respond to the medication therapy or other conservative treatment approaches, then your doctor might recommend surgery. The surgery may include either of the following: 

• Removal of herniated discs or bone spurs
• Removal of a vertebral part that is affected
• Use of a bone graft to fuse a segment of your neck 

Self-management 

If your cervical spondylitis is very mild and doesn’t have any severe symptoms, certain lifestyle measures would help you to prevent the condition. These include: 

• Exercising regularly
• Applying heat or cold application on the affected area
• Placing a soft neck brace to allow your neck muscles to rest 

Risk factors 

• Age: younger children’s bones are easily dislocated compared to adults
• Sports participation: Many elbow dislocations are sports-related
• Heredity: Some people have looser ligaments near the elbow, right from the birth 

Diagnosis 

Your doctor will begin the examination 

• He/she will make sure that your nerves are unhurt; this is ensured by checking your pulse. Your doctor would ask you to move your fingers and wrist to ensure the proper blood flow to the hand.
• Your doctor would then order for a hand X-ray, to evaluate the cracks and fractures or dislocations in the hand.
• If your doctor suspects any injury to the arteries, he or she may order further tests such as an arteriogram. 

Symptoms 

The common symptoms of elbow dislocation include severe elbow pain, swelling, and inability to bend the arm. 

In severe cases, you may feel that you have lost the sensation and no longer feel the pulse. It may be due to the injury to the nerves and arteries that run through the elbow joint. 

When to call a doctor? 

If your elbow joint pain is unbearable and if you feel troublesome to move the joint near the elbow or if you cannot feel your hand, or do not feel the pulse near the injured area then, you must seek medical attention immediately. 

Prevention 

• You must not fall on your outstretched arm.
• You must avoid situations that make you more prone to falls.
• You must take other’s help to get out of bed to perform any activities at least for some days. 

Causes 

The most common causes of an elbow dislocation in adults include: 

• Accidents: you may have a dislocation of the elbow if you’re a victim of a motor vehicle accident.
• Falls: if you’re falling position is such a way that your hand is outstretched, then this can pop up the upper bone out of the ligament and cause elbow dislocation.
• In toddlers, the injury occurs at the time of extra pulling motion; such causes include:
• Improper lifting: Trying to lift weights improperly would lead to elbow dislocation.
• Sudden pulling or jerking: sudden pulling of the child’s arm may cause elbow dislocation due to the overreached elasticity of the arm. 

Treatment of Elbow Dislocation  

At home, you must apply an ice pack. This initial remedy reduces the swelling and further pain. But the next step to take immediately is to go to a doctor. 

• Medications
• Your doctor would prescribe a heavy dose of painkillers to reduce the pain caused while repositioning your elbow.
• Splint
• After placing your elbow in its position, your doctor will get an X-ray and then provide a splint; this is a cast made of plaster of Paris and is applied to keep your elbow devoid of any movements, which ensures a good rest for your elbow.
• Surgery
• Your doctor would recommend surgery if:
• Reattachment is required for torn ligaments
• Damaged nerves or blood vessels require any repair
• There is no evidence of broken bones near the dislocation
• Physical therapy and rehabilitation
• Physiotherapy and appropriate rehabilitation for elbow dislocation are beneficial, but you must first talk to your doctor before choosing them. Your physical advisor would then advise you on certain exercises to improve your range of motion. You will be asked to avoid activities that aggravate the pain near the elbow. 

Follow-Up 

After going home, you must not move your elbow and always wear the splint. Make sure your elbow is in an elevated position to reduce the swelling. 

What happens in shoulder dislocation? 

Your shoulder is a ball and socket joint. The ball (the round top of your arm bone) fits into the groove in your shoulder blade called the socket. 

In the case of shoulder dislocation, the entire ball is moved away from the socket. If the dislocation is partial, then only a part of the ball is out of your socket. This is termed as ‘shoulder subluxation.’ 

Causes 

A dislocated shoulder may result in an unbalanced impact on the joint. It may happen as a result of a sports injury, fall or by experiencing a harsh hit to the affected area. Once your shoulder joint dislocates, it’s more likely to dislocate again in the future. 

Tips for Children 

• Teach the children safe behaviours
• Watch and supervise your children while they are playing
• Put gates on the staircases to prevent your children from falling
• Ensure that your home is childproof and safe from objects that make the children fall 

When to call a doctor? 

You must call your doctor if you have signs of fever if you notice any discolouration near the joint if you experience swelling or pain in the arm, shoulder or hand that gets worse timely. 

Risk Factors 

The most common risk factors for shoulder dislocation include: 

Age: Most older persons are at greater risk for shoulder dislocations due to the lack of mobility. Children are also at greater risk for joint dislocations, because of unsupervised play. Anyone can be a victim of joint dislocations due to falls or some other type of trauma. 

Symptoms 

Bruising, swelling weakness, and numbness are the common symptoms that are presented after a shoulder dislocation. 

In severe cases, dislocation may tear ligaments or tendons in the shoulder or even damage the nerves. 

Diagnosis 

It could be difficult to determine if your bone is broken or dislocated. Your doctor will examine the affected area. He/she will check for the circulation to the affected area and ensure if there is any deformity, or whether there is any breakage to the skin. 

If your doctor finds that there is a dislocation or break, he or she will order an X-ray. To evaluate your bone more specifically, your doctor would order more advanced tests such as MRI; these tools help your doctor understand what is going on in the joint or near the bone that’s involved. 

Treatment 

The initial level of treatment for any dislocation would be R.I.C.E (rest, ice, compression, and elevation). Following this treatment, the dislocated joint would get back to its normal state. In case your joint doesn’t turn back to a normal state, your doctor may use one of the following treatment options, 

Repositioning: This would be painful, your doctor will replace the dislocated joint, and before doing so, you would require a good dose of anesthesia. 
Immobilization: your doctor might ask you to wear a splint or cast for several weeks to retain the replaced joint in its position. This will help prevent the joint from stress and strain due to movements. Depending on the severity of the injury, your doctor would keep your joint immobile. 
Medication: After your joint returns to normal, most of the pain must vanish away. However, your doctor may prescribe a pain reliever or a muscle relaxant if you still experience pain. 
Surgery: your doctor would recommend you for shoulder dislocation surgery if there is any evidence of nerve damage or blood vessel damage, or if your doctor is unable to replace your dislocated joint. 
Rehabilitation: Rehabilitation helps in dislocated shoulder recovery. After repositioning you’re joint to normal, or after removing the cast or splint, your doctors will advise a rehabilitation plan that is appropriate for you. The main aim of rehabilitation is to improve the joint’s strength and restore its range of motion. 

Prevention 

Practising safe behaviour helps in the prevention of joint dislocation. Follow the below tips to reduce the risk of joint dislocations: 

• Avoid the use of throw rugs
• Move the electrical cords off the floor
• Use handrails when climbing up or down the stairs
• Make sure that a first aid kit is available in the area 

Causes and Risk Factors 

The main cause for developing FD is a gene mutation. It affects the cells that produce the bone tissue. These mutations usually occur after conception, in the early phases of fetal development. 

The disorder is inherited from the parents. 

Diagnosis 

Your doctor may ask you about your symptoms and perform a routine physical examination. If there are any signs of FD, your doctor will further order confirmatory tests. 

Imaging tests: Computerized Tomography (CT) scans or Magnetic Resonance Imaging scans (MRI) are ordered. This helps in determining the extent of bones affected. 

Bone scan: This test helps in determining the damaged parts of the bone. For this radioactive tracers are injected into your bloodstream. The damaged parts of the bones are shown brightly on the scan due to the absorption of the radioactive tracer. 

Biopsy: Biopsy helps in the confirmation of the disease. For a biopsy, a small tissue is removed and analyzed. 

Fibrous dysplasia radiology is also performed to get a clear picture of the bone deformities. 

Symptoms 

The most common fibrous dysplasia symptoms may include: 

• Swelling
• Pain near the bones
• Pigmentation on the skin
• Deformities in the face or head 

Complications 

In severe cases, fibrous dysplasia may cause complications such as: 

Fractures: Once your bones get affected they tend to become weak. These weakened bones are more fragile and can easily undergo fractures. 

Hearing loss or visual problems: There may be several nerves related to the eyes and ears that are surrounded by the affected bone. In the case of severe deformity of the facial bones, you may have problems related to ear and eyesight. One such problem is glaucoma, which damages the optic nerve and causes permanent loss of vision. 

Arthritis: You may be a victim of arthritis if the leg and pelvic bones are deformed. Osteoid osteoma is another complication related to the bones. It is a non-cancerous bone tumour that develops in the long bones of the body. 

Cancer: It is rare, but there are chances that your affected bone may turn cancerous. You are more susceptible if you have had radiation therapy earlier. 

Treatment 

Nonsurgical treatment options include: 

• Your doctor would observe the lesions and monitor them, to check if they are causing any symptoms. For this, he/she would order periodic X-rays or other relevant tests.
• Your doctor would prescribe medications such as bisphosphonates. These drugs help in reducing the activity of cells that affect the bones. 

Bracing: Your doctor might recommend bracing to help prevent fractures.  

Surgical Intervention 

Your doctor might schedule you for surgery to remove the lesions or to fix bone fractures. Surgery is recommended if you have: 

• Cancerous lesions that cause severe pain
• Large lesions that may cause a future fracture
• Lesions that cause symptoms and do not respond to the drugs
• Break in the bone (fracture) in which there is a separation of bones
• Hairline cracks in the bone which are hard to recover with castings and braces 

Curettage: This is a surgical procedure used for the treatment of fibrous dysplasia. Here, the tumour is scraped out of the bone. 
Bone graft: After performing curettage your doctor will fill the cavity or space with bone graft, this helps in stabilizing the bone. The bone graft inserted is taken from the donor or any other bone of your body. In the case of a lack of these grafts, a synthetic bone material can be used for filling. 
Internal fixing: To stabilize the bone or to prevent further breakage. Your doctor would recommend for internal fixing that involves placing metal rods, plates, and screws. 
All these are a few fibrous dysplasia treatments which are performed to treat the disease and help the person lead a pain-free and happy life. 

Symptoms 

The fracture symptoms include: 

• Severe pain associated with swelling, bruising, or redness at the affected site
• Bleeding if adjacent blood vessels are damaged
• Inability to move the affected bone
• Change in angulation of bone, the affected bone will bend at an unusual angle 

Some individuals may also feel sickness, along with nausea and dizziness whereas some individuals faint and collapse. Symptoms of fracture also depend on the severity of the fracture, and damage to adjacent structures such as nerves, blood vessels, and skin. 

