OSTEOPOROSIS

OSTEOPOROSIS INFORMATION

 

Osteoporosis is the thinning of bone tissue and loss of bone density over time

General information about Osteoporosis

Osteoporosis is a condition characterized by progressive loss of bone density, thinning of bone tissue

and increased vulnerability to fractures. Osteoporosis may result from disease, dietary or hormonal deficiency or advanced age. Regular exercise and vitamin and mineral supplements can reduce and even reverse loss of bone density.

Osteoporosis is a serious public health problem. Some 28 million people in the United States are affected by this potentially debilitating disease, which is responsible for 1.5 million fractures (broken bones) annually. These fractures, which are often the first sign of the disease, can affect any bone, but the most common locations are the hip, spine, and wrist. Breaks in the hip and spine are of special concern because they almost always require hospitalization and major surgery, and may lead to other serious consequences, including permanent disability and even death.

Information on how Osteoporosis developes

 

To understand osteoporosis, it is helpful to understand the basics of bone formation. Bone is living tissue that's constantly being renewed in a two-stage process (resorption and formation) that occurs throughout life. In the resorption stage, old bone is broken down and removed by cells called osteoclasts. In the formation stage, cells called osteoblasts build new bone to replace the old. During childhood and early adulthood, more bone is produced than removed, reaching its maximum mass and strength by the mid-30s. After that, bone is lost at a faster pace than it's formed, so the amount of bone in the skeleton begins to slowly decline. Most cases of osteoporosis occur as an acceleration of this normal aging process. That's referred to as primary osteoporosis. The condition can also be caused by other disease processes or prolonged use of certain medications that result in bone loss--if so, it's

called secondary osteoporosis.

Information on how Osteoporosis occurs

 

Osteoporosis occurs most often in older people and in women after menopause. It affects nearly half of all those, men and women, over the age of 75. Women, however, are five times more likely than men to develop the disease. They have smaller, thinner bones than men to begin with, and they lose bone mass more rapidly after menopause (usually around age 50), when they stop producing a bone-protecting hormone called estrogen. In the five to seven years following menopause, women can lose about 20% of their bone mass. By age 65 or 70, though, men and women lose bone mass at the same rate. As an increasing number of men reach an older age, there's more awareness that osteoporosis is an important health issue for them as well.

 

 

Researchers estimate that about 20% of American women over the age of 50 have osteoporosis. In addition, another 30% of them have osteopenia, which is abnormally low bone density that may eventually deteriorate into osteoporosis, if not treated.

 

About half of all women over the age of 50 will suffer a fracture of the hip, wrist, or vertebra.

 

Women who are white, especially those with a family history of osteoporosis, have a greater risk of developing osteoporosis. Other risk factors include smoking, eating disorders, low body weight, low amount of calcium in the diet, heavy alcohol consumption, early menopause, absence of menstrual periods (amenorrhea), and use of certain medications, such as steroids and anticonvulsants

 

OSTEOPOROSIS SYMPTOMS

There are no symptoms in the early stages of the Osteoporosis.

Symptoms occurring late in Osteoporosis include:

Fractures of the vertebrae, wrists, or hips (usually the first indication)

Low back pain Neck pain Bone pain or tenderness Loss of height over time Stooped posture

 

OSTEOPOROSIS TREATMENT

Treatments for osteoporosis focus on slowing down or stopping bone loss, preventing bone fractures by minimizing the risk of falls, and controlling pain associated with the disease.

 

There are several different kinds of drugs used to treat osteoporosis. They vary in their side effects, benefits, and costs.

Bisphosphonates in Osteoporosis Treatment

 

Bisphosphonates are a type of drug used for both the prevention and treatment of osteoporosis in postmenopausal women. The two bisphosphonates currently approved for osteoporosis -- alendronate (Fosamax) and risedronate (Actonel) -- prevent existing bone loss and reduce the risk of spinal and hip fractures.

 

While side effects are generally mild, potential side effects include stomach upset and irritation of the esophagus. Because bisphosphonates are difficult to absorb, these medicines should be taken on an empty stomach. The patient should not lie down or consume food or beverages (other than water) for at least 30 minutes after taking the medicine. The physician may also recommend taking calcium and Vitamin D supplements.

 

Actonel is approved for use in men with osteoporosis. Both Actonel and Fosamax prevent and treat osteoporosis in men and women taking daily steroids for chronic conditions like asthma and arthritis.

Raloxifenein Osteoporosis Treatment

 

Raloxifene (Evista) is another drug used for the prevention and treatment of osteoporosis. Raloxifene is similar to the breast cancer drug tamoxifen. Raloxifene can reduce the risk of spinal fractures by almost 50%. (It does not appear to prevent other fractures, including those in the hip.) It may have protective effects against heart disease and breast cancer, though more studies are required.

 

The most serious side effect of raloxifene is a very small risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs (pulmonary embolus).

Harmone replacement therapy in Osteoporosis Treatment

 

A woman's body produces less estrogen during and after menopause, which may affect her bone strength. Based on early studies, many physicians used to believe that HRT might be beneficial for reducing the risk of heart disease and bone fractures caused by osteoporosis in addition to treating menopausal symptoms. The results of a new study, called the Women's Health Initiative (WHI), has led physicians to revise their recommendations regarding HRT.

 

The WHI, started in 1993, enrolled 161,809 women between the ages of 50-79 in 40 different medical centers. Part of the study was intended to examine the health benefits and the risks of hormone replacement therapy, including the risks of breast cancer, heart attacks, strokes, and blood clots.

 

In July 2002, one component of the WHI, which studied the use of estrogen and progestin in women who had a uterus, was stopped early because the health risks exceeded the health benefits. The use of estrogen-only therapy in women who no longer have a uterus still continues.

 

The WHI study showed that women taking HRT had 34% fewer hip fractures and 24% fewer fractures than women not receiving hormones. However, the main reason for stopping the estrogen-progestin study was because of a 26% increase in breast cancer in women taking HRT, as well as increases in heart attacks, strokes, and thromboembolic events (blood clots).

 

Women who are considering taking HRT to prevent osteoporosis should discuss with their physician their individual risk of coronary heart disease, stroke, blood clots, and breast cancer.

Calcitonin in in Osteoporosis Treatment

 

Calcitonin, marketed under the names Miacalcin (nasal spray) and Calcimar (injectable), is a medication that slows the rate of bone loss and relieves bone pain. The main side effects of calcitonin

are nasal irritation from the spray form, and nausea from the injectable form.

 

While calcitonin slows bone loss and reduces the risk of fractures, it appears to be less effective than ERT or biphosphonates. As with some of the other newer medications, it is significantly more expensive than ERT.

Exercise in Osteoporosis Treatment

 

Regular exercise can reduce the likelihood of bone fractures associated with osteoporosis. Studies show that exercises requiring muscles to pull on bones cause the bones to retain and, perhaps, even gain density. Researchers found that women who walk a mile a day have four to seven more years of bone in reserve than women who don't. Some of the recommended exercises include:

Weight-bearing exercises -- walking, jogging, playing tennis, dancing

Resistance exercises -- free weights, weight machines, rubber stretch bands

Balancing exercises -- tai chi, yoga

Riding stationary bicycles

Using rowing machines

Walking

Jogging

 

Any exercise that presents a risk of falling should be avoided!

Diet in Osteoporosis Treatment

 

A diet that includes an adequate amount of calcium, Vitamin D, and protein should be maintained. While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses for bone formation and maintenance is available.

 

Supplemental calcium should be taken as needed to achieve recommended daily calcium dietary intake. Current recommendations are for nonpregnant, menstruating women to consume 1000mg/day, pregnant women need 1200mg/day, and postmenopausal or nursing mothers should consume 1500 mg/day.

 

High-calcium foods include low-fat milk, yogurt, ice cream and cheese, tofu, salmon and sardines (with the bones), and leafy green vegetables, such as spinach and collard greens. Vitamin D aids in calcium absorption and 400-800 IU per day should be taken by all individuals with increased risk of calcium deficiency and osteoporosis.

 

Quit smoking, if you smoke. Also limit alcohol intake. Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone.

Monitoring your Osteoporosis Treatment

 

Your response to treatment can be monitored with serial bone mineral density measurements every 1-2 years, though such monitoring is controversial and expensive. In the future, less elaborate measurements of bone turnover may become a standard means for following osteoporosis.

 

Women taking estrogen should have routine mammograms, pelvic exams, and Pap smears.

Surgeries used in Osteoporosis Treatment

 

There are no surgeries specifically for treating osteoporosis itself. However, a procedure called vertebroplasty can be used to treat any small fractures in your spinal column due to osteoporosis. It can also help prevent weak vertebra from becoming fractured by strengthening the bones in your spinal column. The procedure involves injecting a fast-hardening glue into the regions that are fractured or weak. A similar procedure, called kyphoplasty, uses balloons to widen the spaces that need the glue. (The balloons are removed during the procedure.)

 

 

 

 

OSTEOPOROSIS PREVENTION

 

Building strong bones, especially before the age of 35, and maintaining a healthy lifestyle are the best ways of preventing osteoporosis. To build as much bone mass as early as possible in life, and to help slow the rate of bone loss later in life:

Diet in Osteoporosis Prevention

 

Experts recommend 1,500 milligrams (mg) of calcium per day for adolescents, pregnant or breast-feeding women, older adults (over 65), and postmenopausal women not using hormone replacement therapy. All others should get 1,000 mg per day. Foods are the best source for this important mineral. Milk, cheese, and yogurt have the highest amounts. Other foods that are high in calcium are green leafy vegetables, tofu, shellfish, Brazil nuts, sardines, and almonds.

Calcium supplements in Osteoporosis Prevention

 

Many people, especially those who don't like or can't eat dairy foods, don't get enough calcium in their diets and may need to take a calcium supplement. Supplements vary in the amount of calcium they contain. Those with calcium carbonate have the most amount of useful calcium. Supplements should be taken with meals and accompanied by six to eight glasses of water a day.

Vitamin D in Osteoporosis Prevention

 

Vitamin D helps the body absorb calcium. People can get vitamin D from sunshine with a quick (15-20 minute) walk each day or from foods such as liver, fish oil, and vitamin-D fortified milk. During the winter months it may be necessary to take supplements. Four hundred mg. daily is usually the recommended amount.

