Dr MB Nitheesh CONSULTANT ORTHOPAEDIC, ARTHROSCOPIC & JOINT REPLACEMENT SURGEON
A herniated disk is a condition that can occur anywhere along the spine, but most often occurs in the lower back. It is sometimes called a bulging, protruding, or ruptured disk. It is one of the most common causes of lower back pain, as well as leg pain, or sciatica.
Between 60 and 80% of people will experience low back pain at some point their lives. Some of these people will have low back pain and leg pain caused by a herniated disk. Although a herniated disk can be very painful, the majority of people feel much better with just a few weeks or months of nonsurgical treatment.
Your spine is made up of 24 bones, called vertebrae, that are stacked on top of one another. These bones connect to create a canal that protects the spinal cord.
Five vertebrae make up the lower back. This area is called your lumbar spine.
Other parts of your spine include:
Spinal cord and nerves. These electrical cables travel through the spinal canal carrying messages between your brain and muscles. Nerve roots branch out from the spinal cord through openings in the vertebrae called foramen.
Intervertebral disks. In between your vertebrae are flexible intervertebral disks. These disks are flat and round, and about a half inch thick.
Intervertebral disks act as shock absorbers when you walk or run. They are made up of two components:
If the pressure continues, the jelly-like nucleus may push all the way through disk’s outer ring or cause the ring to bulge. This puts pressure on the spinal cord and nearby nerve roots. Not only is this a mechanical compression of the nerves, but the disk material also releases chemical irritants that contribute to nerve inflammation. When a nerve root is irritated, there may be pain, numbness, and weakness in one or both of your legs, a condition called sciatica.
Osteoporosis is a condition in which the bones become thinner, weaker, and more likely to break.
According to the National Center for Health Statistics (part of the Centers for Disease Control and Prevention), the prevalence of osteoporosis and low bone mass in adults 50 and older was 55.7%*. That means more than half of all adults 50 and older are either living with or have an increased risk of developing osteoporosis.
People with osteoporosis are more vulnerable to fractures (broken bones) than those without this disorder
Your bone changes over time, just like the other tissues in your body. In fact, your body naturally removes old, damaged bone and replaces it with new bone every 7 to 10 years after you become an adult. This process is called bone remodeling.
The levels of certain sex hormones — estrogen in both sexes and testosterone in men — are involved in the process of building and remodeling bones:
Your risk increases if you have:
Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities besides sports can also put you at risk.
Tennis elbow is inflammation or, in some cases, microtearing of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.
There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists and, in some cases, surgeons work together to provide the most effective care.
Your elbow joint is a joint made up of three bones: the upper arm bone (humerus) and the two bones in the forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles, where several muscles of the forearm begin their course. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle. Muscles, ligaments, and tendons hold the elbow joint together.
Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm that are responsible for the extension of your wrist and fingers. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone. The tendon usually involved in tennis elbow is called the extensor carpi radialis brevis (ECRB).
Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The ECRB muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.
The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.
Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle or repetitive extension of the wrist and hand.
Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that auto workers, cooks, and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.
Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the risk factors. In racquet sports like tennis, improper stroke technique and improper equipment may be risk factors.
Lateral epicondylitis can occur without any recognized repetitive injury. This occurence is called idiopathic, or of an unknown cause.
The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms.
Common signs and symptoms of tennis elbow include:
The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however, both arms can be affected.
Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. Over time, the shoulder becomes very hard to move.
After a period of worsening symptoms, frozen shoulder tends to get better, although full recovery may take up to 3 years. Physical therapy, with a focus on shoulder flexibility, is the primary treatment recommendation for frozen shoulder.
Frozen shoulder most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. In addition, people with diabetes are at risk.
Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
The head of the upper arm bone fits into a shallow socket in your shoulder blade. Strong connective tissue, called the shoulder capsule, surrounds the joint.
To help your shoulder move more easily, synovial fluid lubricates the shoulder capsule and the joint.
In frozen shoulder, the shoulder capsule thickens and becomes stiff and tight. Thick bands of tissue — called adhesions — develop. In many cases, there is less synovial fluid in the joint.
The hallmark signs of this condition are severe pain and being unable to move your shoulder -- either on your own or with the help of someone else. It develops in three stages:
In the "freezing" stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.
Painful symptoms may actually improve during this stage, but the stiffness remains. During the 4 to 6 months of the "frozen" stage, daily activities may be very difficult.
Shoulder motion slowly improves during the "thawing" stage. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.
The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder. Diabetes. Frozen shoulder occurs much more often in people with diabetes. The reason for this is not known. In addition, diabetic patients with frozen shoulder tend to have a greater degree of stiffness that continues for a longer time before "thawing."
Other diseases. Some additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson's disease, and cardiac disease. Immobilization. Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.
Pain from frozen shoulder is usually dull or aching. It is typically worse early in the course of the disease and when you move your arm. The pain is usually located over the outer shoulder area and sometimes the upper arm.
Plantar fasciitis (fashee-EYE-tiss) is the most common cause of pain on the bottom of the heel. Approximately 2 million patients are treated for this condition every year.
Plantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed.
The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front of your foot, and supports the arch of your foot.
The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body's natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.