Risk factors 

Advancing age weakens the bones making them susceptible to fracture. Other conditions such as osteoporosis (a condition in which there will be low bone mass and loss of bone tissue), physical inactivity, smoking, alcohol intake, and use of corticosteroids make a bone more liable to fractures. 

Diagnosis 

The diagnosis of a fracture includes the use of imaging tests such as X-ray, computed tomography (CT) or magnetic resonance imaging (MRI) scans. Your doctor can identify the type and exact location of the fracture with the help of an X-ray. Other scans are used for further examination. 

Complications 

The complications of a bone fracture include: 

• Non-union – failure of the bone to heal
• Mal-union – bone fracture healing in the wrong position
• Osteomyelitis – infection of bone or bone marrow, occurs mostly in cases of compound fracture where the bone protrudes out of the skin
• Compartment syndrome – ischemia of affected area because of increased pressure in an enclosed space; may result in amputation if left untreated
• Avascular necrosis – bone death if there is a loss of blood supply 

The complications may be immediate, early, or late and may be seen if the fracture is left untreated. Immediate complications are hypovolemic shock and injury to major blood vessels and muscles. Early complications are infection and compartment syndrome. Late complications are osteomyelitis, joint stiffness, avascular necrosis, non-union, and malunion. 

Fracture first-aid 

When you or someone has a fracture, take these actions while waiting for medical help 

• Apply pressure on the wound with a sterile bandage, to stop the bleeding if any
• Don’t move or push the injured area
• Apply ice packs to reduce swelling and relieve pain
• If the person faints or has shortness of breath, lay the person down by placing the head lower than the trunk and elevate the legs, if possible 

Types of fractures 

Open and closed fractures are the two types of bone fractures. 

• Open fracture: It is also called a compound fracture as the broken bone tears the skin and protrudes out.
• Closed fracture: It is also called a simple fracture as the broken bone doesn’t destroy the overlying skin. 

These two fracture types are equally severe and require medical attention immediately. 

Fractures are also classified as complete and incomplete based on the crack that occurs in the bone. In the case of an incomplete fracture, the bone doesn’t break completely whereas in a complete fracture, the bone completely separates by breaking into two or more pieces. If the bone breaks into several pieces, then it is said to be a comminuted fracture. 

Fractures are also termed transverse, spiral, oblique, impacted, or compressed based on the pattern of bone break. 

Treatment 

The treatment of a fracture involves immobilizing the bone, putting it into the proper position, and allowing it to heal. The treatment depends on the type of fracture. 

Immobilization: Bone healing occurs automatically as it is a natural process. So, providing some time to heal is necessary. In that case, we need to keep the bone immobilized for a certain amount of time. Immobilization of bone is done by using a cast. The cast is made of plastic or fibreglass and keeps the bone in position until it is healed. 

Medications: Medications such as analgesics or nonsteroidal anti-inflammatory drugs are given to treat pain. 

Surgery: Your doctor prefers surgery if the above methods fail to heal or lead to a poor functional outcome or if the fracture is complex or compound. 

• Internal fixation – also called open fixation; the bone is repositioned and immobilized using metal plates and screws
• External fixation – the bone is repositioned using metal pins, connecting rods, and clamps
• Bone grafting – natural or synthetic bone is transplanted in the place of the affected bone 

Physiotherapy: Your doctor may recommend physiotherapy after healing. This therapy helps to improve muscle strength and prevent permanent stiffness. 

Prevention 

You can prevent easy breakage of bones by following the tips like: 

• Calcium is required for the healthy growth of bones. So, consume foods rich in calcium such as milk, cheese, yoghurt, and green leafy vegetables.
• Vitamin D is required to absorb calcium. Exposure to sunlight for some time daily and consuming foods containing vitamin D (eggs) can aid in bone development.
• Performing weight-bearing exercises can strengthen bones. Other physical activities such as walking, jogging, cycling, and skipping can keep your bones healthy. Elderly people are recommended to perform mild exercises as the bones weaken due to reduced mass.
• Avoid smoking and limit alcohol intake as these are the common risk factors for any illness. 

Gout and its causes 

Gout is a common and painful form of arthritis (disease of the joints), caused by the deposition of uric acid crystals in the joints. 

Uric acid is the normal waste product formed when the body breaks down substances called purines, found in all the body’s cells. This uric acid is usually in a dissolved state in the body and is excreted out of the body through urine. However, if the level of uric acid in the body is too high to be eliminated completely or if the body is unable to wash out all the uric acid produced, the uric acid forms needle-like crystals which deposit in the joints. 

These crystals cause pain when the affected joint is moved. In addition, these crystals attract white blood cells of the body which mounts an inflammatory reaction in the affected joint. This inflammatory reaction causes the joint to become red, warm, swollen, stiff, and tender. 

Managing a gout attack 

In addition to taking the medications, you may adopt some measures to manage the pain and swelling. 

• During a gout attack, give rest to the affected joint and keep it elevated; pain may be eased by applying cold packs.
• Keep yourself hydrated and drink plenty of fluids to help your kidneys wash off the extra uric acid in the body.
• You should avoid eating purine-rich foods, especially meats, and consuming alcohol.
• The protein intake should be moderate and preferably from healthy sources like low-fat or fat-free dairy, tofu, eggs, and nut butter. 

Diagnosis 

If you have these symptoms, consult your doctor immediately. The doctor may take a detailed medical history and do a physical examination. He would ask about your symptoms, their duration and their intensity. 

He would examine and assess the status of the affected joint. Thereafter, some tests may be prescribed. The fluid in the joints may be aspirated through a needle, called a joint fluid test, and examined under a microscope to confirm the presence of uric acid crystals. 

Blood tests may also be done to know the uric acid levels in the blood. 

Symptoms 

The symptoms of a gout attack are often acute, sudden come without a warning, and usually at night. Mostly, the lower joint of the big toe is affected by gout, however other joints like feet, ankles, knees, hands and wrists. 

The pain in the affected joint is most severe for the first 12 to 24 hours after which it decreases, but the discomfort stays for days and weeks. 

Due to the inflammation, the joint appears red, feels warm and is swollen. The joint is so tender that even the weight of the bed sheet may cause pain. 

These attacks are recurrent; may come and go initially, but their frequency and intensity gradually increase. 

If left untreated, the uric acid can get deposited in soft tissues and form lumps under the skin, called tophi. The uric acid can also get deposited in the kidneys causing damage and failure. 

Risk factors 

You may have an increased risk of developing gout if you have increased levels of uric acid in the body. 

Uric acid levels in the body may increase if you eat food items rich in purines like shellfish, salmon, sardines, organ meats, asparagus, mushrooms, and herring. If you have certain medical conditions like cancer, obesity, high blood pressure, high cholesterol levels, and diabetes, then your chances of developing gout increase. 

As uric acids are washed out through the kidneys, any disease of the kidneys also increases the likelihood of gout. 

Medications like water pills, aspirin, and drugs used to suppress the immune system increase the likelihood of developing gout. 

Gout affects men more than women, but after menopause, women too have equal risk. If you have a family member with gout, then your risk of getting the disease increases. In addition, alcohol consumption tends to increase the risk of developing gout. 

Treatment 

The sooner you perform gout treatment, the better it is for your joints. Your doctor may prescribe medications for treating your pain and swelling and preventing future attacks. 

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, indomethacin, and naproxen can be taken to relieve pain and swelling in the joints. 

Another drug, colchicines, is effective in relieving the pain if taken early during the attack. For people who cannot take NSAIDs and colchicines, due to other medical conditions or side effects corticosteroids can be used. Corticosteroids can be taken as a pill or injected directly into the joint. 

Once the acute attack subsides, your doctor may prescribe medications to prevent future attacks, these medications include drugs that block the production of uric acid, like allopurinol, and drugs that promote the removal of uric acid from the body, like probenecid. 

Preventing a gout attack 

• A gout attack in the future can be prevented by taking medications regularly and adopting certain lifestyle changes.
• Obesity tends to increase the risk of gout so the first thing to do is to shed the extra pounds. But this should be done gradually, as crash diets may cause excess weight loss and increase uric acid levels.
• Keeping yourself hydrated at all times, helps in keeping the uric acid in dissolved form and helps the kidneys wash it off. Aim to drink at least 2 to 4 litres of fluids, half of which should be water.
• Dietary modifications are necessary to prevent gout attacks in future. The gout foods which should be consumed are: 

Avoid meat, fish and poultry; include more fruits, vegetables, and whole grains in your diet. Dairy products should be fat-free or low-fat. Limit your alcohol intake. You may talk to your doctor about the amount you can take. 

Symptoms of hammer toe 

A few symptoms of hammer toe have been mentioned below. They are: 

• A hammer toe has a downward-bent
• Stiff and has a claw-like appearance
• Callus formation on the sole
• Corn formation on top of the bent toe
• Pain in the bone that joins the big toe with the foot and pain while moving the toe
• Inflammation
• Irritation
• Redness in the affected toe
• Formation of open sores 

 Causes of hammer toe 

The major symptom of hammer toe is hammer-like or claw-like appearing toe. The various causes for the toe to bend downward are: 

• Long toe bones are more likely to bend downwards
• Wearing smaller tight shoes
• Wearing narrow and high-heeled shoes
• Pressure from a bunion (bump that develops in the base bone of the bigger toe, causing the bigger toe to bend towards the other smaller toes)
• In rare cases where all the toes are involved may signal towards nerves or spinal cord problem
• Rheumatoid arthritis & and stroke
• Injury to the toe bone
• Muscle and nerve damage due to diabetic neuropathy
• Having flat feet may also cause hammer-toe
• In a few, it is inherited 

Preventing hammer toe 

You can prevent many of your leg, ankle, and toe problems by wearing proper, comfortable shoes. Remember to check shoe size for yourself and importantly for children who are in their growing age. 

Never wear a small or narrow shoe with a pointed toe and avoid wearing heels. 

Select comfortable athletic shoes, with soft cushioned insole and stiff bottom. 

Avoid buying plastic or vinyl shoes as they do not allow air circulation when your feet sweat. 

Buy adjustable shoes with lace. 

Buy shoes at mid-day as your feet are smaller in the morning and bulge in the evening; in addition, measure the size of both feet as they may not be of the same size in many. 

Happy feet… 

Repairing hammer toe is possible in many patients. A successful outcome is possible only if it is identified in the early stage and proper treatment is given at the right time. 

Do not force your feet into a small unfit shoe. Rather place it comfortably and help your feet to breathe and perspire properly. Happy feet will avoid many future complications. 

Diagnosing and treating hammer toe 

A detailed physical examination is enough to diagnose the hammer toe. During the physical examination, the contracture of the bone is studied and if required X-ray will be taken to study the degree of deformity of the toe bone. 