Avoid smoking and alcohol to help prevent Osteoporosis

 

Smoking reduces bone mass, as does heavy drinking. To reduce risk, do not smok and limit alcoholic drinks to no more than two per day. An alcoholic drink is one-and-a-half ounces of hard liquor, 12 ounces of beer, or five ounces of wine.

The role of exercise in Osteoporosis Prevention

 

Exercising regularly builds and strengthens bones. Weight-bearing exercises--where bones and muscles work against gravity--are best. These include aerobics, dancing, jogging, stair climbing, tennis, walking, and lifting weights. People who have osteoporosis may want to attempt gentle exercise, such as walking, rather than jogging or fast-paced aerobics, which increase the chance of falling. Try to exercise three to four times per week for 20-30 minutes each time.

 

 

 

 

OSTEOPOROSIS CAUSES

Osteoporosis is the most common type of bone disease. There are currently an estimated 10 million Americans suffering from osteoporosis, as well as another 18 million who have low bone mass, or osteopenia.

Osteoporosis Causes - description of Osteoporosis Causes

Osteoporosis occurs when the body fails to form enough new bone, or when too much old bone is reabsorbed by the body, or both.

Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, the body uses these minerals to produce bones. If calcium intake is not sufficient, or if the body does not absorb enough calcium from the diet, bone production and bone tissues may suffer.

As people age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes the bone tissue weaker. Both situations can result in brittle, fragile bones that are subject to fractures, even in the absence of trauma.

Usually, the loss occurs gradually over years. Many times, a person will sustain a fracture before becoming aware that the disease is present. By the time this occurs, the disease is in its advanced stages and the damage is profound.

The leading causes are a drop in estrogen in women at the time of menopause, and a drop in testosterone in men. Women, especially those over the age of 50, get osteoporosis more often than men.

Leading causes of Osteoporosis

 

Other causes include corticosteroid excess from Cushing's syndrome, hyperthyroidism, hyperparathyroidism, being confined to a bed, and bone cancers.

Researchers estimate that about 20% of American women over the age of 50 have osteoporosis. In addition, another 30% of them have osteopenia, which is abnormally low bone density that may eventually deteriorate into osteoporosis, if not treated.

 

About half of all women over the age of 50 will suffer a fracture of the hip, wrist, or vertebra.

Women who are white, especially those with a family history of osteoporosis, have a greater risk of developing osteoporosis. Other risk factors include smoking, eating disorders, low body weight, low amount of calcium in the diet, heavy alcohol consumption, early menopause, absence of menstrual

periods (amenorrhea), and use of certain medications, such as steroids and anticonvulsants

Risk factors that can cause Osteoporosis

Age. Osteoporosis is more likely as people grow older and their bones lose tissue.

Gender. Women are more likely to have osteoporosis because they are smaller and so start out with less bone. They also lose bone tissue more rapidly as they age. While women commonly lose 30-50% of their bone mass over their lifetimes, men lose only 20-33% of theirs.

Race. Caucasian and Asian women are most at risk for the disease, but African American and Hispanic women can get it too.

Figure type. Women with small bones and those who are thin are more liable to have osteoporosis.

Early menopause. Women who stop menstruating early because of heredity, surgery or lots of physical exercise may lose large amounts of bone tissue early in life. Conditions such as anorexia and bulimia may also lead to early menopause and osteoporosis.

Lifestyle. People who smoke or drink too much, or don't get enough exercise have an increased chance of getting osteoporosis.

Diet. Those who don't get enough calcium or protein may be more likely to have osteoporosis. That's why people who constantly diet are more prone to the disease.

Osteoporosis is a major cause of bone fractures and breaks

 

Osteoporosis is often called the "silent" disease, because bone loss occurs without symptoms. People often don't know they have the disease until a bone breaks, frequently in a minor fall that wouldn't normally cause a fracture. A common occurrence is compression fractures of the spine. These can happen even after a seemingly normal activity, such as bending or twisting to pick up a light object. The fractures can cause severe back pain, but sometimes they go unnoticed--either way, the vertebrae collapse down on themselves, and the person actually loses height. The hunchback appearance of many elderly women, sometimes called "dowager's" hump or "widow's" hump, is due to this effect of osteoporosis on the vertebrae

 

 

OSTEOPOROSIS DIAGNOSIS

Certain types of doctors may have more training and experience than others in diagnosing and treating people with osteoporosis. These include a geriatrician, who specializes in treating the aged; an endocrinologist, who specializes in treating diseases of the body's endocrine system (glands and hormones); and an orthopedic surgeon, who treats fractures, such as those caused by osteoporosis.

Test used in Osteoporosis Diagnosis

Bone mineral density (BMD) testing -- as performed in dual-energy x-ray absorptiometry (DEXA) -- measures the demineralization of the bones. This has become the gold standard for evaluation for osteoporosis. BMD testing should be performed on all postmenopausal women with fractures, all women under 65 with an additional risk factor for osteoporosis (besides menopause), and all women 65 and over.

A spine CT can show demineralization. Quantitative computed tomography (QCT) can evaluate bone density, but is less available and is more expensive than DEXA.

A spine or hip x-ray may show fracture or vertebral collapse in severe cases.

Measuring the amount of calcium in your urine can provide some evidence of increased bone turnover, but is of limited value. A number of newer tests to evaluate bone turnover are becoming available, including measurement of urinary N-telopeptide (Osteomark). In the future, these may enhance your physician's ability to diagnose early osteoporosis.

More detailed information about Osteoporosis Diagnosis

 

Before making a diagnosis of osteoporosis, the doctor usually takes a complete medical history, conducts a physical exam, and orders x rays, as well as blood and urine tests, to rule out other diseases that cause loss of bone mass. The doctor may also recommend a bone density test. This is the only way to know for certain if osteoporosis is present. It can also show how far the disease has progressed.

 

Several diagnostic tools are available to measure the density of a bone. The ordinary x ray is one, though it's the least accurate for early detection of osteoporosis, because it doesn't reveal bone loss until the disease is advanced and most of the damage has already been done. Two other tools that are more likely to catch osteoporosis at an early stage are computed tomography scans (CT scans) and machines called densitometers, which are designed specifically to measure bone density.

 

The CT scan, which takes a large number of x rays of the same spot from different angles, is an accurate test, but uses higher levels of radiation than other methods. The most accurate and advanced of the densitometers uses a technique called DEXA (dual energy x-ray absorptiometry). With the DEXA scan, a double x-ray beam takes pictures of the spine, hip, or entire body. It takes about 20 minutes to do, is painless, and exposes the patient to only a small amount of radiation--about one-fiftieth that of a chest x ray.

 

Doctors don't routinely recommend the test, partly because access to densitometers is still not widely available. People should talk to their doctors about their risk factors for osteoporosis and if, and when, they should get the test. Ideally, women should have bone density measured at menopause, and periodically afterward, depending on the condition of their bones. Men should be tested around age 65. Men and women with additional risk factors, such as those who take certain medications, may need to be tested earlier.

THORACIC OUTLET SYNDROME, STILL'S DISEASE, SPINAL STENOSIS, SHOULDER ARTHRITIS,SHOULDER IMPINGEMENT,SCOLIOSIS

 

THORACIC OUTLET SYNDROME

 

Thoracic outlet syndrome is a condition characterized by pain in the neck and shoulder, numbness/tingling of the fingers, and weakening of the grip.

Causes of Thoracic Outlet Syndrome

 

Thoracic outlet syndrome is a rare condition caused by compression of blood vessels and nerves in the area of the clavicle (collar bone). This compression is caused by the presence of an extra cervical rib (above the first rib) or an abnormal tight fibrous band connecting the spinal vertebra to the rib.

 

People with long necks and droopy shoulders may be predisposed to develop this condition because of extra pressure on their nerves and blood vessels

Information about Thoracic Outlet Syndrome

 

The thoracic outlet is an area at the top of the rib cage, between the neck and the chest. Several anatomical structures pass through this area, including the esophagus, trachea, and nerves and blood vessels that lead to the arm and neck region. The area contains the first rib, collar bone (clavicle), the arteries beneath the collar bone (subclavian artery), which supply blood to the arms, a network of nerves leading to the arms (brachial plexus), and the top of the lungs.

 

Pain and other symptoms occur when the nerves or blood vessels in this area are compressed. The likelihood of blood vessels or nerves in the thoracic outlet being compressed increases with increased size of body tissues in this area or with decreased size of the thoracic outlet. The pain of thoracic outlet syndrome is sometimes confused with the pain of angina that indicates heart problems. The two conditions can be distinguished from each other because the pain of thoracic outlet syndrome does not appear or increase when walking, while the pain of angina does. Also, the pain of thoracic outlet syndrome usually increases if the affected arm is raised, which does not happen in cases of angina.

 

There are three types of thoracic outlet syndrome:

True neurogenic thoracic outlet syndrome is caused by a compression of the nerves in the brachial plexus. Abnormal muscle or other tissue causes the problem.

Arterial thoracic outlet syndrome is caused by compression of the major artery leading to the arm, usually by a rib.

Disputed thoracic outlet syndrome describes patients who have chronic pain in the shoulders and arms and have no other disease or syndrome, but the underlying cause cannot be accurately determined.

 

Thoracic outlet syndrome is most common in women who are 35-55 years of age.

Symptoms of Thoracic Outlet Syndrome

Discomfort in the last 3 fingers and inner forearm

Numbness

Pain

Tingling

Pain and tingling in the neck and shoulders (may be worsened by carrying something heavy, such as a suitcase)

Weakness and wasting of the muscles of the hand

 

Compression of blood vessels or nerves in the thoracic outlet causes pain and/or abnormal nerve sensations. Compression usually occurs at the location where the blood vessels and nerves pass out of the thoracic outlet into the arm.

 

There are several factors that contribute to a person developing thoracic outlet syndrome. Poor posture is a major cause and is easy to treat. A person's physical makeup also can cause thoracic outlet syndrome. For example, abnormalities of certain anatomical structures can put pressure on blood vessels or nerves. Typical abnormalities that can cause problems are malformed ribs and too narrow an opening between the collar bone and the first rib.

 

The main symptom is pain in the affected area. The patient can also develop weakness in the arm and hands, tingling nerve sensations, and a condition called Raynaud's syndrome. In Raynaud's syndrome exposure to cold causes small arteries in the fingers to contract, cutting off blood flow. This causes the fingers to turn pale. In very severe cases of blood vessel compression, gangrene can result. Gangrene is the death of tissue caused by the blood supply being completely cut off.

