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Contents
1 2012 5
1.1 April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
All That Tingles Is Not Carpal Tunnel! (2012-04-04 05:51) . . . . . . . . . . . . . . . . . . 5
Arthritis of the Elbow (2012-04-20 05:39) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.2 May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
JOINT ARTHRITIS (2012-05-05 11:20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Arthritis (2012-05-16 11:02) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.3 June . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Plantar Fasciitis (2012-06-08 07:02) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Does Your Shoulder keep you awake at Night? (2012-06-13 06:04) . . . . . . . . . . . . . . 12
1.4 July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Tennis Elbow (2012-07-02 10:11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Knee Arthritis Treatment (2012-07-07 08:10) . . . . . . . . . . . . . . . . . . . . . . . . . . 16
1.5 August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
INJURIES OF THE CERVICAL SPINE (2012-08-16 08:53) . . . . . . . . . . . . . . . . . . 17
Osteomyelitis (Bone Infection Disease) (2012-08-27 08:26) . . . . . . . . . . . . . . . . . . . 20
1.6 September . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Treatment of Amputation (2012-09-07 11:22) . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Injury To The Coccyx (Tailbone) (2012-09-29 08:56) . . . . . . . . . . . . . . . . . . . . . . 28
1.7 October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Rickets (Deﬁciency of Vitamin D, Calcium and Phosphate) (2012-10-09 07:24) . . . . . . . 30
1.8 November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Meniscal (Cartilage) Tear (2012-11-03 12:07) . . . . . . . . . . . . . . . . . . . . . . . . . . 32
How to get relief from Pelvic Pain Injuries? (2012-11-20 12:14) . . . . . . . . . . . . . . . . 35
1.9 December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
How to treat Arthritis Disease? (2012-12-18 06:01) . . . . . . . . . . . . . . . . . . . . . . . 42
What will causes of Ankle Pain Injury? (2012-12-28 07:34) . . . . . . . . . . . . . . . . . . 49
3

2 2013 55
2.1 January . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
To Know About Genu Valgum (Knock Knees) (2013-01-02 11:40) . . . . . . . . . . . . . . . 55
How can we prevent Medial Meniscus Injury? (2013-01-15 05:27) . . . . . . . . . . . . . . . 58
2.2 February . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
How to treat Hip Dislocation? (2013-02-05 10:26) . . . . . . . . . . . . . . . . . . . . . . . . 61
How to diagnose Knee Joint Injury? (2013-02-21 09:48) . . . . . . . . . . . . . . . . . . . . 65
2.3 March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Obesity is emerging as a serious health threat among children (2013-03-06 07:05) . . . . . . 68
2.4 April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Carpal Tunnel Syndrome (2013-04-10 05:52) . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
2.5 June . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
How to Recover from Rheumatoid Arthritis? (2013-06-24 11:16) . . . . . . . . . . . . . . . 71
2.6 July . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Diving and Swimming Tips (2013-07-29 03:35) . . . . . . . . . . . . . . . . . . . . . . . . . 73
2.7 August . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Safety Tips for Young Drivers (2013-08-21 06:39) . . . . . . . . . . . . . . . . . . . . . . . . 74
2.8 October . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Experts’ Advice to Avoid Medical Errors (2013-10-22 08:22) . . . . . . . . . . . . . . . . . . 75
Steroid Injection Therapy May Increase Risk of Spinal Fracture (2013-10-29 07:33) . . . . . 79
2.9 November . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Advantages of Computer Assisted Surgery (2013-11-20 10:14) . . . . . . . . . . . . . . . . . 80
2.10 December . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Treatment for Achilles Tendon Injuries (2013-12-19 09:36) . . . . . . . . . . . . . . . . . . . 81
3 2014 85
3.1 January . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Post Knee Rehabilitation: Do’s and Don’ts (2014-01-15 12:14) . . . . . . . . . . . . . . . . 85
3.2 February . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Morton’s Neuroma (2014-02-14 05:38) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
3.3 March . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
BONE & JOINT (2014-03-14 07:13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
3.4 April . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Greenstick Fracture (2014-04-26 12:30) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
3.5 May . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Legg- Calve Perthes Disease (2014-05-27 11:21) . . . . . . . . . . . . . . . . . . . . . . . . . 94
4

Chapter 1
2012
1.1 April
All That Tingles Is Not Carpal Tunnel! (2012-04-04 05:51)
In Reality, All Tinglings are not Carpal Tunnel Syndromes
Numbness of the hands and [1]carpal tunnel syndrome are synonymous for many patients. If hand or ﬁngers
experience weakness or tingling sensation, there is an automatic assumption of [2]carpal tunnel syndrome.