In most cases, plantar fasciitis develops without a specific, identifiable reason. There are, however, many factors that can make you more prone to the condition:
Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.
The most common symptoms of plantar fasciitis include:
Trigger finger is a condition that causes pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger. The condition is also known as “stenosing tenosynovitis.” The ring finger and thumb are most often affected by trigger finger, but it can occur in the other fingers, as well. When the thumb is involved, the condition is called “trigger thumb.”
The flexor tendons are long cord-like structures that attach the muscles of the forearm to the bones of the fingers. When the muscles contract, the flexor tendons allow the fingers to bend. Each of the flexor tendons passes through a tunnel in the palm and fingers that allows it to glide smoothly as the finger bends and straightens. This tunnel is called the “tendon sheath.” Along the tendon sheath, bands of tissue called “pulleys” hold the flexor tendons closely to the finger bones. The tendons pass through the pulleys as the finger moves. The pulley at the base of the finger is called the “A1 pulley.” This is the pulley that is most often affected.
In a patient with trigger finger, the A1 pulley becomes inflamed or thickened, making it harder for the flexor tendon to glide through it as the finger bends. Over time, the flexor tendon may also become inflamed and develop a small nodule on its surface. When the finger flexes and the nodule passes through the pulley, there is a sensation of catching or popping. This is often painful. In a severe case of trigger finger, the finger locks and becomes stuck in a bent position. Sometimes the patient must use his or her other hand to straighten the finger.
While the causes of trigger finger are not well known, several factors may increase your risk for developing the condition. These include:
Symptoms of trigger finger often start without a single injury. They may follow a period of heavy or extensive hand use, particularly pinching and grasping activities.
This patient's trigger finger is locked in a bent position.
Symptoms may include:
Stiffness and locking tend to be worse after periods of inactivity, such as when you wake up in the morning.
In a severe case, the involved finger may become locked in a bent position.
Recent advances in technology have changed our lives dramatically, in many ways for the better. Increasingly, people are using their electronic mobile devices to stay connected to the digital world. However, overuse of handheld devices can lead to unintended problems involving the hand, wrist, and arm.
High demands are placed on the thumbs and wrists when people use their smartphones excessively. Repetitive typing and swiping can lead to irritation and swelling of the thumb flexor tendon. Over time, some people can develop painful popping or locking of the thumb, a condition called “trigger thumb.” Holding a smartphone with the wrist in an awkward position for a prolonged period of time can irritate the wrist and forearm tendons and may contribute to a painful condition known as “DeQuervain’s tendinosis.” This type of wrist tendinitis is typically seen in young mothers whose hands are in high demand while caring for their newborns.
Additionally, excessive smartphone use can also cause problems other than tendinitis. People with pre-existing arthritis may experience an increase in pain and swelling when the thumb basilar joint is overworked, such as with frequent texting. Furthermore, soreness in the arm, shoulder, or neck may arise from using a mobile device improperly. Looking down at a smartphone for hours a day with poor posture can strain the muscles of the shoulders and neck.
The primary treatment for these problems involves commonsense changes in behavior. Many people routinely type hundreds of text messages per day—an activity which is probably not what our hands were designed to do. Texting less frequently, improving upper body posture, and modifying the way the handheld device is used can help. If symptoms do not improve with rest, treatments such as splints, medications, hand therapy, and cortisone injections are available. It is okay to use smartphones, but it is important to recognize the potential for overuse problems.
Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.
In most patients, carpal tunnel syndrome gets worse over time, so early diagnosis and treatment are important. Early on, symptoms can often be relieved with simple measures like wearing a wrist splint or avoiding certain activities.
If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients.
The carpal tunnel is a narrow passageway in the wrist, about an inch wide. The floor and sides of the tunnel are formed by small wrist bones called carpal bones.
The roof of the tunnel is a strong band of connective tissue called the transverse carpal ligament. Because these boundaries are very rigid, the carpal tunnel has little capacity to "stretch" or increase in size.
The median nerve is one of the main nerves in the hand. It originates as a group of nerve roots in the neck. These roots come together to form a single nerve in the arm. The median nerve goes down the arm and forearm, passes through the carpal tunnel at the wrist, and goes into the hand. The nerve provides feeling in the thumb and index, middle, and ring fingers. The nerve also controls the muscles around the base of the thumb.
The nine tendons that bend the fingers and thumb also travel through the carpal tunnel. These tendons are called flexor tendons.
Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when tissues surrounding the flexor tendons swell, putting pressure on the median nerve. These tissues are called the synovium.Normally, the synovium lubricates the tendons, making it easier to move your fingers.
When the synovium swells, it takes up space in the carpal tunnel and, over time, crowds the nerve. This abnormal pressure on the nerve can result in pain, numbness, tingling, and weakness in the hand.
Most cases of carpal tunnel syndrome are caused by a combination of factors. Studies show that women and older people are more likely to develop the condition.
Other risk factors for carpal tunnel syndrome include:
In most cases, the symptoms of carpal tunnel syndrome begin gradually—without a specific injury. Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.
Night-time symptoms are very common. Because many people sleep with their wrists bent, symptoms may awaken you from sleep. During the day, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book.
Many patients find that moving or shaking their hands helps relieve their symptoms.