There are two treatment approaches for hammer toe which are non-surgical and surgical. 

Treatment begins once your doctor checks the flexibility of the affected toe. If the affected toe is still flexible, then it can be treated by non-surgical procedures like tapping or immobilizing the toe to a straighter position. 

Your doctor might teach you how exactly you should do this so that you can do it at home. 

He may also suggest corrective footwear, corn pads, and other devices to reduce pain. 

Your doctor may teach you certain exercises like moving your toe gently with your hands to keep them flexible. 

You can also try picking up small, lightweight objects like marbles or towels using your toe. 

Apply ice packs if it’s painful or swollen. 

Non-steroid anti-inflammatory medicines can be effective, but if pain and swelling are severe then your physician might go for a steroid shot in the toe joint. 

Surgical treatments are preferred only in severe cases. If your toe is stiffer, it cannot be straightened without surgery. 

Surgery is done under local anesthesia and you can leave right after the surgery. The surgical procedure depends on the severity and deformity of the bone. If your toe is mildly flexible then surgery involves cutting or moving the tendons to straighten the toe. 

If your condition is severe and your toe is immovably stiffer then surgery may be done to realign the tendons along with removal of some parts of the bent toe and then fusing the other joints to make the toe straighter and shorter. 

Symptoms 

Most commonly seen hip fractures in elders are the femoral neck and intertrochanteric regions, resulting from not only falls, but at times due to certain actions like rolling over in bed, getting up from a chair, or walking, all involving minimal force. The symptoms seen include: 

• Severe pain in the hip or groin
• Immobility after the fall
• Inability to bear weight on the injured leg
• The shorter appearance of the injured leg, with the foot and knee turned outwards
• Stiffness, bruising or swelling in the hip 

Treatment decisions are made based on an X-ray of the hip and femur. 

Road to recovery 

• The main goal after the surgery is to regain mobility and activity in your daily life.
• Walking aids such as a cane, walker or crutches might be needed initially.
• By following the physical therapist’s instructions and taking the necessary precautions to prevent further falls, recovery will be faster.
• Be mindful that healthy lifestyle choices will significantly reduce the risks of fracture recurrence. 

Treatment options 

In most cases, surgery is the choice of hip fracture treatment, but in rare cases where the patient’s health condition and age are an added risk, then surgery would not be recommended. Such people will be put into traction (tension system) and confined to a bed. Hip fracture surgery involves: 

Repairing with metal screws- If the bone is still aligned well, metal screws are inserted to hold it well till the fracture heals. This is done in intertrochanteric fractures. For additional stability, bone nails (gamma nails) are also used. 
Replacement of part of the femur- In cases where the ends of the bone are broken, and alignment is lost, the head and neck of the femur are replaced with a metal prosthesis (artificial joint). This is known as hemiarthoplasty. 
Total hip replacement- Here the upper femur and the socket of the pelvic bone are replaced with a metal prosthesis. Both, hemiarthoplasty and total hip replacement are surgical procedures used in older people. Nevertheless, the likelihood of total hip replacement depends upon the nature of the fracture, the severity of symptoms, the personal risk associated and the degree of mobility before the fracture.  

Post-surgical recovery 

If all goes well, within one-day post-surgery, the patient will be coaxed to move with the help of a walker. 

Physical therapy will also be started, focusing on a range of motion and strengthening exercises. 

A week after the surgery and hospital stay, an extended care facility might be provided to the patient. After a month, working with an occupational therapist in extended care and at home will teach the patient to perform day-to-day activities independently, such as using the toilet, bathing and dressing. 

When total hip replacement has been done, advice on certain precautionary measures and how to live effectively with the new hip is given to the recovering patient. 

On returning home, prevention of accidents is important, by keeping the premises hazard-free, and help from a nurse or family member will be required till recovery. 

Complications 

A hip fracture is a serious injury, and though treatable, at times some complications can occur, which may be life-threatening. When traction is applied instead of surgery, it can lead to the following issues: 

• Muscle deterioration and weakness
• Risk of permanent loss of mobility
• Risk of developing blood clots (thrombosis)
• Superficial or deep vein thrombosis 

Rarely, when the patient does not get up and move around, a blood clot can get lodged in the pulmonary artery, and blood flow to the lungs gets blocked. This results in pulmonary embolism, which can be fatal. 

Other complications as a result of immovability include bedsores, urinary tract infections and pneumonia. 

There is also an increased risk of having another fracture in those who have suffered from one previously. 

In those patients who have undergone a total hip replacement, the average life expectancy of an artificial hip joint (prosthesis) is 10 to 15 years, after which hip revision surgery might be required, due to the looseness of the joint or infection setting. 

Prevention 

The leading cause of fractures in elderly people is falls and most of these (more than 60%) happen at home, while the remaining happen in the community or institutions for the elderly. Hence, preventing these falls is very important, especially in the aged group, who tend to have fragile bones. 

Multiple factors contribute to these falls; taking medication such as sedatives, conditions affecting balance (Parkinson’s disease), side effects of taking many medicines and alcohol consumption. 

At home, certain arrangements might have to be made to make it a safer place: 

• Floors: All loose wires, rugs and any clutter must be removed.
• Bathrooms: Bars should be placed for gripping and non-skid tape placed in the tub or shower
• Lighting: Halls, stairways and entrances must be well-lit
• Kitchen: Clean any spills immediately and keep non-skid mats near the sink.
• Stairs: Make sure that railings are secure
• Exercise: This improves balance, strength, coordination and flexibility 

Supplementing a daily diet with calcium (1,200 mg per day) and vitamin D (400 to 600 IU per day) is recommended. Sunlight exposure of 10 to 15 minutes twice a week will help ensure adequate levels of vitamin D. 

Wearing proper footwear (rubber-soled) and avoiding risky behaviour that can lead to falls is important. 

Being unduly fearful about falling will not help; as such fear will prevent the person from being active and mobile. 

Symptoms 

In the early stages of hip impingement, often symptoms are not evident leading to an underdiagnosis. In some patients, the hip impingement goes unnoticed for a few years. Some of the typical symptoms include: 

• Stiffness in the hip, thigh, or groin
• Limited range of motion (flexion of the hip beyond a right angle is not possible/difficult)
• Pain in the groin region felt especially after the hip has been flexed (for example, after running, jumping or extended periods of sitting down)
• Pain in the groin, hip, or lower back that occurs not only during activity but also while taking rest 

Types of Hip Impingement 

There are about two main types of hip impingement: 

Cam impingement: This condition occurs due to the imperfection in the ball-shaped head of the thigh bone. 
Pincer impingement: This condition occurs due to excessive coverage of the ball by the socket. Also, both types can co-exist in some cases. 

Complications 

If hip impingement is left untreated, it can lead to cartilage damage and thus, osteoarthritis. 

Causes and Risk Factors 

Hip impingement can occur in people of any age group, including adolescents and young adults. 

Hip impingement occurs either due to the deformed femoral neck or femoral head or a large hip socket that covers the femoral head to a greater extent. 

Recurrent and repetitive movement of the hip joint (legs) beyond the range of motion can lead to hip impingement. This is more common in people who play certain sports such as football or hockey. 

Any injury to the hip joint also can cause symptoms of hip impingement. 

Other conditions that can cause hip impingement are: 

• Legg-Calve-Perthes disease - inadequate blood supply to the ball portion leading to the death of the tissue
• Coxa vara - different growth paces of the thigh bone and ball leading to deformity of the joint
• Slipped capital femoral epiphysis -detachment of the ball from the thigh bone, commonly seen in obese children 

Diagnosis 

A quick diagnosis helps the doctor in initiating the treatment as soon as possible. Diagnosis begins with taking a complete medical history. Following this, a physical examination is performed to check the range of motion of the hip joint. Further, your doctor will order one or more of the below imaging tests: 

Treatment 

Treatment is based on the type of hip impingement and its severity. In some patients, conservative therapies are successfully helpful in managing the condition. They include: 

• Resting the affected leg
• Physiotherapy (certain exercises are recommended by your physical therapist to strengthen the muscles)
• Reducing certain types of physical activity
• Taking medications to manage pain and inflammation
• If there is no relief with the above therapies, then you may have to undergo surgery. The type of surgery is based on the cause of the hip impingement and the extent of damage to the cartilage. The surgical procedures include:
• Reshaping the ball or the socket using certain tools
• Arthroscopy, which uses a light scope and tools inserted through the small incision made over the joint
• Microfracture technique in which your surgeon cuts away the worn-out cartilage or drills holes in the bone to stimulate the growth of such cartilage.
• In the case of severe damage, hip replacement surgery can help to improve the function of the joint. 

Symptoms 

You may experience the following symptoms: 

• Sharp-catching pain in the hip
• The sensation of locking of the hip
• Stiffness of the hip joint
• Limited range of motion
• Pain in front of your groin
• Pain that worsens with standing or walking 

Risk factors 

Individuals who perform sports or physical activities that require repeated twisting or pivoting motions and individuals with previous hip problems are at increased risk for hip labral tear. 

Diagnosis 

Your doctor diagnoses the condition with a thorough physical examination that involves assessing the range of motion of your hip. Your doctor might order any of the following tests. 

Imaging scans: Your doctor recommends an X-ray of the hip to visualize the bone. It helps to identify any fracture or structural abnormalities. Your doctor might order magnetic resonance imaging for detailed images of your hip’s soft tissues. Sometimes, a contrast material is injected into your hip joint to find out the exact location of the labral tear. 

Causes 

The following are the causes of a tear in the hip labrum: 

• Trauma: An injury to the hip joint, during car accidents or while playing contact sports such as football or hockey, may lead to tearing of the labrum. Contact sports may require sudden twisting of the hip and increase the susceptibility to hip labral tears.
• Structural causes: Some individuals with structural abnormalities such as CAM or Pincer morphology are more likely to be affected by the hip labral tear. 

Treatment 

Your doctor might recommend the treatment based on the severity of symptoms. The treatment may range from simple conservative therapy to arthroscopic surgery for repairing the labral tear. 

• Physical therapy: Your doctor might refer you to a physical therapist. The physical therapist helps you to stretch your tissues to increase the range of motion of your joint. Physical therapy also includes activities that strengthen your bones. Once the pain, motion, and strength improve, your physical therapist may provide you with functional training. Functional training involves teaching exercises that help your body to perform daily activities.
• Medications: Your doctor might prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. If the pain is severe, corticosteroids are injected into the joint to reduce the inflammation for about six months.
• Surgical management: If medication or other conservative therapies do not reduce your symptoms, your doctor might suggest an arthroscopic surgery. During the procedure, a fibre-optic camera is inserted by making an incision in your skin. Then, depending on the extent of the tear, your doctor removes the torn piece of labral cartilage or repairs it by sewing it back. After the surgery, the recovery may take about six to 12 weeks. You will be able to move your joints freely after the surgery. However, physical therapy is still essential for healing, good range of motion, and strengthening your muscles. 