The term has gained familiarity in the work places where upper extremities are exposed to repetitive motion.
Keyboards are gaining notoriety for contributing to the condition. The syndrome has become a common
household term in the nineties
[3]
Carpal Tunnel Syndrome Treatment
An assortment of factors produces [4]pain, numbness, and weakness in the upper extremities and closely
mimics the picture of carpal tunnel syndrome. Numbness is not necessarily a result of nerve pinching either -
this is a second common misconception.
Conditions aﬀecting as remote areas as the shoulders may produce a heavy and numb sensation in the [5]upper
extremity. None of this has to do with any nerves whatsoever. Conversely, a [6]carpal tunnel syndrome pain
may extend as high as the shoulder and can be confused with a shoulder condition.
5

Vascular conditions that compromise the circulation to the extremity are also accompanied by tingling
and numbness. Conditions of the heart have been known to produce extremity symptoms these include[7]
symptoms oftingling and numbness.
Metabolic disorders are another culprit on the list mimicking carpal tunnel syndrome. On the top of the list
are [8]Diabetes and thyroid disorders. These produce symptoms with or without nerve compression (nerve
pinching).
Conditions of the neck frequently produce numbness, pain, and weakness of the hands. Arthritic or disc
conditions of the neck may produce nerve compression in the neck which produce [9]symptoms in the upper
extremities.
The term [10]carpal tunnel is derived from the tunnel shaped configuration of the tiny wrist bones. This
tunnel harbors tendons that flex our fingers. A nerve called the median nerve is packed along the tendons.
The median nerve carries sensations to the thumb and the majority of the fingers. The space has very little
tolerance to any swelling and the resulting pressure. A wide variety of [11]causes may produce pressure in the
carpal tunnel. One of the physiological causes is pregnancy. Pregnancy related symptoms usually disappear
after childbirth.
It is not uncommon to experience pain at night. Positions of wrist flexion such as driving and holding a
newspaper [12]trigger pain andnumbness. Keyboards have a similar effect.
Treatments:
Examination usually requires a careful history and evaluation of the related symptoms. Blood tests and nerve
conduction studies may be necessary to establish the diagnosis. Treatment usually consists of treating the
underlying causes if they are identifiable. Splinting, protection, and anti-inflammatory medications produce
considerable relief for most cases. [13]Carpal tunnel injections may be useful for more [14]chronic cases.
C decompression is indicated for advanced or truely refractory cases. This out-patient procedure can be
performed under a local or regional anesthesia.
1. http://centerforadvancedorthopedics.com/
2. http://centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx
3. http://centerforadvancedorthopedics.files.wordpress.com/2012/04/carpal-tunnel-treatment.jpg
4. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx
Arthritis of the Elbow (2012-04-20 05:39)
Arthritis of the Elbow: Causes, Types, Treatments, Procedure.
How many times a day do you bend your elbow? A person usually bends their [1]elbow hundreds of times a
day. Now imagine if every time you bent your elbow, you [2]felt the pain of arthritis. For many Americans,
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this scenario is all too true. [3]Arthritis of the elbow can cause pain not only when they bend their elbow,
but also when they straighten it.
Causes of Arthritis of the Elbow:
• [4]Rheumatoid Arthritis (RA).
• [5]Osteoarthritis (OA or ”wear-and-tear” arthritis)
• [6]Trauma
[7]RA is a disease of the joint linings, or synovia. As the joint lining swells, the joint space narrows. The
disease gradually destroys the bones and soft tissues. Usually, [8]RA affects both elbows, as well as other
joint s such as the hand, wrist and shoulder.