 

In the case of arterial thoracic outlet syndrome, the artery beneath the collar bone leading to the arm is compressed causing the artery to increase in size. Blood clots (thrombi) may form in the blood vessel. When blood vessels are compressed, the hands, arms, and shoulders do not receive proper blood supply. They can swell and turn blue from a lack of blood.

 

In the case of true neurogenic thoracic outlet syndrome, the nerves most affected are those of the network of nerves supplying the chest, shoulder, arm, forearm, and hand (brachial plexus). When a nerve is affected in thoracic outlet syndrome it produces a tingling sensation (paresthesia). It can also cause weakness in the hand and reduced sensation in the palm and fingers.

Diagnosis of Thoracic Outlet Syndrome

 

There are no specific diagnostic tests for thoracic outlet syndromes. The diagnosis is made by ruling out other diseases and by observing the patient. Two non-specific tests that can suggest the presence of thoracic outlet syndrome are the Adson's test and the Allen test. In the Adson test, the patient takes a deep breath and tilts his or her head back and turns it to one side. The physician tests to see if the strength of the patient's pulse is reduced in the wrist on the arm on the opposite side of the head turn. In the Allen test, the arm in which the patient is experiencing symptoms is raised and rotated while the head is turned to the opposite side. The physician tests to see if the pulse strength at the wrist is reduced. If the strength of the pulse is reduced in either of these two tests it indicates compression of the subclavian artery.

 

Occasionally, examination with a stethoscope may reveal abnormal sounds in affected blood vessels. X rays can reveal constrictions in blood vessels if a special dye is injected into the blood stream to make the blood vessels visible (angiography).

 

Certain tests are available to help with the diagnosis of nerve compression. These include the nerve conduction velocity test and somatosensory evoked potential test. In the nerve conduction velocity test, electrodes are placed at various locations on the skin along a nerve that is being tested. A mild electrical impulse is delivered through an electrode at one end of the nerve and the electrical activity is recorded by the other electrodes. The time it takes for the electrical impulse to travel down the nerve from the stimulating electrodes to the recording electrodes is used to calculate the nerve conduction velocity. This can be used to determine if any nerve damage exists.

 

In a somatosensory evoked potential test, electrodes are placed on the skin at the scalp, neck, shoulder, and wrist. A mild electrical impulse is delivered at the wrist, and a recording is made of the response by the brain and spinal cord. This test also can determine the presence of nerve damage.

Treatment of Thoracic Outlet Syndrome

 

The main treatment for thoracic outlet syndrome is physical therapy. Exercises aimed at improving the posture of the affected person are also useful. In some cases, surgery can be performed to remove the cervical rib if this is causing the problem and physical therapy has failed to work. However, surgery is generally not used to treat thoracic outlet syndrome.

 

 

 

 

STILL'S DISEASE

 

Still's disease is a disorder featuring inflammation that is characterized by high spiking fevers, evanescent (transient) salmon-colored rash and/or arthritis. Still's disease was first described in children, but it is now known to occur, much less commonly, in adults (in whom it is referred to as adult-onset Still's disease).

Causes of Still's disease

 

The cause of Adult Still's disease is unknown. The condition rarely occurs in adults. It is more common in children, where it is called Systemic Juvenile Rheumatoid Arthritis. No risk factors for the disease have been identified.

Symptoms of Still's disease

 

Almost all patients will have fever, joint pain, sore throat, and a rash. The fever usually comes on quickly once per day, most commonly in the afternoon or evening. The rash is typically salmon pink colored and comes and goes with the fever.

 

Another common symptom is joint pain and inflammation (warmth and swelling of the joint). Usually, several joints are involved at the same time.

 

Additional symptoms include swollen lymph nodes (glands), pain with a deep breath (pleurisy), abdominal pain and swelling, and weight loss.

 

Diagnosis of Still's disease

 

The physical exam may show the fever, rash, and arthritis. Other signs include enlargement of the lymph nodes, liver, or spleen. Also, the presence of changes in the sound of the heart or lungs may indicate pericarditis or pleurisy.

 

Blood tests that can be helpful in diagnosing Adult Still's Disease include:

Elevation in the ESR (sedimentation rate)

Elevation in the White Blood Cell count

Elevation in liver function tests

Decrease in the Red Blood Cell count

Very high elevation in the Ferritin level

Negative rheumatoid factor and ANA test

 

Other tests may include:

joint X-rays

chest X-ray that may show pericarditis or pleural effusion

abdominal X-ray, CT scan or ultrasound for liver and spleen enlargement

 

Adult Still's Disease can only be diagnosed after other diseases are excluded. It may require many medical tests before a final diagnosis is made.

 

Treatment of Still's disease

 

The symptoms of arthritis are generally controlled with adequate doses of salicylates (aspirin) or nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen. Prednisone may be used for more severe cases. In the disease becomes chronic immunosuppressive medications might be needed. These may include methotrexate or new biologic therapies.

 

Expectations (prognosis)

 

Studies show that about 20% of patients have all of the symptoms go away in a year and never come back. About 30% of patients have all of the symptoms go away, but they come back several times over the next years. The rest of the patients (about 50%) will develop a chronic arthritis.

 

Complications

arthritis

liver disease

spleen enlargement

pericarditis

pleural effusion

 

Calling your health care provider

 

Call for an appointment with your health care provider if symptoms are present that are suggestive of Adult Still's disease.

 

Call your health care provider if cough, difficulty breathing, or other symptoms develop in a person with Adult Still's.

 

 

 

 

SPINAL STENOSIS

 

Spinal stenosis is narrowing of the spinal canal. This can develop as you age from drying out and shrinking of the disk spaces. (80% of the disks are made up of water) If this happens, even a minor injury can cause inflammation of the disk and put pressure on the nerve. You can feel pain anywhere along your back or leg(s) that this nerve supplies.

Information about Spinal Stenosis

 

Spinal stenosis mainly affects middle-aged or elderly people. It may be caused by osteoarthritis or Paget's disease or by an injury that causes pressure on the nerve roots and/or the spinal cord itself.

 

Spinal stenosis is a progressive narrowing of the opening in the spinal canal. The spine is a long series of bones called vertebrae. Between each pair of vertebra is a fibrous intervertebral disk. Collectively, the vertebrae and disks are called the backbone. Each vertebra has a hole through it. These holes line up to form the spinal canal. A large bundle of nerves called the spinal cord runs through the spinal canal. This bundle of 31 nerves carries messages between the brain and the various parts of the body. At each vertebra, some smaller nerves branch out from these nerve roots to serve the muscles and tissue in the immediate area. When the spinal canal narrows, nerve roots in the spinal cord are squeezed. Pressure on the nerve roots causes chronic pain and loss of control over some functions because communication with the brain is interrupted. The lower back and legs are most affected by spinal stenosis. The nerve roots that supply the legs are near the bottom of the spinal cord. The pain gets worse after standing for a long time and after some forms of exercise. The posture required by these physical activities increases the stress on the nerve roots. Spinal stenosis usually affects people over 50 years of age. Women have the condition more frequently than men do.

 

Cervical spinal stenosis is a narrowing of the vertebrae of the neck (cervical vertebrae). The disease and its effects are similar to stenosis in the lower spine. A narrower opening in the cervical vertebrae can also put pressure on arteries entering the spinal column, cutting off the blood supply to the remainder of the spinal cord.

Symptoms of Spinal Stenosis

 

Pain in the buttocks, thighs or calves that is worse with walking or exercise

 

Numbness in the buttocks, thighs or calves, that is worse with standing, walking or exercise

 

Back pain that radiates to the legs

 

Weakness of the legs

 

Neck pain

 

Leg pain

 

Difficulty or imbalance when walking

 

Spinal stenosis causes pain in the buttocks, thigh, and calf and increasing weakness in the legs. The patient may also have difficulty controlling bladder and bowel functions. The pain of spinal stenosis seems more severe when the patient walks downhill. Spinal stenosis can be congenital, acquired, or a combination. Congenital spinal stenosis is a birth defect. Acquired spinal stenosis develops after birth. It is usually a consequence of tissue destruction (degeneration) caused by an infectious disease or a disease in which the immune system attacks the body's own cells (autoimmune disease). The two most common causes of spinal stenosis are birth defect and progressive degeneration of the tissue of the joints (osteoarthritis). Other causes include improper alignment of the vertebrae as in spondylolisthesis, destruction of bone tissue as in Paget's disease, or an overgrowth of bone tissue as in diffuse idiopathic skeletal hyperostosis. The spinal canal is usually more than 11.5 millimeters in diameter. A smaller diameter indicates stenosis. The diameter of the cervical spine ranges is 15-25 millimeters. Any opening under 13 millimeters in diameter is considered evidence of stenosis. Acquired spinal stenosis usually begins with degeneration of the intervertebral disks or the surfaces of the vertebrae or both. In trying to heal this degeneration, the body builds up the spinal column. In the process, the spinal canal can become narrower.

Diagnosis of Spinal Stenosis

 

The physician must determine that the symptoms are caused by spinal stenosis. Conditions that can cause similar symptoms include a slipped (herniated) intervertebral disk, spinal tumors, and disorders of the blood flow (circulatory disorders). Spinal stenosis causes back and leg pain. The leg pain is usually worse when the patient is standing or walking. Some forms of spinal stenosis are less painful when the patient is riding an exercise bike because the forward tilt of the body changes the pressure in the spinal column. Doppler scanning can trace the flow of blood to determine whether the pain is caused by circulatory problems. X-ray images, computed tomography scans (CT scans), and magnetic resonance imaging (MRI) scans can reveal any narrowing of the spinal canal. Electromyography, nerve conduction velocity, or evoked potential studies can locate problems in the muscles indicating areas of spinal cord compression.

Treatment of Spinal Stenosis

 

Mild cases of spinal stenosis may be treated with rest, nonsteroidal anti-inflammatory drugs (such as aspirin) and muscle relaxants. Spinal stenosis can be a progressive disease, however, and the source of

pressure may have to be surgically removed (surgical decompression) if the patient is losing control over bladder and bowel functions. The surgical procedure removes bone and other tissues that have entered the spinal canal or put pressure on the spinal cord. Two vertebrae may be fused, to eliminate improper alignment, such as that caused by spondylolisthesis. For surgery, patients lie on their sides or in a modified kneeling position. This position reduces bleeding and places the spine in proper alignment. Alignment is especially important if vertebrae are to be fused. Surgical decompression can eliminate leg pain and restore control of the legs, bladder, and bowels, but usually does not eliminate lower back pain. Physical therapy and massage can help reduce the symptoms of spinal stenosis. An exercise program should be developed to increase flexibility and mobility. A brace or corset may be worn to improve posture. Activities that place stress on the lower back muscles should be avoided.