There are two types of infections: 

Acute infections – They account for 95 % of infectious arthritis cases. Cartilage damage occurs within hours or days. 

Chronic infections – They develop gradually over weeks. These infections are seen in people who are at high risk. 

The infection can damage the cartilage of the joint. So, prompt treatment is essential to reduce joint damage. If the infection is left untreated, it may lead to joint degeneration and permanent damage. Osteoarthritis may also occur due to chronic infectious arthritis. 

Symptoms 

Symptoms of infectious arthritis include: 

• Severe pain in the joint
• Difficulty in moving the affected joint
• Redness
• Swelling
• General weakness
• Fever and chills
• Loss of appetite 

The symptoms may vary depending on the cause or the underlying disease. 

Risk factors 

History of joint problems such as arthritis, lupus, and gout, history of joint surgery, presence of open wounds, history of cancer and diabetes, having a weak immune system, and smoking are some of the risk factors for infectious arthritis. Joint trauma such as animal bites or cuts also increases the risk of infectious arthritis. 

Conditions such as Lyme disease, tuberculosis, gonorrhoea, and staphylococcus infections also lead to infectious arthritis. 

Treatment 

The treatment for infectious arthritis includes the use of medications and surgical joint drainage. Your doctor chooses the medications for effective treatment based on the diagnostic results. 

Joint drainage is the procedure involving the removal of synovial fluid from the infected joint. Your doctor may drain the joint fluid by inserting a needle or using arthroscopy. 

Arthroscopy is a device inserted into the joint through a small incision. Then the suction and the drainage tubes are inserted around the joint to drain the fluid. In some instances such as infection in a hip joint, open surgery is performed to drain the fluid. Antibiotics are given if the underlying cause is bacteria. The treatment lasts for two to six weeks. Nausea, vomiting, and diarrhoea are the common side effects that can be seen with the use of antibiotics. Antifungals are prescribed if the causative organism is a fungus. If a virus is causing infectious arthritis, no treatment is given. 

Causes 

Infectious arthritis occurs due to bacterial, fungal, or viral infections. Staphylococcus aureus is a common bacterial species that lives on healthy skin. But when a skin infection or urinary tract infection occurs or when there is a wound, skin puncture, or surgery, it enters the bloodstream and results in infection of the joint. 

Diagnosis 

Your doctor may ask you questions about symptoms and perform a physical examination. 

Arthrocentesis (joint fluid analysis) is carried out to diagnose infectious arthritis. A sample of synovial fluid (joint fluid) is collected by inserting a needle. The sample is sent to a laboratory for the examination of appearance, consistency, and the presence of white blood cells. 

Blood tests are performed to assess the signs of infection. Imaging tests are performed to evaluate the damage to the affected joint. Ultrasonography is performed to identify the pus formation. 

Types of joint dislocations 

• Hip joint dislocation
• Knee joint dislocation
• Elbow joint dislocation/li>
• Ankle joint dislocation
• Shoulder joint dislocation 

Causes 

Joint dislocation occurs when you experience any expected or unexpected falls, injuries or accidents. After a joint dislocation, you are more likely to dislocate the joint again in the future so you must be careful enough to use the dislocated joint in future too. 

Diagnosis 

It is really difficult to estimate if the bone is just dislocated or even broken or crushed. So, it is worth it to immediately rush to an emergency room for medical supervision. 

Your doctor may examine the affected joint. He/she will check if the circulation to the joint is interrupted or perfect. 

Your doctor may order further tests to understand if the bone is broken or just dislocated. Your doctor may suggest you go for an X-ray imaging and also other diagnostic tests such as MRI to understand the severity of the joint dislocation. 

Prevention 

Prevention is always better than cure, to prevent a joint dislocation, you must 

• Take safety precautions that avoid falls
• Instruct your kids or supervise them while they are playing
• Avoid recurrence of re-dislocation of joints as the joint has a history of dislocation and is more likely to dislocate in future 

Risk factors 

Risk factors for a joint dislocation include: 

• Hereditary
• Unexpected falls
• Sports injuries
• Motor vehicle accidents 

Symptoms 

In most severe cases you may easily view the dislocated joint. The location can be swollen or bruised; it may get discoloured, bent or change its shape. 

Other symptoms would include: 

• Pain when the part is tried to move
• Feeling numb around the affected area
• Tingling sensation near the traumatized area
• Loss of the range of motion near the affected limb or part 

Treatment 

The basic treatment for joint dislocation includes RICE therapy (rest, ice, compression, elevation). These techniques would be as a first aid for the joint dislocated patient. In severe cases, your doctor would indicate other treatment options that include: 

Manipulation: This treatment option includes repositioning the dislocated joint back to its normal state. Your doctor would give you an anaesthetic while performing the technique because it may be painful. Anesthesia also lets you avoid contracting the muscles while performing repositioning. 

Immobilization: Once your joint comes back to its position, your doctor will make your joint immobile by fixing casts, slings or splints. This prevents your joint from moving. You must keep your joint immobile based on the severity of the injury. 

Drugs: Your doctor would prescribe painkillers to relieve the pain near the site or may prescribe muscle relaxants in case the pain persists. 

Surgery: If your doctor cannot reposition back, you’re joint, or if the dislocation caused damage to your nerves or blood vessels then the best treatment option would be surgery. Surgery also is needed in patients who have dislocated the same joint which was previously dislocated. Your doctor would surgically fix the displaced joint, and this can prevent radiolocation. 

Rehabilitation: Rehabilitation is advised after your joint is replaced and after your casts or splints are removed. It involves making you regain a better range of motion near the joint. It is also helpful in restoring the joint’s strength and flexibility. But, this must be a slow process because you must be careful not to reinjure yourself. 

Signs and Symptoms 

The symptoms of joint infections can vary depending on age and the medications you’re taking. The symptoms include severe pain that worsens with movement, swelling of the joint warmth and redness around the joint, fever, chills, fatigue, weakness, decreased appetite, a rapid heart rate, and irritability. 

Causes 

Infections are caused by organisms which include bacteria, viruses, and fungi. Many different bacteria can infect a joint. The types of bacteria causing joint infection are classified depending on the patient’s age: 

Infants and young children are most often infected with staphylococci, streptococci, and bacteria known as gram-negative bacilli. 

Older children and adults are most often infected with staphylococci, streptococci, and gonococci. 

Bacteria such as spirochetes and those that cause Lyme disease, and syphilis can also infect joints. 

Viruses such as parvoviruses, HIV and those that cause mumps, rubella, and hepatitis B and hepatitis C, can infect patients of any age. 

Risk factors 

There are many risk factors for joint infections. Most children who develop joint infections do not have identified risk factors. Open wounds are at a higher risk for joint infections. If you have a weakened immune system or pre-existing conditions such as cancer, diabetes, intravenous drug abuse, and immune deficiency disorders you may be at a higher risk of joint infections. Previously damaged joints have an increased likelihood of becoming infected. 

Complications 

If the condition is left unnoticed or untreated, you are at risk of complete disabling of the joint. 

Prevention or self-management 

Joint infections can be prevented by seeking prompt medical assistance if you suspect any infection. This can help reduce your risk of developing pain and inflammation associated with the joint infection. If you are suspected as a risk factor for septic arthritis, consult your doctor and discuss taking preventive antibiotics. 

Diagnosis 

The joint infections are usually diagnosed with the help of laboratory tests. The tests used to diagnose joint infections include: 

• Analysis and culture of joint fluid
• Blood tests
• Sputum, spinal fluid, and urine tests
• Magnetic resonance imaging (MRI) or ultrasonography 

Your doctor usually suspects and diagnoses joint infections if you have severe or unexplained arthritis or joint pain and also have other combinations of symptoms that are common with people who have infectious joints. 

A sample of joint fluid is aspirated with the help of a needle and examined for an increased number of WBCs, and the type of bacteria (culture) and other organisms. 

Blood tests are often recommended by your doctor as bacteria causing joint infections often appear in the bloodstream. 

Sputum, spinal fluid, and urine are also tested for bacteria to determine the source of infection and the presence of infection in any other part. 

If the infected joint is not easily accessible for examination or aspiration, then your doctor may order a magnetic resonance imaging (MRI) or ultrasonography to identify accumulations of fluid or collections of pus. 

Treatment 

The objective of joint infection treatment is to relieve the symptoms followed by removing the infection from the body. The treatment procedure is performed in three different steps which include: 

• Usage of antibiotics or antifungal drugs
• Splinting of the joint and physical therapy
• Removal of pus 

Antibiotics are started as soon as an infection is suspected even before the infected organism is identified by the laboratory reports. The laboratory test to identify the causative organism in the joint fluid takes at least 48 hours. Intravenous antibiotics are also given to ensure the immediate effect of the drug. Antibiotics may be changed after receiving the laboratory reports after 48 hours depending on the sensitivity of the particular bacteria to specific antibiotics. 

The puss is removed or drained by placing a needle as the accumulation of pus may damage the joint and may be more difficult to be cured with antibiotics. Sometimes drainage with a needle is difficult in the case of hip joint infection, arthroscopy or surgical procedure may be needed to drain the joint. The procedure for draining may be done more than once and sometimes a drain tube is left in the joint to drain the pus. 

Splinting of the joint is done to help ease the pain. Physical therapy is started later to strengthen muscles and prevent stiffness and permanent loss of function of the joint. 

Nonsteroidal anti-inflammatory drugs (NSAIDs) are also used as they can help to reduce pain, inflammation, and fever. 

Causes of Joint Sprains 

The ligaments are tough elastic bands of fibrous tissue. They help in stabilizing the bones, connecting one bone to the other and preventing excess movement. When there is excess force that makes the ligaments go beyond their normal range and get damaged, this is called a sprain. 

A movement like a twist, turn or roll can cause a stretch or tear in the ligament causing a sprain. 

There may be a visible swelling along with pain in the sprained area. Pain is mild, if the sprain is not severe. In case of a severe sprain, swelling and severe pain occur. 

The movement of the joint may be restricted. The person may find the sprained area, cold and numb. It might become difficult to bear the body weight on the affected leg. 

Diagnosis 

For diagnosing a joint sprain, an X-ray may be taken to capture images of the internal structure of the joint. 

A bone scan may be conducted in which a radioactive substance is injected intravenously into the bone. This radioactive substance gets attached to the damaged bone which is seen in the scan as bright spots. 

The Magnetic resonance imaging (MRI) scan is done in which radio waves and a magnetic field are used to produce good images of the internal structure of the joint. 