[9]OA affects the cushioning cartilage on the ends of the bones that enables them to move smoothly in the
[10]joint. As the cartilage is destroyed, the bones begin to rub against each other. Loose fragments within
the joint may accelerate degeneration.
[11]Trauma or injury to the elbow can also damage the articular cartilage. This eventually leads to the
development of post [12]traumatic arthritis. Usually, this form of arthritis is confined to the injured joint.
In the early stages of RA, pain may be primarily on the outer side of the joint. Pain generally worse ns as you
turn (rotate) your forearm. The pain of OA may intensify as you extend your arm. Pain that [13]continues
during the night or when you are at rest indicates a more advanced stage of OA. In addition to pain, one may
experience swelling, inability to perform daily activities because the elbow gives away, inability to straighten
or [14]bend the elbow, [15]locking of the elbow, and [16]stiffness in the elbow. At times, both elbows are
involved or pain can occur at the wrist, shoulders, and elbow; this is indicative of RA.
Treatment:
The initial treatment is non- surgical and depends on the [17]type of arthritis. Your physician will discuss
the options with you and develop an individualized program of medical and physical activities. Among the
therapies that can be used are: activity modification; since, OA may be linked to repetitive overuse of the
joint, modifying job or sports activities can be helpful. Intermittent periods of rest can relieve[18] stress on
the elbow. Painkillers, such as acetaminophen or ibuprofen can provide short-term pain relief. More potent
agents can be prescribed to treat RA. These include anti malarial agents, gold salts, immunosuppressive
drugs, and corticosteroids. An injection of a corticosteroid into the joint can often help. Physical therapy is
another treatment option; heat or cold applications and gentle exercises may be prescribed. A splint worn
at night, or one that permits movement as it protects the elbow from stresses, may also be helpful. Other
assistive devices, such as handle extensions, can be used to maintain daily activities.
Surgical Treatment:
If your arthritis does not respond to the above [19]treatments, you and your physician may discuss surgical
options. Because several nerves are near the elbow, a skilled orthopedic surgeon should be consulted.
[20]Surgery usually results in improved pain control and increased range of motion.
Procedure:
The exact procedure will depend on the [21]type of arthritis you have, the stage of the disease, your age,
expectations, and activity requirements. Arthroscopy, a procedure involving pencil-sized instruments and
two or three small incisions, allows the surgeon to remove bone spurs, loose fragments, or a portion of the
diseased synovium. This procedure can be used to treat both RA and OA. Another procedure is called a
synovectomy; here, the [22]surgeon removes the diseased synovium. Sometimes, a port ion of bone is also
removed to provide a greater range of motion. This procedure is often used in the early stages of RA. In
7

an osteotomy, part of the bone is removed to relieve pressure on the joint. This procedure is often used to
treat OA. In an arthroplasty, the surgeon creates an artificial joint using either an internal prosthesis or an
external fixation device. A total [23]joint replacement is usually reserved for patients over 60 years old or
patients with RA in advanced stages.
7. http:
//centerforadvancedorthopedics.com/Contact-Main-Office-And-Hollywood-Office-For%20Advanced-Orthopedics.aspx
9. http:
11. http:
12. http://centerforadvancedorthopedics.com/About-Your-Visit-in-Center-For-Advanced-Orthopedics.aspx
1.2 May
JOINT ARTHRITIS (2012-05-05 11:20)
Is [1]ARTHRITIS LIMITING YOU?
[2]Arthritis is a painful joint condition that affects a reported 32.9 million American adults. Though it
commonly occurs in adults however, children can also be affected. Arthritis can occur in an [3]injured or
[4]diseased joint. A joint is where the ends of two or more bones meet. The bone ends of a joint are covered
with cartilage, a smooth material that cushions the bone and allows the[5] joint to move smoothly without
pain.
Types:
Though there are more than a hundred different types of[6] arthritis, the two most common types
are called [7]Osteoarthritis and [8]Rheumatoid Arthritis.