Prognosis of Spinal Stenosis

 

Surgical decompression does not stop the degenerative processes that cause spinal stenosis, and the condition can develop again. Nevertheless, most patients achieve good results with surgical decompression. The patient will probably continue to have lower back pain after the surgical procedure.

 

 

 

 

 

 

SHOULDER ARTHRITIS

 

An inflammation of the shoulder joint can cause pain and restricted joint movement

 

Arthritis is a degenerative disease caused by either wear and tear (osteoarthritis) or an inflammation (rheumatoid arthritis) of one or more joints. Arthritis not only affects joints; it may secondarily affect supporting structures such as muscles, tendons, and ligaments.

Symptoms of shoulder arthritis

 

The usual signs of arthritis of the shoulder are pain, particularly over the acromioclavicular (AC) joint, and a decrease in shoulder motion. A doctor may suspect the patient has arthritis when there is both pain and swelling in the joint.

Diagnosis of shoulder arthritis

 

The diagnosis may be confirmed by a physical examination and x rays. Blood tests may be helpful for diagnosing rheumatoid arthritis, but other tests may be needed as well. Analysis of synovial fluid from the shoulder joint may be helpful in diagnosing some kinds of arthritis. Although arthroscopy permits direct visualization of damage to cartilage, tendons, and ligaments, and may confirm a diagnosis, it is usually only done if a repair procedure is to be performed.

Treatment of shoulder arthritis

 

Most often osteoarthritis of the shoulder is treated with nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen. (Rheumatoid arthritis of the shoulder may require physical therapy and additional medicine, such as corticosteroids.)

 

When conservative treatment of osteoarthritis of the shoulder fails to relieve pain or improve function, or when there is severe deterioration of the joint causing parts to loosen and move out of place, shoulder joint replacement (arthroplasty) may provide better results. In this operation, a surgeon replaces the shoulder joint with an artificial ball for the humerus and a cap (glenoid) for the scapula.

 

Passive shoulder exercises (where someone else moves the arm to rotate the shoulder joint) are started soon after surgery. Patients begin exercising on their own about 3 to 6 weeks after surgery. Eventually, stretching and strengthening exercises become a major part of the rehabilitation program. The success of the operation often depends on the condition of rotator cuff muscles prior to surgery and the degree to which the patient follows the exercise program.

 

 

 

 

 

SHOULDER IMPINGEMENT

What is Shoulder Impingement?

 

Impingement refers to mechanical compression and/or wear of the rotator cuff tendons. The rotator cuff is actually a series of four muscles connecting the scapula (shoulder blade) to the humeral head (upper part of the shoulder joint.) The rotator cuff is important in maintaining the humeral head within the glenoid (socket) during normal shoulder function and also contributes to shoulder strength during activity. Normally, the rotator cuff glides smoothly between the undersurface of the acromion and the humeral head.

How Does Shoulder Impingement Occur?

 

Any process which compromises this normal gliding function may lead to mechanical impingement. Common causes include weakening and degeneration within the tendon due to aging, the formation of bone spurs and/or inflammatory tissue within the space above the rotator cuff (subacromial space), and overuse injuries. Overuse activities that can lead to impingement are most commonly seen in tennis players, pitchers and swimmers.

How is Shoulder Impingement Diagnosed?

 

The diagnosis of shoulder impingement can usually be made with a careful history and physical exam. Patients with impingement most commonly complain of pain in the shoulder, which is worse with overhead activity and sometimes severe enough to cause awakening in the night. Manipulation of the shoulder in a specific way by your doctor will usually reproduce the symptoms and confirm the diagnosis. X-rays are also helpful in evaluating the presence of bone spurs and/or the narrowing of the subacromial space. MRI (magnetic resonance imaging), a test that allows visualization of the rotator cuff, is usually not necessary in cases of shoulder impingement, but may be used to rule out more serious diagnoses.

How is Shoulder Impingement Treated?

 

The first step in treating shoulder impingement is eliminating any identifiable cause or contributing factor. This may mean temporarily avoiding activities like tennis, pitching or swimming. A non-steroidal anti-inflammatory medication may also be recommended by your doctor. The mainstay of treatment involves exercises to restore normal flexibility and strength to the shoulder girdle, including strengthening both the rotator cuff muscles and the muscles responsible for normal movement of the shoulder blade. This program of instruction and exercise demonstration may be initiated and carried out either by the doctor or a skilled

physical therapist. Occasionally, an injection of cortisone may be helpful in treating this condition.

 

Is Surgery Necessary?

 

Surgery is not necessary in most cases of shoulder impingement. But if symptoms persist despite adequate non-surgical treatment, surgical intervention may be beneficial. Surgery involves debriding, or surgically removing tissue that is irritating the rotator cuff. This may be done with either open or arthroscopic techniques. Outcome is favorable in about 90% of the cases.

 

 

 

 

 

 

SCOLIOSIS

Abnormal curvature in the spine is known as scoliosis, and generally begins just at the onset of puberty and progresses during the period of rapid growth. Most junior high schools routinely screen for scoliosis because, if caught early, progressive spine curvature can be prevented. Scoliosis affects girls much more frequently than boys.

 

There are three general causes of scoliosis: congenital, usually related to a problem with the formation of vertebrae or fused ribs during prenatal development; neuromuscular (poor muscle control or muscular weakness or paralysis due to diseases like cerebral palsy, muscular dystrophy, spina bifida and polio); and idiopathic (of unknown cause), which appears in a previously straight spine.

 

The idiopathic form in adolescents is the most common and may have a genetic predisposition. Most cases occur in girls and curves generally worsen during growth spurts. There are also infantile and juvenile forms that are less common and affect a similar number of boys and girls.

 

Scoliosis may be suspected when one shoulder appears to be higher than the other, or the pelvis appears to be tilted. It is often unnoticeable to an untrained observer, however.

 

Routine scoliosis screening is now done in junior high school/middle school and many early cases are detected that previously would have gone undetected until they were more advanced.

 

There may be fatigue in the spine after prolonged sitting or standing. Pain will become persistent if irritation of ligaments results. The greater the initial curve of the spine, the greater the chance for progression of the condition after growth is complete. Severe scoliosis (curves in the spine greater than 100 degrees) may cause breathing (respiratory) problems.

 

More information about Scoliosis

 

When viewed from the rear, the spine usually appears perfectly straight. Scoliosis is a lateral (side-to-side) curve in the spine, usually combined with a rotation of the vertebrae. (The lateral curvature of scoliosis should not be confused with the normal set of front-to-back spinal curves visible from the side.) While a small degree of lateral curvature does not cause any medical problems, larger curves can cause postural imbalance and lead to muscle fatigue and pain. More severe scoliosis can interfere with breathing and lead to arthritis of the spine (spondylosis).

 

Approximately 10% of all adolescents have some degree of scoliosis, though fewer than 1% have curves which require medical attention beyond monitoring. Scoliosis is found in both boys and girls, but a girl's spinal curve is much more likely to progress than a boy's. Girls require scoliosis treatment about five times as often. The reason for these differences is not known.

Symptoms of Scoliosis

the spine curving abnormally to the side (laterally)

shoulders and/ or hips appearing uneven

backache or low back pain

fatigue

 

Note: Kyphoscoliosis also involves abnormal front-to-back curvature, with a "rounded back" appearance.

 

Four out of five cases of scoliosis are idiopathic, meaning the cause is unknown. While idiopathic scoliosis tends to run in families, no responsible genes had been identified as of 1997. Children with idiopathic scoliosis appear to be otherwise entirely healthy, and have not had any bone or joint disease early in life. Scoliosis is not caused by poor posture, diet, or carrying a heavy bookbag exclusively on one shoulder.

 

Idiopathic scoliosis is further classified according to age of onset:

Infantile. Curvature appears before age three. This type is quite rare in the United States, but is more common in Europe.

Juvenile. Curvature appears between ages 3 and 10. This type may be equivalent to the adolescent type, except for the age of onset.

Adolescent. Curvature appears between ages of 10 and 13, near the beginning of puberty. This is the most common type of idiopathic scoliosis.

Adult. Curvature begins after physical maturation is completed.

 

Causes are known for three other types of scoliosis:

Congenital scoliosis is due to congenital birth defects in the spine, often associated with other organ defects.

Neuromuscular scoliosis is due to loss of control of the nerves or muscles which support the spine. The most common causes of this type of scoliosis are cerebral palsy and muscular dystrophy.

Degenerative scoliosis may be caused by degeneration of the discs which separate the vertebrae or arthritis in the joints that link them.

 

Scoliosis causes a noticeable asymmetry in the torso when viewed from the front or back. The first sign of scoliosis is often seen when a child is wearing a bathing suit or underwear. A child may appear to be standing with one shoulder higher than the other, or to have a tilt in the waistline. One shoulder blade may appear more prominent than the other due to rotation. In girls, one breast may appear higher than the other, or larger if rotation pushes that side forward.

 

Curve progression is greatest near the adolescent growth spurt. Scoliosis that begins early on is more likely to progress significantly than scoliosis that begins later in puberty.

 

More than 30 states have screening programs in schools for adolescent scoliosis, usually conducted by trained school nurses or gym teachers.

Diagnosis of Scoliosis

 

Diagnosis for scoliosis is done by an orthopedist. A complete medical history is taken, including questions about family history of scoliosis. The physical examination includes determination of pubertal development in adolescents, a neurological exam (which may reveal a neuromuscular cause), and measurements of trunk asymmetry. Examination of the trunk is done while the patient is standing, bending over, and lying down, and involves both visual inspection and use of a simple mechanical device called a scoliometer.

 

If a curve is detected, one or more x rays will usually be taken to define the curve or curves more precisely. An x ray is used to document spinal maturity, any pelvic tilt or hip asymmetry, and the location, extent, and degree of curvature. The curve is defined in terms of where it begins and ends, in which direction it bends, and by an angle measure known as the Cobb angle. The Cobb angle is found by projecting lines parallel to the vertebrae tops at the extremes of the curve; projecting perpendiculars from these lines; and measuring the angle of intersection. To properly track the progress of scoliosis, it is important to project from the same points of the spine each time.