To get cross-sectional images of the joint, a computerized tomography (CT scan) is done. 

Symptoms 

The following symptoms may appear in a person suffering from ankle sprain. They are: 

• Swelling
• Tenderness
• Inflammation
• Pain
• Stiffness
• Skin discoloration
• Inability to put weight on the affected area
• Bruising 

Treatment 

Following is the treatment for a sprained ankle. For initial management of a sprain, the RICE approach may be followed. 

The letter ‘R’ stands for rest; the letter ‘I’ stands for ice; the letter ‘C’ stands for Compression and ‘E’ stands for elevation. 

According to the RICE approach, one must rest the joint sufficiently and use crutches, if needed. 

To decrease swelling, muscle spasms, bruising and pain, ice packs should be applied for at least 3 days after injury. 

Compressing the joint with wraps helps in preventing bruising and swelling. 

An elastic bandage is wrapped around the joint in a figure ‘8’ pattern leaving the joint exposed. 

One must make sure that it is not wrapped so tightly that the blood flow is stopped. 

With adhesive strips, one can attach the elastic bandage firmly. The joint wrap can be kept in place for up to a week. 

To prevent the swelling from getting worse, one must raise the joint above heart level and keep it that way for 2 to 3 hours every day. 

The medications used for reducing swelling include acetaminophen (Tylenol), Ibuprofen (Motrin, Advil), and naproxen (Aleve). 

Physical therapy is given after the swelling comes down. This increases the balance, flexibility, motion and strength of the joint. 

A cast or a walking boot may be necessary for proper healing of the joint. 

Surgery is needed for ligament tear. 

 The right way to use an ice pack 

• Ice has to be placed not more than 20 minutes at a time on the affected part of the joint. The minute the person feels numb, the ice has to be removed.
• Ice should be used once every 2 to 4 hours for the first 3 days after a sprain.
• The ice pack can be made by crushing ice and placing it in a plastic bag. After placing the ice pack one must wrap an elastic band around it to hold it in place.
• For a good ice massage, ice should be first frozen in a Styrofoam cup (4 to 8 ounces).
• The top part of the cup is torn to expose the ice and then it is massaged onto the affected area for not more than 30 seconds.
• For an ice slush bath, one must fill the bucket with ice and water, and then place the joint in it till it gets numb. 

Signs and Symptoms of Knee Bursitis 

The symptoms of knee bursitis include 

• Pain, redness, and tenderness in the knee
• Warmness in the knee
• Swollen area in the knee
• Limited movement of the knee
• Fever (due to septic bursitis) 

Prevention of Knee Bursitis 

Knee bursitis can be prevented by following some simple measures such as 

• Wearing kneepads while at work or during sports
• Resting the knees periodically
• Avoiding prolonged stress on the knees
• Wearing knee pads
• voiding excessive squatting
• Stretching and relaxing the legs in between activities
• Applying ice packs on knees after a workout
• Elevating the legs when at rest 

Causes of Knee Bursitis 

Knee bursitis occurs when the bursa becomes inflamed or infected. The inflammation can be due to injury or repetitive movement of the joint. The infections can occur due to the attack of bacteria at the puncture wounds. The bacterium which usually causes knee bursitis is Staphylococcus. Knee bursitis due to infection from bacteria is usually called septic bursitis. Knee bursitis can be caused by infection of the bursa, direct trauma to the knee, repeated pressure on the knee, continuous and frequent pressure on the knee, and complications such as gout, rheumatoid arthritis, and osteoarthritis. 

Diagnosis of Knee Bursitis 

The diagnosis of knee bursitis starts with a physical exam of the knee. During the physical examination, the doctor will inspect the knee by pressing gently on different areas and observe for swelling warmness and pain upon pressing. The comparison of both knees helps to determine the level of inflammation in the knee. The doctor determines the range of motion of the knee joint by moving the knee in different positions. Some imaging tests are used to diagnose knee bursitis. They include: 

X-ray: X-rays are useful in identifying bone fractures, tumours or arthritis. Bursae are not visualized by X-rays. 
Ultrasound: High-energy sound waves are used to produce images of the joints and visualize swelling in the affected bursa. 
Magnetic resonance imaging (MRI): High-frequency radio waves and a strong magnetic field are used to produce detailed images of the whole body. Bursae can be visualized by MRIs. 
Aspiration Test: To identify if the swelling of the knee area is due to infection in the bursae, the doctor takes the sample of bursa fluid by inserting an aspiration needle into the affected area. The laboratory testing of the sample bursa fluid reveals the infection by the presence of bacteria in the sample fluid. 

Treatment for Knee Bursitis 

Depending on the cause of knee bursitis, the doctors may recommend different types of treatments. If it is due to inflammation of the bursa, the doctors suggest the following methods to relieve pain. 

Rest: The doctors suggest discontinuing the activities that may worsen the symptoms. Resting of the leg is suggested to relieve pain and inflammation of the knee. 
Ice Packs: The doctors suggest applying ice packs on the knee at regular intervals of 3 or 4 times a day for 20 minutes at a time to relieve the pain and inflammation. The ice packs can reduce swelling if the knee is rested for prolonged periods without activity. 
Elevation: The doctors suggest elevating the affected leg while at rest to relieve pain and inflammation. 
Exercises: The doctors suggest some exercises to improve flexibility and strengthen the muscles of the knees. 
Medications: The doctors suggest taking anti-inflammatory medications, such as naproxen or ibuprofen to relieve inflammation and pain. If the bursitis is caused due to infection, then the doctors suggest antibiotics. 

Some invasive treatments for knee bursitis include: 

Corticosteroid Injection: If the bursitis does not respond to basic treatments, the doctor may suggest corticosteroid injections into an affected bursa to reduce inflammation. 
Aspiration: It is the technique of removal of excess fluid from the bursa. It is used to treat inflammation of the bursa. The process is carried out with an aspiration needle. This process may cause short-term pain and swelling in the knee. Knee immobilizers are suggested after the treatments for a short period to reduce the chances of recurrent swelling. 
Surgery: If the bursitis is chronic and does not respond to the treatments, then the doctor may suggest the surgical removal of the bursa. 

Signs and Symptoms of Knee Pain 

The symptoms of knee pain include: 

• Swelling and stiffness
• Redness and warmth in the knee
• Weakness
• Popping or crunching noises
• Inability to straighten the knee
• Difficulty walking due to instability
• Limping
• Difficulty walking up or down steps
• Unable to bend the knee
• Inability to extend the knee
• Pain in the kneecap 

Causes of Knee Pain 

There are different knee pain causes such as injuries, mechanical problems, different types of arthritis and other problems. Overuse of the knee joint triggers knee pain. Knee injuries affect ligaments, tendons, bursae, bones, cartilage, and ligaments. Different types of knee injuries that trigger the knee pain include: 

Ligament Injury: The tearing of the anterior cruciate ligament (ACL) is called an ACL injury. ACL is one of the four ligaments that connect the shinbone to the thighbone. It can occur when a sudden change in knee direction takes place. 

Fractures: The fracture of bones of the knee can lead to knee pain. Knee fractures can be due to accidents or simply stepping wrong. 

Knee Bursitis: Bursitis is the inflammation of the bursae leading to knee pain. 

Patellar Tendinitis: It is irritation and inflammation of one or more patellar tendons in the knee causing knee pain. 

Meniscus Injury: Meniscus is a tough, rubbery cartilage that acts as a shock absorber between the shinbone and the thighbone. The tearing of the meniscus causes knee pain. It can be torn suddenly when the knee twists while bearing weight on it. 

Some mechanical problems such as loose body, iliotibial band syndrome, hip or foot pain, and dislocation knee pain can lead to knee pain. Different types of arthritis such as osteoarthritis, rheumatoid arthritis, gout, pseudogout, and septic arthritis can cause severe knee pain. Patellofemoral pain syndrome also leads to knee pain. 

Diagnosis of Knee Pain 

The knee pain diagnosis primarily involves a physical examination of the knee. During the physical exam, the doctor inspects the knee for swelling, pain, tenderness, warmth and visible bruising. The range of motion of the knee is checked by moving the leg in different directions. The doctor also evaluates the integrity of the knee by pushing on or pulling the knee joint. Some imaging tests that are used for the diagnosis of knee pain are: 

X-ray: An X-ray of the bones is suggested to detect knee bone fractures and degenerative joint diseases which are leading to knee pain. 

CT scan: Cross-sectional images of the whole body are taken by X-rays. It helps to diagnose bone problems and detect loose bodies. 

Ultrasound: High-frequency sound waves are used to produce images of soft tissue structures within and around the knee. These images help in detecting damages and underlying conditions. 

Magnetic Resonance Imaging (MRI): High-frequency radio waves along with a powerful magnet are used to create three-dimensional images of the inside of the knee. These images reveal injuries to the soft tissues such as ligaments, tendons, cartilage, and muscles. 

Arthrocentesis is the process of removal of fluid present in between the joints. The fluid is evaluated in the laboratory for the presence of infections and to identify underlying conditions such as gout or different types of arthritis. 

Knee Pain Treatment 

The treatment for knee pain depends on the cause of the pain. If the knee pain is due to underlying conditions, the treatment will be based on curing the condition. The treatment options for knee pain include: 

Physical Therapy: It is suggested to strengthen the muscles around the knee. Exercises will be suggested to improve the balance and reduce the pain. Proper exercises and movements help in relieving pressure and stress from the knees. 

Injections: Knee pain can be reduced by injecting some medications such as corticosteroids into the knee joint directly. It helps in relieving the pain and other symptoms of knee pain. In some cases, hyaluronic acid (acts as lubricating fluid) is injected into the joints directly. Platelet-rich plasma (PRP) is also injected to reduce inflammation and promote healing. It is useful in mild arthritis. 

Surgery: Surgery may be suggested sometimes if an injury in the knee is responsible for the pain. Some of the surgeries include: 

Arthroscopic surgery: It is used to remove loose bodies from the knee joint, remove or repair damaged cartilage, and reconstruct torn ligaments which in turn manages the knee joint pain. It is performed by using a fibre-optic camera and a long, narrow tool. It is inserted by making small incisions around the knee. 

Partial Knee Replacement Surgery: In this procedure, the damaged portion of the knee is replaced with parts made of metal and plastic. It is usually performed through small incisions on the knee. 

Total Knee Replacement Surgery: In this procedure, the damaged bone and cartilage from the thighbone, shinbone and kneecap are replaced with an artificial joint which is made of metal alloys, high-grade plastics, and polymers. 

In some cases, in patients who have knee pain due to osteoarthritis are suggested with glucosamine and chondroitin supplements to relieve the pain. Acupuncture also relieves knee pain caused by osteoarthritis. 