 

Occasionally, magnetic resonance imaging (MRI) is used, primarily to look more closely at the condition of the spinal cord and nerve roots extending from it if neurological problems are suspected.

Treatment of Scoliosis

 

Treatment decisions for scoliosis are based on the degree of curvature, the likelihood of significant progression, and the presence of pain, if any.

 

Curves less than 20 degrees are not usually treated, except by regular follow-up for children who are still growing. Watchful waiting is usually all that is required in adolescents with curves of 20-30 degrees, or adults with curves up to 40 degrees or slightly more, as long as there is no pain.

 

For children or adolescents whose curves progress to 30 degrees, and who have a year or more of growth left, bracing may be required. Bracing cannot correct curvature, but may be effective in halting or slowing progression. Bracing is rarely used in adults, except where pain is significant and surgery is not an option, as in some elderly patients.

 

Two general styles of braces are used for daytime wear. The Milwaukee brace consists of metal uprights attached to pads at the hips, rib cage, and neck. The underarm brace uses rigid plastic to encircle the lower rib cage, abdomen, and hips. Both these brace types hold the spine in a vertical position. Because it can be worn out of sight beneath clothing, the underarm brace is better tolerated and often leads to better compliance. A third style, the Charleston bending brace, is used at night to bend the spine in the opposite direction. Braces are often prescribed to be worn for 22-23 hours per day, though some clinicians allow or encourage removal of the brace for exercise.

 

Bracing may be appropriate for scoliosis due to some types of neuromuscular disease, including spinal muscular atrophy, before growth is finished. Duchenne muscular dystrophy is not treated by bracing, since surgery is likely to be required, and since later surgery is complicated by loss of respiratory capacity.

 

Surgery for idiopathic scoliosis is usually recommended if:

The curve has progressed despite bracing

The curve is greater than 40-50 degrees before growth has stopped in an adolescent

The curve is greater than 50 degrees and continues to increase in an adult

There is significant pain.

 

Orthopedic surgery for neuromuscular scoliosis is often done earlier. The goals of surgery are to correct the deformity as much as possible, to prevent further deformity, and to eliminate pain as much as possible. Surgery can usually correct 40-50% of the curve, and sometimes as much as 80%. Surgery cannot always completely remove pain.

 

The surgical procedure for scoliosis is called spinal fusion, because the goal is to straighten the spine as much as possible, and then to fuse the vertebrae together to prevent further curvature. To achieve fusion, the involved vertebra are first exposed, and then scraped to promote regrowth. Bone chips are usually used to splint together the vertebrae to increase the likelihood of fusion. To maintain the proper spinal posture before fusion occurs, metal rods are inserted alongside the spine, and are attached to the vertebrae by hooks, screws, or wires. Fusion of the spine makes it rigid and resistant to further curvature. The metal rods are no longer needed once fusion is complete, but are rarely removed unless their presence leads to complications.

 

Spinal fusion leaves the involved portion of the spine permanently stiff and inflexible. While this leads to some loss of normal motion, most functional activities are not strongly affected, unless the very lowest portion of the spine (the lumbar region) is fused. Normal mobility, exercise, and even contact sports are usually all possible after spinal fusion. Full recovery takes approximately six months.

Alternative treatment for Scoliosis

 

Although important for general health and strength, exercise has not been shown to prevent or slow the development of scoliosis. It may help to relieve pain from scoliosis by helping to maintain range of motion. Good nutrition is also important for general health, but no specific dietary regimen has been shown to control scoliosis development. In particular, dietary calcium levels do not influence scoliosis progression.

 

Chiropractic treatment may relieve pain, but it cannot halt scoliosis development, and should not be a substitute for conventional treatment of progressing scoliosis. Acupuncture and acupressure may also help reduce pain and discomfort, but they cannot halt scoliosis development either.

Prognosis of Scoliosis

 

The prognosis for a person with scoliosis depends on may factors, including the age at which scoliosis begins and the treatment received. More importantly, mostly unknown individual factors affect the likelihood of progression and the severity of the curve. Most cases of mild adolescent idiopathic scoliosis need no treatment and do not progress. Untreated severe scoliosis often leads to spondylosis, and may impair breathing.

GUILLAIN-BARRÉ SYNDROME, LYMPHATIC FILARIASIS, PLEURISY, SCIATICA, SACROILIAC DISEASE, AND OSTEOCHONDROSIS

GUILLAIN-BARRÉ SYNDROME

 

Definition of Guillain-Barré syndrome

 

 

Guillain-Barrè (ghee-yan bah-ray) syndrome is a disorder in which the body's immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs. In many instances the weakness and abnormal sensations spread to the arms and upper body. These symptoms can increase in intensity until certain muscles cannot be used at all and, when severe, the patient is almost totally paralyzed. In these cases the disorder is life threatening – potentially interfering with breathing and, at times, with blood pressure or heart rate – and is considered a medical emergency. Such a patient is often put on a respirator to assist with breathing and is watched closely for problems such as an abnormal heart beat, infections, blood clots, and high or low blood pressure. Most patients, however, recover from even the most severe cases of Guillain-Barrè syndrome, although some continue to have a certain degree of weakness.

 

Guillain-Barrè syndrome can affect anybody. It can strike at any age and both sexes are equally prone to the disorder. The syndrome is rare, however, afflicting only about one person in 100,000. Usually Guillain-Barrè occurs a few days or weeks after the patient has had symptoms of a respiratory or gastrointestinal viral infection. Occasionally surgery or vaccinations will trigger the syndrome. The disorder can develop over the course of hours or days, or it may take up to 3 to 4 weeks. Most people reach the stage of greatest weakness within the first 2 weeks after symptoms appear, and by the third week of the illness 90 percent of all patients are at their weakest.

Description of Guillain-Barré syndrome

 

The classic scenario in GBS involves a patient who has just recovered from a typical, seemingly uncomplicated viral infection. Symptoms of muscle weakness appear one to four weeks later. The most common preceding infections are cytomegalovirus, herpes, Epstein-Barr virus, and viral hepatitis. A gastrointestinal infection with the bacteria Campylobacter jejuni is also common and may cause a severe type of GBS from which it is particularly difficult to recover. About 5% of GBS patients have a surgical procedure as a preceding event. Patients with lymphoma, systemic lupus erythematosus, or AIDS have a higher than normal risk of GBS. Other GBS patients have recently received an immunization, while still others have no known preceding event. In 1976-77, there was a vastly increased number of GBS cases among people who had been recently vaccinated against the Swine flu. The reason for this phenomenon has never been identified, and no other flu vaccine has caused such an increase in GBS cases.

Causes & symptoms of Guillain-Barré syndrome

 

The cause of the weakness and paralysis of GBS is the loss of myelin, which is the material that coats nerve cells (the loss of myelin is called demyelination). Myelin is an insulating substance which is wrapped around nerves in the body, serving to speed conduction of nerve impulses. Without myelin, nerve conduction slows or stops. GBS has a short, severe course. It causes inflammation and destruction of the myelin sheath, and it disturbs multiple nerves. Therefore, it is considered an acute inflammatory demyelinating polyneuropathy.

 

The reason for the destruction of myelin in GBS is unknown, although it is thought that the underlying problem is autoimmune in nature. An autoimmune disorder is one in which the body's immune system, trained to fight against such foreign invaders as viruses and bacteria, somehow becomes improperly programmed. The immune system becomes confused, and is not able to distinguish between foreign invaders and the body itself. Elements of the immune system are unleashed against areas of the body, resulting in damage and destruction. For some reason, in the case of GBS, the myelin sheath appears to become a target for the body's own immune system.

 

The first symptoms of GBS consist of muscle weakness (legs first, then arms, then face), accompanied by prickly, tingling sensations (paresthesias). Symptoms affect both sides of the body simultaneously, a characteristic that helps distinguish GBS from other causes of weakness and paresthesias. Normal reflexes are first diminished, then lost. The weakness eventually affects all the voluntary muscles, resulting in paralysis. When those muscles necessary for breathing become paralyzed, the patient must be placed on a mechanical ventilator which takes over the function of breathing. This occurs about 30% of the time. Very severely ill GBS patients may have complications stemming from other nervous system abnormalities which can result in problems with fluid balance in the body, severely fluctuating blood pressure, and heart rhythm irregularities.

Diagnosis of Guillain-Barré syndrome

 

Diagnosis of GBS is made by looking for a particular cluster of symptoms (progressively worse muscle weakness and then paralysis), and by examining the fluid that bathes the brain and spinal canal through cerebrospinal fluid (CSF) analysis. This fluid is obtained by inserting a needle into the lower back (lumbar region). When examined in a laboratory, the CSF of a GBS patient will reveal a greater-than-normal quantity of protein, with normal numbers of white blood cells and a normal amount of sugar. Electrodiagnostic studies may show slowing or block of conduction in nerve endings in parts of the body other than the brain. Minor abnormalities will be present in 90% of patients.

Treatment

 

There is no direct treatment for GBS. Instead, treatments are used that support the patient with the disabilities caused by the disease. The progress of paralysis must be carefully monitored, in order to provide mechanical assistance for breathing if it becomes necessary. Careful attention must also be paid to the amount of fluid the patient is taking in by drinking and eliminating by urinating. Blood pressure, heart rate, and heart rhythm also must be monitored.

 

A procedure called plasmapheresis, performed early in the course of GBS, has been shown to shorten the course and severity of GBS. Plasmapheresis consists of withdrawing the patient's blood, passing it through an instrument that separates the different types of blood cells, and returning all the cellular components (red and white blood cells and platelets) along with either donor plasma or a manufactured replacement solution. This is thought to rid the blood of the substances that are attacking the patient's myelin.

 

It has also been shown that the use of high doses of immunoglobulin given intravenously (by drip through a needle in a vein) may be just as helpful as plasmapheresis. Immunoglobulin is a substance naturally manufactured by the body's immune system in response to various threats. It is interesting to note that corticosteroid medications (such as prednisone), often the mainstay of anti-autoimmune disease treatment, are not only unhelpful, but may in fact be harmful to patients with GBS.