Types of Kyphosis 

The types of kyphosis are postural, Scheuermann's, and congenital. 

• Postural Kyphosis is an increased curve in the upper spine. It can be caused by slouching. It is most common in teenagers.
• Scheuermann's Kyphosis usually occurs in puberty. It leads to rounding of the back during the growth.
• Congenital Kyphosis is the abnormal development of the spine in the womb. Kyphosis can also be present at birth due to conditions such as Marfan syndrome or Prader-Willi disease. 

Signs and Symptoms of Kyphosis 

The symptoms of Kyphosis include: 

• Fatigue
• Tiredness
• Mild back pain
• Decreased appetite
• Difficulty breathing
• Stiffness in the spine
• Tenderness in the spine
• Round back appearance 

Causes of Kyphosis 

Kyphosis occurs when the vertebrae in the upper back become more cured than normal. Usually, a normal curve is common in every individual but a curve of more than 45 is problematic. This can be caused by many reasons such as: 

• Osteoporosis
• Disk degeneration
• Scheuermann's disease
• Birth defects, syndromes
• Cancer treatments
• Trauma
• Spondylolisthesis 

Some other causes of Kyphosis include tumours, spina bifida, polio scoliosis, Paget disease, neurofibromatosis, muscular dystrophy, some endocrine diseases, connective tissue disorders, and infections such as tuberculosis. 

Diagnosis of Kyphosis 

The diagnosis of Kyphosis involves a physical examination along with a neurological examination to check reflexes. If numbness or muscle weakness is observed, doctors may recommend several tests to determine nerve impulses that travel between the spinal cord and extremities. Some imaging tests that are helpful in the diagnosis of Kyphosis include: 

X-ray: X-rays help in determining the degree of curvature and help in detecting deformities of the vertebrae, which in turn helps identify the type of kyphosis. 
CT scan: Cross-sectional X-ray images are taken from different angles to identify the internal structures and deformities. Magnetic Resonance Imaging (MRI): High-frequency radio waves and a very strong magnet are used to produce detailed images of bone and soft tissues. It helps to detect a tumour or infection that is causing Kyphosis. 
Bone Density Test: This is required to know whether the Kyphosis is due to osteoporosis. 
Pulmonary Function Tests: If breathlessness is observed as a symptom, the doctors may suggest this test. 

Treatment of Kyphosis 

The Kyphosis treatment depends on the cause and symptoms that are present. The doctors may suggest over-the-counter pain-relieving medications such as acetaminophen, ibuprofen, or naproxen. If the Kyphosis is due to osteoporosis, then the treatment involves treating osteoporosis. Bone-strengthening drugs help to prevent additional spinal fractures. 

Physical therapy exercises help in improving spinal flexibility and posture. The exercises usually include stretching and strengthening exercises. The progression of Scheuermann's Kyphosis in children can be stopped by body bracing. It is called a Kyphosis brace. Maintaining a healthy lifestyle (body weight and regular physical activity) will help prevent back pain and relieve symptoms of kyphosis. Maintaining healthy bone density can decrease the risk of osteoporosis and eventually Kyphosis. 

Surgery: If the curve and symptoms are very severe, kyphosis surgery may be suggested to reduce the degree of curvature. The surgical procedure is called spinal fusion and it involves the connection of the affected vertebrae with pieces of bone, metal rods, and screws. This process helps in correcting the posture. 

Signs and symptoms 

Pain is the main symptom, often described as a sharp ache or burning sensation in the associated muscles and tendons. It may get worse by prolonged activity and is relieved by rest. 

You may also experience muscle stiffness, especially in the morning which may last for less than 30 minutes or until the daily activities are started. In some patients, the crackling sound is felt when the affected joint is moved or touched. Other signs and symptoms of osteoarthritis include loss of flexibility, grating sensation, and bone spurs. 

Consult the doctor immediately when you have joint pains or stiffness that doesn’t go away. 

Causes and Risk Factors 

OA is mainly caused by “wear and tear” of the joints. It occurs when the cartilage gradually deteriorates. However, certain factors are attributed to OA. 

• A gene called FAAH, previously linked to increased pain sensitivity is mostly found in people affected with OA.
• Being overweight puts pressure on hips and knees causing the cartilage to break down faster and ultimately leading to OA.
• Injury to the joints such as fracture, surgery or ligament tear may also lead to OA.
• Other joint disorders like rheumatoid arthritis, and hemochromatosis, may cause OA.
• Women are at increased risk than men to develop OA; however, the reason is unknown. 

Diagnosis 

Your doctor initially examines the affected joint thoroughly, and checks for tenderness, swelling, redness, and range of motion of the joint. If OA is suspected, then the doctor might suggest further tests like: 

• X-ray: to check the presence of bone spurs around the joint
• Magnetic resonance imaging (MRI): it gives detailed images of bone and soft tissues including cartilage
• Blood test: This test helps to rule out other problems like rheumatoid arthritis
• Joint fluid analysis: fluid is drawn from the affected area to determine if there is inflammation or to check if the pain is caused by gout or infection. 

 Treatment 

Osteoarthritis is a chronic, long-term disease and hence there is no cure. However, there are several osteoarthritis treatment options available to manage the symptoms. 

Medications 

• Analgesics/painkillers, opioids, and corticosteroids are prescribed to relieve pain.
• Nonsteroidal anti-inflammatory drugs are used to reduce inflammation and related pain.
• Hyaluronic acid injections are provided to manage the symptoms of joint breakdown. 

Physical therapy

It is a special exercise program that helps to strengthen your muscles around the joint, improves the range of motion and reduces the pain. 

Occupational Therapy, Tai Chi, and Yoga

These are also the best treatment options to reduce stress and improve joint movement. But these should be done only in the presence of an instructor because certain moves may cause pain in your joints. 

Surgery

This is mainly suggested when you do not respond to other treatment options. Joint replacement surgery is the commonly preferred surgical technique in which the doctor removes the damaged joint surface and replaces it with plastic and metal parts. 

Self-management 

You can easily manage the symptoms of OA just by adopting the following lifestyle changes. 

• Regular exercise not only improves your stamina but also strengthens the muscles around the joint and makes your joint more stable. Do not worry if you have joint pains after the exercise.
• Manage your weight according to your body mass index (BMI) because overweight increases the pressure or stress on the joints.
• Application of capsaicin (two to three times a day) may help you manage pain, especially if you are not taking painkillers.
• Use heat and cold compressors to reduce muscle spasms, pain, and muscle stiffness.
• Use assistive devices to reduce the stress on your knees and hips. 

About Osteoporosis 

Osteoporosis is a condition in which, due to loss of calcium, the bones become porous. This causes bone weakness and leads to breakage of bones over time. It has been observed that osteoporosis occurs more in women, especially after menopause. 

In the human body, there is continuous remodeling of the bone which involves new bone being made and old bone lost. The bone mass increases when one is young as the amount of bone made is more than the amount of bone lost. 

The peak bone mass is reached around 30 years of age. After which one starts losing bone more than one makes bone. After menopause or surgical removal of ovaries, the estrogen levels in women fall drastically which speeds up bone loss leading to osteoporosis. 

The other risk factors of osteoporosis include 

• Menopause occurs before the age of 45 years
• Surgical removal of ovaries
• Deficiency of calcium
• Family history of menopause
• Belonging to Asian or Caucasian race
• Sedentary lifestyle
• Thin and small body frame
• Alcohol abuse
• Smoking
• Anorexia nervosa ( eating disorder)
• Hyperthyroidism (thyroid gland being overactive)
• Medications used for hypothyroidism(thyroid gland being underactive)
• Use of corticosteroid medications 

Osteoporosis can manifest as severe back pain due to a fractured vertebra. There can be fractures in the bones of the hip and wrist as well. The posture of the affected person is stooped and there is a loss of height over time. 

Symptoms 

There are a few symptoms of osteoporosis. They are: 

• Back pain caused by fracture
• Loss of height over time
• Wrong posture 

Support 

Women who have crossed their menopausal stage should be aware of osteoporosis and its debilitating effects. By taking the necessary precautionary steps, one can strengthen the bones considerably. 

Tips to keep bones strong 

To keep bones strong and keep osteoporosis away, one must exercise regularly. Strength training exercises help strengthen the muscles and bones of the upper spine and arms, whereas weight-bearing exercises like jogging, stair climbing, skipping rope, walking and sports activities help make the bones strong. The diet should contain at least 1000mg of calcium per day. Smoking should be strictly avoided as it decreases estrogen production in women which leads to bone loss. 

Taking more than two alcoholic beverages decreases bone formation considerably. 

Diagnosis 

To check the bone density, a screening test known as dual X-ray absorptiometry (DEXA) is done which checks the density of bones in the wrist, spine and hip. Other tests that help in measuring bone density are single photon absorptiometry, quantitative computerized tomography and ultrasound. 

Calcium requirement 

The calcium required by women before menopause is 1000mg of calcium per day. After menopause, if the woman is not taking estrogen, then the calcium needed per day is 1500mg; while taking estrogen, it is 1000mg per day. Food sources that are rich in calcium include yoghurt, cheese, milk, spinach, broccoli, pink salmon and dried beans. Vitamin D helps in the absorption of calcium in the body. Hence, food sources rich in vitamin D should be taken like fish oils, saltwater fish, egg yolks, liver, and fortified milk. 

Treatment 

There are medications for the treatment of osteoporosis. 

Biphosphonates: The biphosphonates help in increasing the density of bones in the spine and the hip, and help reduce the risk of bone fractures. They are taken in the form of intravenous injections or the form of oral pills. People who have low calcium levels in the blood, pregnant women, and people who have kidney disease cannot take the biphosphonates. The side effects that can occur due to biphosphonates include oesophagal irritation, vision problems, irregular heartbeats, osteonecrosis of the jaw (bone loss in the jaw), abdominal pain, and nausea. 
Calcitonin: Calcitonin is a hormone produced by the thyroid gland which helps in slowing bone loss and prevents spine fractures. It is available in the form of an injection or nasal spray. There can be nasal irritation in some people due to the use of nasal spray. People who can’t take biphosphonates generally use it. 
Raloxifene: Raloxifene gives the same beneficial effects of the hormone estrogen without causing any risks. It helps in increasing bone density in postmenopausal women without causing any risks like uterine cancer or breast cancer. Raloxifene should not be used in people with a history of blood clots. A side effect of this drug is experiencing hot flashes. 
Alendronate and risendronate: These medications decrease the rate of bone loss and thus reduce the risk of fracture. They are taken in the form of pills. The common side effect that may be experienced is a stomach upset. 
Ibandronate: Ibandronate helps in increasing the density of bone and reducing bone resorption. The medication is given in the form of an injection once in 3 months. If taken in the pill form it is available as a daily pill or a monthly pill. The side effects of the medication include bloody urine, chest tightness, shortness of breath and lower back pain. 
Terparatide: This medication helps in bone growth. It is a form of synthetic parathyroid hormone. It is given in the form of injection into the abdomen or thigh in both men and women. The side effects that can be seen include loss of appetite, muscle weakness, abdominal pain, headache, and nausea. 

Causes of Sacroiliitis 

The major causes of sacroiliitis involve: 

• Injury: Any sudden impact, such as an unexpected motor vehicle accident or a fall, can damage your sacroiliac joints.
• Arthritis: Due to arthritis, there would be wear and tear in the sacroiliac joints, and conditions such as ankylosing spondylitis can also cause sacroiliitis.
• Pregnancy: At the time of labour, the sacroiliac joints tend to loosen and stretch to accommodate childbirth. Due to alterations in the gait and an increase in weight, there would be extra pressure on the joints which can lead to abnormal wear, and finally sacroiliitis.
• Infection: In a few situations, the sacroiliac joints can be infected. 

Sacroiliitis Symptoms 

The common symptoms associated with sacroiliitis are pain near the buttocks and lower back. The pain can also extend towards the legs, groin, and even feet. The pain severity increases by prolonged standing, climbing stairs, running, and bearing more weight on one leg compared to another leg. 

Complications 

The common complications due to painful sacroiliitis are insomnia and depression. 

Diagnosis 

Initially, your doctor will perform a physical examination to find out the exact spot where your pain arises from and then press the areas on the hips and buttocks where the pain initiates. He/ she might move your legs at different angles to stress the sacroiliac joints. 

Imaging tests 

To determine the extent of damage to your sacroiliac joints, your doctor would order X-ray imaging. If your doctor finds evidence of ankylosing spondylitis, then he/she would order further tests such as MRI. 

Anaesthetic injections 

As lower back pain may have many causes, your doctor might suggest the use of anaesthesia for the diagnosis. If it stops your pain, it's obvious that the problem is in your sacroiliac joint. 

Sacroiliitis Treatment 

The treatment mainly depends on the underlying cause of your pain. Your doctor might recommend: 

• Painkillers- to relieve pain
• Muscle relaxants-to reduce the muscle spasms often associated with sacroiliitis
• Tumour necrosis factor (TNF) inhibitors are prescribed to relieve sacroiliitis associated with ankylosing spondylitis. 

To help you increase joint flexibility, your physical therapist would recommend stretching exercises and range-of-motion improving tips. 

 Surgical and other procedures 

Your doctor might suggest other methods to alleviate your pain if the above medications do not work out. 

• Injections: to reduce inflammation and pain, your doctor would administer corticosteroids.
• Radiofrequency denervation: This technique damages or destroys the pain-causing nerve tissue.
• Electrical stimulation: The electrical stimulator is fixed near the joint and reduces the pain caused by sacroiliitis.
• Joint fusion: Surgery is rarely used to treat sacroiliitis, your doctor would fuse the two bones with metal hardware which helps relieve pain caused due to sacroiliitis. 

Types of scoliosis

• Infantile idiopathic scoliosis- in children less than three years old
• Juvenile idiopathic scoliosis- in children between three and ten years of age
• Adolescent idiopathic scoliosis- in children who are between 10 and 18 years old 

Risk factors 

The common risk factors which may increase your risk of developing scoliosis include: 

• Age - the symptoms often occur during puberty
• Gender - females are at higher risk than males
• Genetics - people are more likely to have scoliosis if the family members are affected by it 

Signs and symptoms 

The common signs and symptoms of scoliosis include uneven shoulders and waist, and one hip appears more prominent than the other. The individual may lean to one side due to uneven leg length and also the clothes do not hang properly. 

Notify your doctor immediately when you notice signs and symptoms of scoliosis in your child. 

Causes 

The exact cause is not known. However, congenital spinal malformations such as cerebral palsy, muscular dystrophy, and Marfan syndrome, may be responsible for the condition. Babies are born with scoliosis as a result of a problem with the development of the spine in the womb. 

Complications 

Most of the patients have a mild form of scoliosis, but it may cause certain complications such as heart and lung damage, chronic back pain, uneven hips, and a shift of the waist and trunk to the side. 

Self-management 

Scoliosis cannot be prevented, but exercising daily or participating in sports can improve the overall health and well-being of the patient. 

Diagnosis 

Your doctor will first perform a physical examination of the spine, ribs, hips and shoulders. During this your child will be asked to stand and then bend forward by loosely hanging the arms, this helps the doctor to check if one side of the rib cage is more prominent than the other. Then the doctor measures the degree of scoliosis using a scoliometer. The neurological test is also performed to check for muscle weakness, numbness, and abnormal reflexes. 

An imaging test such as an X-ray is performed to check for the shape, direction, location and angle of the curve. If your child has more symptoms, such as back pain, or if the symptoms are severe, an MRI scan or CT scan is performed. 

 Treatment 

The scoliosis treatment depends on the age, severity, and extent of developing complications. In mild cases, i.e., children with low curvature of the spine may not require treatment as it may naturally improve as the child gets older. However, if the condition is severe, braces or casts are provided. 

If the child’s curve continues to progress despite bracing or casting, surgery would be the preferred treatment option. During the surgery, metal rods are inserted into the back to stabilize the spine. These rods are lengthened as your child grows. 

In older children, scoliosis may not improve with time and may progressively get worse. In such cases, the treatment options are: 

• Non-surgical therapy- such as painkillers and exercises
• Back brace- worn until the child stops growing to prevent the spine from curving further
• Surgery– spinal fusion is the most common type of scoliosis surgery in which two or more bones of the spine are connected, and pieces of bone or bone-like material are placed between the vertebrae; screws, hooks, wires, and metal rods are used to hold the spine straight. 

Diagnosis 

Diagnosis of a separated shoulder includes a physical examination and an imaging test such as an X-ray. During the physical examination, your doctor evaluates the severity and location of pain. An X-ray is performed to confirm the diagnosis. In most cases, X-ray appears to be normal in the early stages. In case of any deformity, it is easy to confirm the diagnosis due to the clear appearance in the X-ray. 

Your doctor may classify the separated shoulder into six types based on the severity of the damage ranging from small injury to severe trauma or fracture of the ligaments. 

Causes and risk factors 

If your shoulder is separated you may experience symptoms such as shoulder pain and weakness, bruising or swelling in the affected area, restricted movement of the shoulder, popping sensation with slight movement. 

The most common cause of a broken shoulder is a direct fall onto the shoulder. A hard blow to the acromioclavicular joint also causes a separated shoulder. 

Some people have persistent pain even with a minor deformity. This could be due to the development of arthritis or abnormal contact between the bone ends or at the joint during motion. 

Participating in contact sports such as football, hockey, and wrestling or sports such as gymnastics and volleyball that involve falling also increases the risk of separated shoulders. 

Symptoms 

If your shoulder is separated you may experience symptoms such as shoulder pain and weakness, bruising or swelling in the affected area, restricted movement of the shoulder, popping sensation with slight movement. 

Treatment 

The treatment for separated shoulders involves conservative therapy or non-surgical therapy such as resting and, the use of ice and pain relievers. In most cases, the shoulder regains its full function within a few weeks. In the case of severe deformity or if the pain persists after conservative therapy, your doctor may recommend surgery. 

Non-surgical treatment 

Non-surgical treatment involves using pain relievers, taking adequate rest, using ice packs, and physical therapy. Pain relievers or over-the-counter medications such as acetaminophen or ibuprofen are used to reduce the pain. Avoid activities that may increase your shoulder pain. You may also immobilize the arm with a sling to reduce pressure on the shoulder and promote healing until the pain subsides. 

The use of ice packs every four hours for 15 to 20 min can reduce pain and swelling. Physical therapy involving stretching and strengthening exercises can help to regain normal motion flexibility and strength of your shoulder. 

Surgical treatment 

If the pain and discomfort are not relieved with non-surgical treatment options, then your doctor would recommend surgery. Surgery involves trimming back the end of the collarbone to prevent its rubbing against the shoulder blade. If there is a severe deformity, your surgeon may reconstruct the ligaments. 

After the surgery, your doctor will advise you to wear a sling to immobilize and protect the shoulder. After a few days of the surgery, your doctor recommends ice therapy, electrical stimulation, or massage to alleviate the pain. After four weeks, stretching and strengthening exercises must be performed to improve the movement of the joint. 

Prevention 

You can reduce the risk of shoulder separation by following some simple tips which include: 

• You must perform stretching before practising exercises
• You must stop any kind of physical activity if you feel any shoulder pain
• You must apply an ice pack to the shoulder after any physical activity in case of a history of shoulder separation
• You must use protective padding to protect from falls 

Types of tendinitis based on the affected tendon

• Achilles tendinitis (the largest tendon that connects calf muscles to the heel bone)
• Patellar tendinitis (connects the kneecap (i.e. patella) to shinbone)
• Bicep tendinitis or Bicipital tendinitis (the tendon that is present around the long head of the biceps muscle)
• Rotator cuff tendinitis (tendons that move the shoulder joint) 

Symptoms of Tendinitis 

Tendinitis symptoms may last for a few days to several weeks depending on the severity of tendinitis, and include: 

• Pain and tenderness along a tendon (mainly near a joint)
• Mild swelling
• Pain at night times
• Pain that worsens with movement or activity 

Causes Tendinitis 

Tendinitis often results from repeated injury to an area such as the wrist or ankle which is common during sports or repetitive movements. Some of the tendinitis problems are named after the sports such as pitcher's shoulder, swimmer's shoulder, tennis elbow, golfer's elbow, and jumper's knee. The other causes are: 

• Bad posture or walking habits
• Arthritis and related conditions (for example, osteoarthritis, rheumatoid arthritis, and gout)
• Stress on soft tissues which results from a poorly positioned joint or bone
• Diabetes
• Side effects from certain medications 

Risk factors 

The most significant risk factor is playing certain sports that involve repetitive movements such as swimming, volleyball, and basketball. The other factors are: 

• Old age due to reduced flexibility of the joint.
• Certain occupations involve awkward positions, forceful exertion, repetitive movement, frequent overhead reaching, etc. 

Self-management 

Self-management means taking a proactive role in treatment. The best measure to prevent the recurrence of tendinitis is to avoid or modify the activities which are causing the problem. Performing certain exercises within the range of motion of the affected joint can help to improve flexibility and reduce the stiffness of the joint. 