Prognosis

 

About 85% of GBS patients make reasonably good recoveries. However, 30% of adult patients, and a greater percentage of children, never fully regain their previous level of muscle strength. Some of these patients suffer from residual weakness, others from permanent paralysis. About 10% of GBS patients begin to improve, then suffer a relapse. These patients suffer chronic GBS symptoms. About 5% of all GBS patients die, most from cardiac rhythm disturbances.

 

Patients with certain characteristics tend to have a worse outcome. These include people of older age, those who required breathing support with a mechanical ventilator, and those who had their worst symptoms within the first seven days.

Prevention

Because so little is known about what causes GBS to develop, there are no known methods of prevention.

 

 

 

 

 

 

LYMPHATIC FILARIASIS

 

Lymphatic filariasis, also known as Elephantiasis, is best known from dramatic photos of people with grossly enlarged or swollen arms and legs. The disease is caused by parasitic worms, including Wuchereria bancrofti, Brugia malayi, and B. timori, all transmitted by mosquitoes. Lymphatic filariasis currently affects 120 million people worldwide, and 40 million of these people have serious disease.

 

When an infected female mosquito bites a person, she may inject the worm larvae, called microfilariae, into the blood. The microfilariae reproduce and spread throughout the bloodstream, where they can live for many years. Often disease symptoms do not appear until years after infection. As the parasites accumulate in the blood vessels, they can restrict circulation and cause fluid to build up in surrounding tissues. The most common, visible signs of infection are excessively enlarged arms, legs, genitalia, and breasts.

 

Medicines to treat lymphatic filariasis are most effective when used soon after infection, but they do have some toxic side effects. In addition, the disease is difficult to detect early. Therefore, improved treatments and laboratory tests are needed. A vaccine is not yet available.

Description of Lymphatic Filariasis

 

True Lymphatic Filariasis is the result of a parasitic infection caused by three specific kinds of round worms. The long, threadlike worms block the body's lymphatic system--a network of channels, lymph nodes, and organs that helps maintain proper fluid levels in the body by draining lymph from tissues into the bloodstream. This blockage causes fluids to collect in the tissues, which can lead to great swelling, called "lymphedema." Limbs can swell so enormously that they resemble an elephant's foreleg in size, texture, and color. This is the severely disfiguring and disabling condition of Lymphatic Filariasis.

 

There are a few different causes of Lymphatic Filariasis, but the agents responsible for most of the Lymphatic Filariasis in the world are filarial worms: white, slender round worms found in most tropical and subtropical places. They are transmitted by particular kinds (species) of mosquitoes, that is, bloodsucking insects. Infection with these worms is called "lymphatic filariasis" and over a long period of time can cause Lymphatic Filariasis.

 

Lymphatic filariasis is a disease of underdeveloped regions found in South America, Central Africa, Asia, the Pacific Islands, and the Caribbean. It is a disease of the poor that has been present for centuries, as ancient Persian and Indian writings clearly described elephant-like swellings of the arms, legs, and genitals. It is estimated that 120 million people in the world have lymphatic filariasis, as of 1997. The disease appears to be spreading, in spite of decades of research in this area.

 

Other terms for Lymphatic Filariasis are Barbados leg, elephant leg, morbus herculeus, mal de Cayenne, and myelolymphangioma.

 

Other situations that can lead to Lymphatic Filariasis are:

A protozoan disease called leishmaniasis.

A repeated streptococcal infection.

The surgical removal of lymph nodes (usually to prevent the spread of cancer).

A hereditary birth defect.

Causes & symptoms of Lymphatic Filariasis

 

Three kinds of round worms cause Lymphatic Filariasis filariasis: Wuchereria bancrofti, Brugia malayi, and Brugia timori. Of these three, W. bancrofti makes up about 90% of the cases. Man is the only known host of W. bancrofti.

 

Culex, Aedes, and Anopheles mosquitoes are the carriers of W. bancrofti. Anopheles and Mansonia mosquitoes are the carriers of B. malayi. In addition Anopheles mosquitoes are the carriers of B. timori.

 

Infected female mosquitoes take a blood meal from a human, and, in doing so, introduce larval forms of the particular parasite they carry to the person. These larvae migrate toward a lymphatic channel, then travel to various places within the lymphatic system, usually positioning themselves in or near lymph nodes throughout the body. During this time, they mature into more developed larvae and eventually into adult worms. Depending upon the species of round worm, this development can take a few months or more than a year. The adult worms grow to about 1 in (3.5 cm) to 4 in (10 cm) long.

 

The adult worms can live from about 3-8 years. Some have been known to live to 20 years, and in one case 40 years. The adult worms begin reproducing numerous live embryos, called microfilariae. The microfilariae travel to the bloodstream, where they can be ingested by a mosquito when it takes a blood meal from the infected person. If they are not ingested by a mosquito, the microfilariae die within about 12 months. If they are ingested by a mosquito, they continue to mature. They are totally dependent on their specific species of mosquito to develop further. The cycle continues when the mosquito takes another blood meal.

 

Most of the symptoms an infected person experiences are due to the blockage of the lymphatic system by the adult worms and due to the substances (excretions and secretions) produced by the worms.

 

The body's allergic reactions may include repeated episodes of fever, shaking chills, sweating, headaches, vomiting, and pain. Enlarged lymph nodes, swelling of the affected area, skin ulcers, bone and joint pain, tiredness, and red streaks along the arm or leg also may occur. Abscesses can form in lymph nodes or in the lymphatic vessels. They may appear at the surface of the skin as well.

 

Long-term infection with lymphatic filariasis can lead to lymphedema, hydrocele (a buildup of fluid in any saclike cavity or duct) in the scrotum, and Lymphatic Filariasis of the legs, scrotum, arms, penis, breasts, and vulvae. The most common site of Lymphatic Filariasis is the leg. It typically begins in the ankle and progresses to the foot and leg. At first the swollen leg may feel soft to the touch but eventually becomes hard and thick. The skin may appear darkened or warty and may even crack, allowing bacteria to infect the leg and complicate the disease. The microfilariae usually don't cause injury. In some instances, they cause "eosinophilia," an increased number of eosinophils (a type of white blood cells) in the blood.

 

This disease is more intense in people who never have been exposed to lymphatic filariasis than it is in the native people of tropical areas where the disease occurs. This is because many of the native people often are immunologically tolerant.

Diagnosis of Lymphatic Filariasis

 

The only sure way to diagnose lymphatic filariasis is by detecting the parasite itself, either the adult worms or the microfilariae.

 

Microscopic examination of the person's blood may reveal microfilariae. But many times, people who have been infected for a long time do not have microfilariae in their bloodstream. The absence of them, therefore, does not mean necessarily that the person is not infected. In these cases, examining the urine or hydrocele fluid or performing other clinical tests is necessary.

 

Collecting blood from the individual for microscopic examination should be done during the night when the microfilariae are more numerous in the bloodstream. (Interestingly, this is when mosquitoes bite most frequently.) During the day microfilariae migrate to deeper blood vessels in the body, especially in the lung. If it is decided to perform the blood test during the day, the infected individual may be given a "provocative" dose of medication to provoke the microfilariae to enter the bloodstream. Blood then can be collected an hour later for examination.

 

Detecting the adult worms can be difficult because they are deep within the lymphatic system and difficult to get to. Biopsies usually are not performed because they usually don't reveal much information.

Treatment of Lymphatic Filariasis

 

The drug of choice in treating lymphatic filariasis is diethylcarbamazine (DEC). The trade name in the United States is Hetrazan.

 

The treatment schedule is typically 2 mg/kg per day, three times a day, for three weeks. The drug is taken in tablet form.

 

DEC kills the microfilariae quickly and injures or kills the adult worms slowly, if at all. If all the adult worms are not killed, remaining paired males and females may continue to produce more larvae. Therefore, several courses of DEC treatment over a long time period may be necessary to rid the individual of the parasites.

 

DEC has been shown to reduce the size of enlarged lymph nodes and, when taken long-term, to reduce Lymphatic Filariasis. In India, DEC has been given in the form of a medicated salt, which helps prevent spread of the disease.

 

The side effects of DEC almost all are due to the body's natural allergic reactions to the dying parasites rather than to the DEC itself. For this reason, DEC must be given carefully to reduce the danger to the individual. Side effects may include fever, chills, headache, dizziness, nausea and vomiting, itching, and joint pain. These side effects usually occur within the first few days of treatment. These side effects usually subside as the individual continues taking the drug.

 

There is an alternate treatment plan for the use of DEC. This plan is designed to kill the parasites slowly (to reduce allergic reactions to the dead microfilariae and dying adult worms within the body). Lower doses of DEC are taken for the first few days, followed by the higher dose of 2 mg/kg per day for the remaining three weeks. In addition, steroids may be prescribed to prevent the individual's body from reacting severely to the dead worms.

 

Another drug used is Ivermectin. Early research studies of Ivermectin show that it is excellent in killing microfilariae, but the effects of this drug on the adult worms are still being investigated. It is probable that patients will need to continue using DEC to kill the adult worms. Mild side effects of Ivermectin include headache, fever, and myalgia.

 

Other means of managing lymphatic filariasis are pressure bandages to wrap the swollen limb and elastic stockings to help reduce the pressure. Exercising and elevating a bandaged limb also can help reduce its size.

Surgery can be performed to reduce Lymphatic Filariasis by removing excess fatty and fibrous tissue, draining the swelled area, and removing the dead worms.

Prognosis of Lymphatic Filariasis

With DEC treatment, the prognosis is good for early and mild cases of lymphatic filariasis. The prognosis is poor, however, for heavy parasitic infestations.

Prevention of Lymphatic Filariasis

 

The two main ways to control this disease are to take DEC preventively, which has shown to be effective, and to reduce the number of carrier insects in a particular area.

Avoiding mosquito bites with insecticides and insect repellents is helpful, as is wearing protective clothing and using bed netting.

Much effort has been made in cleaning the breeding sites (stagnant water) of mosquitoes near people's homes in areas where filariasis is found.

Before visiting countries where lymphatic filariasis is found, it would be wise to consult a travel physician to learn about current preventative measures.

 

 

 

 

 

 

 

 

 

 

PLEURISY

 

Pleurisy is an inflammation of the pleura, the lining of the lungs, with subsequent pain

Information about Pleurisy

 

Pleurisy may develop in the presence of lung inflammation (for example, pneumonia, tuberculosis), rheumatic diseases, chest trauma, certain cancers, and asbestos-related disease. The main symptom is pain over the chest wall at the site of the inflammation. In some circumstances, the pain may be felt in the shoulder.