Complications 

Possible complications that may result from untreated tendinitis are: 

• Long-term inflammation increases the risk of further injuries, such as tendon rupture.
• Recurrence of tendinitis symptoms. 

Tendinitis Diagnosis 

Initially, your doctor reviews sports history and medical history which includes information regarding previous joint injuries, etc. Your doctor will perform a physical examination to look for the presence of swelling, redness, tenderness, and muscle weakness and check for a range of motion in the affected area. Further, one or more of the following tests are performed to confirm the diagnosis: 

Tendinitis Treatments 

The treatment of tendinitis initially aims at reducing pain and swelling. Most types of tendinitis, such as tendinitis of the ankle, and tendinitis in the shoulder relieved without medications. The following options are available for tendinitis treatment. 

Rest and splints: The first choice of treatment includes resting the affected area and avoiding certain activities for a while. Splints, braces or slings may be used for this purpose. 

Hot and cold therapy: Pain that lasts for a long time (i.e. even after 48 hours) may be relieved by dry or moist heat (such as a warm bath). A cold compress can help to relieve pain in the initial hours and also prevent further swelling. 

Compression and elevation: The use of compression bandages and elevating the affected knee or leg above the level of the heart can help to minimize further swelling. 

Physical therapy: This involves soft tissue or joint mobilization through manual therapy; a personalized exercise program; the use of pressure-relieving devices; analysis of posture and walking; education and counselling regarding appropriate activities. 

Medications: To relieve pain and inflammation, over-the-counter (OTC) and prescription medicines such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are needed. If the symptoms are severe, corticosteroid injections which are powerful anti-inflammatory medications are injected directly into the affected joint. However, they are not used on a long-term basis due to side effects. 

Surgery: Severe tendinitis can lead to tendon rupture which needs surgical repair. In the case of chronic tendinitis, a procedure called FAST is performed. 

Focused Aspiration of Scar Tissue (FAST) – It is a minimally invasive procedure which uses ultrasound and some very small instruments to remove the affected tendon scar tissue. Most of the patients return to their normal activities within one or two months. 

Causes 

Overuse of the muscles damages the muscle tissue and develops a tear at the site where it anchors to the arm bone and elbow. It can happen when repeated stress is applied to the muscles. Repeated bending and straightening of the elbow can lead to a Golfer’s Elbow. Some of the cases where it occurs repeatedly are painting, raking, chopping wood, using a computer, doing assembly-line work, hammering, and cooking. Chronic Golfer’s Elbow can also occur due to the poor health of the soft tissues in the region. The injury can occur quickly leading to inflammation, pain, and swelling of the elbow. The golfer’s elbow can occur due to overdoing of some sports such as golf, racket sports, throwing sports, and weight lifting. 

Signs and Symptoms 

The symptoms of a Golfer’s Elbow include 

• Pain and tenderness inside the elbow
• Numbness
• Tingling sensation
• Weakness
• Stiffness 

The pain may worsen in conditions such as 

• Squeezing
• Pitch a ball
• Flexing wrist
• Shaking hands
• Lifting weights
• Turning a doorknob
• Swing a golf club or racket
• Pick up something from down with the palm 

If Golfer’s Elbow is left untreated, it could lead to complications such as 

• Severe elbow pain
• Limited range of motion
• A lasting bend in the elbow 

The symptoms of Tennis Elbow include the gradual onset of pain at the lateral epicondyle that radiates to the forearm. The pain worsens if you perform extension movements of the forearm. 

Risk factors 

The risk of developing a Golfer’s Elbow or Tennis Elbow increases with age (usually above 40), obesity, smoking and performing repeated elbow activities. 

Diagnosis 

It is usually diagnosed by a physical examination. It involves the application of pressure and moving the arm, wrist, and fingers in different ways. An X-ray will be helpful to rule out the exact cause of the pain. Sometimes MRI scan may also be suggested by the doctor. 

Treatment 

The treatment for tennis elbow is similar to that of treatment for Golfer’s Elbow. Depending on the severity of the pain and the diagnostic result, your doctor suggests some activities to relieve the pain and return to usual activities. They include: 

Rest: The doctor suggests to take rest until the pain is gone, repeated activity may worsen the pain. 

Pain relievers: The doctor suggests taking over-the-counter pain relievers to get some relief from the pain. Some of them include ibuprofen, naproxen sodium, and acetaminophen. 

Placing ice on the affected area: The application of ice packs on the affected area for 15 to 20 minutes and two to three times a day helps to alleviate pain. 

Braces: The use of braces can help to reduce strain on muscles and tendons. 

An elastic bandage or splint: The use of an elastic bandage or splint to wrap on the elbow can reduce the load on the elbow. 

Stretching and strengthening exercises: These exercises help in gradually reducing the pain. 

If the pain does not subside in 6 to 12 months, surgery can be suggested by your doctor to remove the scar tissue from the region (guided by ultrasound). It is not required as the pain usually subsides by following the measures suggested by your doctor. 

Tennis Elbow and Golfer’s Elbow are self-limiting conditions. Tennis Elbow cure is usually seen within one year. The recovery period is also similar to a Golfer’s Elbow. 

Prevention 

These conditions can be prevented by: 

• Lifting properly
• Resting periodically
• Strengthening the muscles
• Stretching before the activity
• Using the appropriate equipment 

Based on the severity of the strain, Hamstring injury can be graded as below: 

• Grade 1 which involves only a mild strain or pull
• Grade 2 involves a partial muscle tear
• Grade 3 involves a complete muscle tear 

Symptoms 

The symptoms of Hamstring injury depend on the severity of the strain on the muscles. 

Causes 

The Hamstring injury is caused due to the excessive and sudden stretching of the muscles. This is common with athletes who perform rapidly accelerating activities such as running or initiating running, etc. However, it can also occur during slower movements involving overstretching of the Hamstring muscles. 

They are common in people who play sports such as soccer, football, and track. 

Risk factors 

The below risk factors increase a person’s chance of having a Hamstring injury. 

• Muscle weakness within the Hamstring muscles
• Inadequate warm-up and poor stretching before strenuous exercises
• Recurrent injuries even before the injured muscle completely heals from the previous damage
• Muscle weakness between the Hamstrings and quadriceps
• Poor footwear 

Complications 

Recurrent injuries are quite common if a person with a Hamstring injury does not take adequate rest before resuming vigorous activities.  

Diagnosis 

A pulled Hamstring is diagnosed based on the medical history and physical examination. Circumstances of the injury give the type of injury while the grade of injury is obtained based on the physical examination. 

Medical history includes questions such as previous injuries, and Arthritis of the knee or back or hip, which can affect the range of motion and flexibility of the muscle. This increases the chances of another injury. 

Physical examination includes touching the muscles to check for tenderness and swelling. Based on the severity of the pain and the location, the extent of damage can be determined. Also, the range of motion of the affected leg is checked by moving the leg in different directions and positions. This gives an idea if the ligament or tendon has been damaged and the point of the muscle affected. 

Imaging studies are conducted in the case of a severe Hamstring injury, where muscle detachment can occur from the pelvis or the shinbone. X-rays are used to check for fractures while MRI Scan is used to visualize tears in the muscles and tendons. 

Management 

Recovery from a Hamstring injury may take a few days to weeks or even months, depending on the severity. In the case of a grade 3 injury, it will take several months during which playing sports is not allowed. 

Initial management of hamstring injury involves the following home care steps: 

• Rest: Do not move your leg to the extent possible and avoid doing any kind of physical activity. You may use crutches in severe cases.
• Ice: Apply ice wrapped in cloth for 15-20 minutes to the affected area. Repeat this every three to four hours every day. Do not apply direct ice to the skin.
• Compression: Apply a compression bandage to avoid further swelling. The bandage should not be too firm causing pain or too loose.
• Elevation: To decrease swelling, the affected leg should be elevated above the level of the heart. 

Medications 

To reduce inflammation and pain, medications such as ibuprofen or acetaminophen may be prescribed. Grade 1 and 2 Hamstring injuries heal without further treatment within a few weeks. However, if the symptoms persist, then you may have to undergo physical therapy. These exercises help to improve the strength and flexibility of the muscles. 

In the case of grade 3 Hamstring injury, if a bone fragment has occurred, reattachment is required. Muscle ultrasound and electrical stimulation therapy may be used to improve blood circulation and allow for the healing of the muscles. 

The most commonly affected muscles are: 

• Back of the lower leg or calf muscles
• Muscles in the front or the back of the thigh 

The other muscles which are commonly affected include those of the arms, feet, abdomen, along ribcage. 

Symptoms 

Cramps usually last for about a few seconds to 15 minutes or longer. Also, it can recur several times before it goes away completely. 

• Muscle cramps can lead to a slight pinching pain to an agonizing pain in the affected body part.
• The cramped muscles can appear visibly distorted and feel hard to touch.
• There can be a lump formation beneath the skin. 

Causes 

Muscle cramps are common in overused or injured muscles. 

• If you strain your muscle during a dehydrated state or when your mineral levels (calcium, potassium, sodium and magnesium) are low, then it can lead to cramps in those muscles.
• Decreased blood supply to the legs and feet can cause cramping in these areas while performing activities.
• Nerve compression in your spine can also lead to cramps in your legs. 

Playing games such as tennis, bowling, swimming, golf, etc. can also cause cramps. 

Risk factors 

Everyone will experience muscle cramps at some time in life. However, the below factors can increase one’s chances of getting muscle cramps: 

• Age: Infants young children, and people above 65 years of age are more prone to cramps
• Athletes: Overexertion during work and exercise causes cramps usually after 4-6 hours of straining.
• Medical conditions: Overweight, Kidney Failure, Hypothyroidism
• Certain medications
• Pregnancy
• Menstruation 

Diagnosis 

Mild muscle cramps do not require a doctor’s attention, but severe cramps need medical help. Your doctor will perform a physical examination and will ask you certain related questions to know the cause of the cramps. 

Treatment 

Usually, cramps go away on their own without a doctor’s consultation. But, if your cramps do not go with simple stretching exercises, then your doctor may initially suggest you take over-the-counter medications such as ibuprofen to relieve pain. It helps to stretch the sore muscles slowly. 

• If you have low levels of calcium and potassium, then you may be prescribed these supplements.
• If your sleep is disturbed due to recurrent cramps, then you will be prescribed medicines to relax your muscles. 

Self-management 

You may take the below steps to overcome the problem: 

• Stop doing the activities which trigger the cramps.
• Gently massage and stretch the affected muscle. You may hold the muscle in the stretched position till the cramp stops.
• If you have tense or tight muscles, you may apply heat. Applying ice is helpful for sore or tender muscles.
• Drink plenty of fluids while exercising. Take fluids such as orange juice and bananas which are rich in potassium.