 

The pain is increased by deep breathing, coughing, and chest movement. The normally smooth pleural surfaces, now roughened by inflammation, rub together with each breath, and may produce a rough, grating sound called a "friction rub". This can be heard with the stethoscope or an ear held against the chest.

 

Fluid often accumulates at the site of pleural inflammation. A localized collection of fluid separates the lung pleura from the chest wall pleura causing the chest pain to disappear even though the illness may be worsening.

 

Large accumulations of fluid compromise breathing and may cause coughing, shortness of breath with rapid breathing (tachypnea), cyanosis, and retractions.

Symptoms of Pleurisy

Recent or present respiratory illness with its symptoms

Cough

Fever

Malaise

Localized chest pain on the chest wall

Pain with each breath

Worsened by coughing

Worsened by deep breathing

Diagnosis of Pleurisy

 

 

 

 

 

Physical examination may show abnormal lung sounds:

A friction rub -- a rough scratchy sound that accompanies inspiration and expiration

Rales (may be present if there is an accompanying pneumonia)

Rhonchi (may be present with accompanying pneumonia or bronchitic process)

Decreased breath sounds (may be present if there is a collection of fluid around the lung

 

Tests:

CBC (may help differentiate bacterial versus viral infection)

X-ray of the chest

Ultrasound of the chest

Thoracentesis (a collection of fluid from the pleural cavity)

Causes of Pleurisy

 

A variety of conditions can give rise to pleurisy. The following list represents the most common sources of pleural inflammation.

Infections, including pneumonia, tuberculosis, and other bacterial or viral respiratory infections

Immune disorders, including systemic lupus erythematosus, rheumatoid arthritis, and sarcoidosis

Diseases, including cancer, pancreatitis, liver cirrhosis, and heart or kidney failure

Injury, from a rib fracture, collapsed lung, esophagus rupture, blood clot, or material such as asbestos

Drug reactions, from certain drugs used to treat tuberculosis (isoniazid), cancer (methotrexate, procarbazine), or the immune disorders mentioned above (hydralazine, procainamide, phenytoin, quinidine).

 

 

Symptomatic pain

 

The hallmark symptom of pleurisy is sudden, intense chest pain that is usually located over the area of inflammation. Although the pain can be constant, it is usually most severe when the lungs move during breathing, coughing, sneezing, or even talking. The pain is usually described as shooting or stabbing, but in minor cases it resembles a mild cramp. When pleurisy occurs in certain locations, such as near the diaphragm, the pain may be felt in other areas such as the neck, shoulder, or abdomen (referred pain). Another indication of pleurisy is that holding one's breath or exerting pressure against the chest causes pain relief.

Breathing difficulties

 

Pleurisy is also characterized by certain respiratory symptoms. In response to the pain, pleurisy patients commonly have a rapid, shallow breathing pattern. Pleural effusion can also cause shortness of breath, as excess fluid makes expanding the lungs difficult. If severe breathing difficulties persist, patients may experience a blue colored complexion (cyanosis).

 

Additional symptoms of pleurisy are specific to the illness that triggers the condition. Thus, if infection is the cause, then chills, fever, and fatigue will be likely pleurisy symptoms.

Diagnosis of Pleurisy

 

The distinctive pain of pleurisy is normally the first clue physicians use for diagnosis. Doctors usually feel the chest to find the most painful area, which is the likely site of inflammation. A stethoscope is also used to listen for abnormal chest sounds as the patient breathes. If the doctor hears the characteristic friction rub, the diagnosis of pleurisy can be confirmed. Sometimes, a friction rub is masked by the presence of pleural effusion and further examination is needed for an accurate diagnosis.

 

Identifying the actual illness that causes pleurisy is more difficult. To make this diagnosis, doctors must evaluate the patient's history, additional symptoms, and laboratory test results. A chest x ray may also be taken to look for signs of accumulated fluid and other abnormalities. Possible causes, such as pneumonia, fractured ribs, esophagus rupture, and lung tumors may be detected on an x ray. Computed tomography scan (CT scan) and ultrasound scans are more powerful diagnostic tools used to visualize the chest cavity. Images from these techniques more clearly pinpoint the location of excess fluid or other suspected problems.

 

The most helpful information in diagnosing the cause of pleurisy is a fluid analysis. Once the doctor knows the precise location of fluid accumulation, a sample is removed using a procedure called thoracentesis. In this technique, a fine needle is inserted into the chest to reach the pleural space and extract fluid. The fluid's appearance and composition is thoroughly examined to help doctors understand how the fluid was produced. Several laboratory tests are performed to analyze the chemical components of the fluid. These tests also determine whether infection-causing bacteria or viruses are present. In addition, cells within the fluid are identified and counted. Cancerous cells can also be detected to learn whether the pleurisy is caused by a malignancy.

 

In certain instances, such as dry pleurisy, or when a fluid analysis is not informative, a biopsy of the pleura may be needed for microscopic analysis. A sample of pleural tissue can be obtained several ways: with a biopsy needle, by making a small incision in the chest wall, or by using a thoracoscope (a video-assisted instrument for viewing the pleural space and collecting samples).

Treatment of Pleurisy

Pain management

 

The pain of pleurisy is usually treated with analgesic and anti-inflammatory drugs, such as acetaminophen, ibuprofen, and indomethacin. People suffering from pleurisy may also receive relief from lying on the painful side. Sometimes, a painful cough will be controlled with codeine-based cough syrups. However, as the pain eases, a person with pleurisy should try to breathe deeply and cough to clear any congestion, otherwise pneumonia may occur. Rest is also important to aid in the recovery process.

Treating the source of Pleurisy

 

The treatment used to cure pleurisy is ultimately defined by the underlying cause. Thus, pleurisy from a bacterial infection can be successfully treated with antibiotics, while no treatment is given for viral

infections that must run their course. Specific therapies designed for more chronic illnesses can often cause pleurisy to subside. For example, tuberculosis pleurisy is treated with standard anti-tuberculosis drugs. With some illnesses, excess fluid continues to accumulate and causes severe respiratory distress. In these individuals, the fluid may be removed by thoracentesis, or the doctor may insert a chest tube to drain large amounts. If left untreated, a more serious infection may develop within the fluid, called empyema.

Alternative treatment of Pleurisy

 

Alternative treatments can be used in conjunction with conventional treatment to help heal pleurisy. Acupuncture and botanical medicines are alternative approaches for alleviating pleural pain and breathing problems. An herbal remedy commonly recommended is pleurisy root (Asclepias tuberosa), so named because of its use by early American settlers who learned of this medicinal plant from Native Americans. Pleurisy root helps to ease pain, inflammation, and breathing difficulties brought on by pleurisy. This herb is often used in conjunction with mullein (Verbascum thapsus) or elecampane (Inula helenium), which serve as expectorants to clear excess mucus from the lungs. In addition, there are many other respiratory herbs that are used as expectorants or for other actions on the respiratory system. Herbs thought to combat infection, such as echinacea (Echinacea spp.) are also included in herbal pleurisy remedies. Anitviral herbs, such as Lomatium dissectum and Ligusticum porteri, can be used if the pleurisy is of viral origin. Traditional Chinese medicine uses the herb ephedra (Ephedra sinica), which acts to open air passages and alleviate respiratory difficulties in pleurisy patients. Dietary recommendations include eating fresh fruits and vegetables, adequate protein, and good quality fats (omega-3 fatty acids are anti-inflammatory and are found in fish and flax oil). Taking certain nutritional supplements, especially large doeses of vitamin C, may also provide health benefits to people with pleurisy. Contrast hydrotherapy applied to the chest and back, along with compresses (cloths soaked in an herbal solution) or poultices (crushed herbs applied directly to the skin) of respiratory herbs, can assist in the healing process. Homeopathic treatment, guided by a trained practitioner, can be effective in resolving pleurisy.

Prognosis of Pleurisy

 

Prompt diagnosis, followed by appropriate treatment, ensures a good recovery for most pleurisy patients. Generally speaking, the prognosis for pleurisy is linked to the seriousness of its cause. Therefore, the outcome of pleurisy caused by a disease such as cancer will vary depending on the type and location of the tumor.

Prevention of Pleurisy

 

Preventing pleurisy is often a matter of providing early medical attention to conditions that can cause pleural inflammation. Along this line, appropriate antibiotic treatment of bacterial respiratory infections may successfully prevent some cases of pleurisy. Maintaining a healthy lifestyle and avoiding exposure to harmful substances (for example, asbestos) are more general preventative measures.

 

 

 

 

 

 

SCIATICA

 

Sciatica is a condition involving impaired movement and/or sensation in the leg, caused by damage to the sciatic nerve.

Information about Sciatica

 

Sciatica is a form of peripheral neuropathy. It occurs when there is damage to the sciatic nerve, located in the back of the leg. This nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg and the sole of the foot. Incomplete damage to the sciatic nerve may appear identical to damage to one of the branches of the sciatic nerve (tibial nerve dysfunction or common peroneal nerve dysfunction).

 

A problem in a single nerve group, such as the sciatic nerve, is classified as a mononeuropathy. The usual causes are direct trauma (often due to an injection into the buttocks), prolonged external pressure on the nerve, and pressure on the nerve from nearby body structures. It can also be caused by entrapment -- pressure on the nerve where it passes through a narrow structure. The damage slows or prevents conduction of impulses through the nerve.

 

The sciatic nerve is commonly injured by fractures of the pelvis, gunshot wounds, or other trauma to the buttocks or thigh. Prolonged sitting or lying with pressure on the buttocks may also injure it. Systemic diseases, such as diabetes, can typically damage many different nerves, including the sciatic nerve. The sciatic nerve may also be harmed by pressure from masses such as a tumor or abscess, or by bleeding in the pelvis.

 

In many cases, no cause can be identified.

 

Note: A ruptured lumbar disk in the spine may cause symptoms that simulate the symptoms of sciatic nerve dysfunction.

Symptoms of Sciatica

Sensation changes

Of the back of the calf or the sole of the foot

Numbness, decreased sensation

Tingling, burning sensation

Pain, may be severe

Abnormal sensations

Weakness of the knee or foot

Difficulty walking

Inability to move the foot (in severe cases)

Inability to bend the knee (in severe cases)

 

Individuals with sciatica may experience some lower back pain, but the most common symptom is pain that radiates through one buttock and down the back of that leg. The most identified cause of the pain is compression or pressure on the sciatic nerve. The extent of the pain varies between individuals. Some people describe pain that centers in the area of the hip, and others perceive discomfort all the way to the foot. The quality of the pain also varies; it may be described as tingling, burning, prickly, aching, or stabbing.

 

Onset of sciatica can be sudden, but it can also develop gradually. The pain may be intermittent or continuous, and certain activities, such as bending, coughing, sneezing, or sitting, may make the pain worse.

 

Chronic pain may arise from more than just compression on the nerve. According to some pain researchers, physical damage to a nerve is only half of the equation. A developing theory proposes that some nerve injuries result in a release of neurotransmitters and immune system chemicals that enhance and sustain a pain message. Even after the injury has healed, or the damage has been repaired, the pain continues. Control of this abnormal type of pain is difficult.

Diagnosis of Sciatica

 

Before treating sciatic pain, as much information as possible is collected. The individual is asked to recount the location and nature of the pain, how long it has continued, and any accidents or unusual activities prior to its onset. This information provides clues that may point to back strain or injury to a specific location. Back pain from disk disease, piriformis syndrome, and back strain must be differentiated from more serious conditions such as cancer or infection. Lumbar stenosis, an overgrowth of the covering layers of the vertebrae that narrows the spinal canal, must also be considered. The possibility that a difference in leg lengths is causing the pain should be evaluated; the problem can be easily be treated with a foot orthotic or built-up shoe.

 

Often, a straight-leg-raising test is done, in which the person lies face upward and the health- care provider raises the affected leg to various heights. This test pinpoints the location of the pain and may reveal whether it is caused by a disk problem. Other tests, such as having the individual rotate the hip joint, assess the hip muscles. Any pain caused by these movements may provide information about involvement of the piriformis muscle, and piriformis weakness is tested with additional leg-strength maneuvers.

 

Further tests may be done depending on the results of the physical examination and initial pain treatment. Such tests might include magnetic resonance imaging (MRI) and computed tomography scans (CT scans). Other tests examine the conduction of electricity through nerve tissues, and include studies of the electrical activity generated as muscles contract (electromyography), nerve conduction velocity, and evoked potential testing. A more invasive test involves injecting a contrast substance into the space between the vertebrae and making x-ray images of the spinal cord (myelography), but this procedure is usually done only if surgery is being considered. All of these tests can reveal problems with the vertebrae, the disk, or the nerve itself.

Treatment of Sciatica

 

Initial treatment for sciatica focuses on pain relief. For acute or very painful flare-ups, bed rest is advised for up to a week in conjunction with medication for the pain. Pain medication includes acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, or muscle relaxants. If the pain is unremitting, opioids may be prescribed for short-term use or a local anesthetic will be injected directly into the lower back. Massage and heat application may be suggested as adjuncts.

 

If the pain is chronic, different pain relief medications are used to avoid long-term dosing of NSAIDs, muscle relaxants, and opioids. Antidepressant drugs, which have been shown to be effective in treating pain, may be prescribed alongside short-term use of muscle relaxants or NSAIDs. Local anesthetic injections or epidural steroids are used in selected cases.

 

As the pain allows, physical therapy is introduced into the treatment regime. Stretching exercises that focus on the lower back, buttock, and hamstring muscles are suggested. The exercises also include finding comfortable, pain-reducing positions. Corsets and braces may be useful in some cases, but evidence for their general effectiveness is lacking. However, they may be helpful to prevent exacerbations related to certain activities.

 

With less pain and the success of early therapy, the individual is encouraged to follow a long-term program to maintain a healthy back and prevent re-injury. A physical therapist may suggest exercises and regular activity, such as water exercise or walking. Patients are instructed in proper body mechanics to minimize symptoms during light lifting or other activities.

 

If the pain is chronic and conservative treatment fails, surgery to repair a herniated disk or cut out part or all of the piriformis muscle may be suggested, particularly if there is neurologic evidence of nerve or nerve-root damage.

Alternative treatment of Sciatica

 

Massage is a recommended form of therapy, especially if the sciatic pain arises from muscle spasm. Symptoms may also be relieved by icing the painful area as soon as the pain occurs. Ice should be left on the area for 30-60 minutes several times a day. After 2-3 days, a hot water bottle or heating pad can replace the ice. Chiropractic or osteopathy may offer possible solutions for relieving pressure on the sciatic nerve and the accompanying pain. Acupuncture and biofeedback may also be useful as pain control methods. Body work, such as the Alexander technique, can assist an individual in improving posture and preventing further episodes of sciatic pain.

Prognosis of Sciatica

 

Most cases of sciatica are treatable with pain medication and physical therapy. After 4-6 weeks of treatment, an individual should be able to resume normal activities.

Prevention of Sciatica

 

Some sources of sciatica are not preventable, such as disk degeneration, back strain due to pregnancy, or accidental falls. Other sources of back strain, such as poor posture, overexertion, being overweight, or wearing high heels, can be corrected or avoided. Cigarette smoking may also predispose people to pain, and should be discontinued.

 

General suggestions for avoiding sciatica, or preventing a repeat episode, include sleeping on a firm mattress, using chairs with firm back support, and sitting with both feet flat on the floor. Habitually crossing the legs while sitting can place excess pressure on the sciatic nerve. Sitting a lot can also place pressure on the sciatic nerves, so it's a good idea to take short breaks and move around during the work day, long trips, or any other situation that requires sitting for an extended length of time. If lifting is required, the back should be kept straight and the legs should provide the lift. Regular exercise, such as swimming and walking, can strengthen back muscles and improve posture. Exercise can also help maintain a healthy weight and lessen the likelihood of back strain.

 

 

 

 

 

SACROILIAC DISEASE

 

Sacroiliac disease is high-impact trauma to the sacroiliac joint that can cause death, or bone, and nerve damage.

General information about Sacroiliac disease

 

The sacroiliac joint is a strong, weight bearing synovial joint between the ilium and sacrum bones of the pelvis. The bones are held in place and allowed limited movements by a system of sacroiliac ligaments. Relaxation of this and other joints and ligaments is important during pregnancy and is accomplished by a special hormone called relaxin. Usually the sacroiliac is damaged by high-impact injuries. These injuries may be life threatening and mortality is approximately 20% if neighboring structures are also damaged. Injuries to this area often includes neurological deficits. Dislocation and nerve damage are frequently missed in the diagnosis.

Causes of Sacroiliac disease

 

The primary cause of dislocations, fractures, and accompanying damage is usually a traumatic accident. Patients receiving such injuries require emergency medical attention. There may be severe blood loss due to breakage of large bones and resuscitative measures may be required for stabilization.

Diagnosis of Sacroiliac disease

 

The diagnosis can be difficult since nerve damage can mimic other conditions with similar symptoms (i.e., low back pain in persons with sciatica). Additionally imaging studies and physical examination maneuvers will miss the diagnosis. The definitive method for diagnosing sacroiliac pathology would be injection of local anesthetic in the correct area of the affected sacroiliac joint. This procedure is usually performed using advance guidance systems (CT or fluoroscopic assisted guidance). If the pain is relieved by anesthetic injection, then the diagnosis is confirmed. There are three typical patterns of pain: pain directly over the joint, pain in the groin extending down the affected leg that can mimic the signs associated with a herniated lumbar disc, and pain widely dispersed in the affected leg.

Treatment of Sacroiliac disease

 

Treatment initially can include emergency interventions, but usually is conservative. Treatment includes physical therapy, manipulation, and medications for pain control. In some cases a sacroiliac belt can help with symptoms. In sacroiliac joint disease that has already progressed and is chronic and severe, corrective joint fusion may be indicated.

 

 

 

 

 

OSTEOCHONDROSIS

 

Osteochondrosis disease is a painful swelling of the bump on the front of the upper tibia (lower leg bone) in an area called the anterior tibial tubercle.

Information about of Osteochondrosis

 

To understand what's going on in osteochondrosis, you need to understand a bit about how bones grow. Bones grow by initially forming a cartilage template, onto which calcium is deposited to form bone, (this process is called "ossification", and when the cartilage has been turned into bone it is "ossified"). Osteochondrosis is an abnormality in this normal development of bones, and generally affects the joints. It resembles, but is distinct from hip dysplasia in many respects, in that it too is a developmental disorder of cartilage-bone formation. The ends of a bone grow in two places. Firstly, at the epiphyseal plate. This is a cartilaginous region of the bone, the location of the greatest part of growth. Secondly, the cartilage which overlies the end of the bone, at the joint, also grows, and becomes ossified at the junction of bone and cartilage. You can see these areas of growth on this picture:

 

There are two main forms of osteochondrosis. If the problem occurs at the epiphyseal plate, then the overlying bone will not join properly to the main shaft of the bone. If the problem occurs at the joint surface, then a thickened area of cartilage develops which is only loosely attached to the underlying bone. This can shear, resulting in the formation of a flap. This is known as osteochondritis dissecans (OCD).

Causes of Osteochondrosis

 

Many theories have been advanced to account for osteochondrosis, but none has proven fully satisfactory. Stress and ischemia (reduced blood supply) are two of the most commonly mentioned factors. Athletic young children are often affected when they overstress their developing limbs with a particular repetitive motion. Many cases are idiopathic, meaning that no specific cause is known.

 

The most common symptom for most types of osteochondrosis is simply pain at the affected joint, especially when pressure is applied. Locking of a joint or limited range of motion at a joint can also occur.

 

Scheuermann's disease can lead to serious kyphosis (hunchback condition) due to erosion of the vertebral bodies. Usually, however, the kyphosis is mild, causing no further symptoms and requiring no special treatment.

Diagnosis of Osteochondrosis

 

A doctor can make a diagnosis during a physical examination. A bone X-ray may be normal, may show soft tissue swelling, or may demonstrate fragmentation of the the tibial tubercle.

Treatment of Osteochondrosis

 

Initial treatment includes rest, ice, and nonsteroidal anti-inflammatory medication (NSAIDS, for example ibuprofen). In many cases, the condition will disappear with rest, pain medication, and the reduction of sports or exercise.

 

In the rare case where symptoms do not resolve, the affected leg may be immobilized by a cast or brace until healing takes place. This typically takes 6 to 8 weeks. Crutches can be used for walking to keep weight off the affected leg.

 

Rarely, surgery may be needed if the initial treatment fails.