8

[9]Osteoarthritis Arthritis:
[10]Osteoarthritis is found in the joints of older people and in injured or overused joints of younger
individual. It is commonly found in the knee, hips, and spine. In this type of [11]arthritis, the cartilage
covering the joint begins to wear away. Occasionally, bone growths, called ”spurs”, can develop in the joint.
The resulting inflammation in the[12] joint causes pain and swelling.
[13]Rheumatoid Arthritis:
[14]Rheumatoid arthritis, another common form of [15]arthritis, is a long lasting disease in which
the joint lining swells. This swelling invades surrounding tissues and causes chemical substances to attack
and destroy the joint surface. Though [16]rheumatoid arthritis is commonly found in the hands and feet, it
can also occur in the knees, hips, and elbows. [17]Swelling, pain, and stiffness are present even when the joint
is not used. Though rheumatoid arthritis can affect anyone, more than seventy percent of those with this
disease are above thirty. The main approach to treating arthritis centers on pain relief, increased motion, and
increased strength. Many over-the-counter medications, including aspirin, ibuprofen, and naproxen can be
used to control pain and inflammation associated with arthritis. Prescription medications are also available if
over-the counter medications are not effective. People with [18]arthritic joints can use canes, crutches, and
walkers to help relieve the stress placed on arthritic joints.
[19]Treatment:
Exercising and physical therapy can also be helpful in decreasing stiffness and in strengthening
muscles around the joints. If these methods of [20]treatment are not successful, surgery is recommended.
The type of surgery depends on the extent of [21]arthritis in the joints, its type, and the physical condition of
the patient. [22]Surgical procedures include removal of the diseased or damaged joint lining, realignment of
the joints, [23]total joint replacement, and fusion of the bone ends of a joint to prevent joint motion and
relieve joint pam.
Though there is no present cure for arthritis, researchers continue to make progress in finding the
underlying causes for the major [24]types of arthritis.
Still, people with arthritis can continue to perform normal activities. Various exercise programs,
anti inflammatory drugs, and [25]weight reduction programs for obese people are ways to reduce pain,
stiffness, and improve function. In persons with severe cases of arthritis, [26]orthopedic surgery can often
provide dramatic pain relief and restore lost joint function. A total joint replacement, for example, can
usually enable a person with severe arthritis in the hip or the knee to walk around without pain or stiffness.
Consult your orthopedic doctor if you are having symptoms typical of arthritis.
3. http://centerforadvancedorthopedics.com/Default.aspx
5. http:
6. http:
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9. http://centerforadvancedorthopedics.com/Location-Of-Advaced-Orthopedics.aspx
19. http://centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.
Arthritis (2012-05-16 11:02)
Managing Arthritis in Active Adults:
All painful knees are not necessarily [1]arthritic. The knee is a complex joint with several moving parts
which is frequently challenged during regular and recreational activities. It is not uncommon for one part or
another to start showing signs of strain or regular wear and tear of the[2] joint surface, which is also known
as articular cartilage. This surface has appearance of a resilient plastic that is well constructed to absorb the
repetitive loads during walking and running. The joint surface may start to show signs of wear and tear with
or without apparent injury. This wear and tear of the joint surface is also known as degenerative [3]arthritis.
If the pain is produced by strains of parts other than the joint surface, the condition is not [4]arthritic.
Smoking, overweight, trauma, repetitive loading and misalignments of the joint contribute to the development
and continuation of the [5]knee arthritis. The knee has three main compartments or moving sections, which
absorb the body loads during physical activities. The arthritic condition may involve one, two or all three
compartments of the joint. It is important for the patients to have this knowledge, since the treatment may
differ depending upon the involvement of a particular compartment. [6]Pain and stiffness are two of the most
common [7]symptoms of arthritis. At times, this may be accompanied by swelling, popping, clicking and
sensations of giving out. It is important to know that non-[8]arthritic conditions of the knee can also produce
similar symptoms that closely mimic arthritis. A history of symptoms, clinical examination and standing X-
rays are usually sufficient to make a correct diagnosis of degenerative arthritis. On rare occasions, additional
testing such as CT scan or MRI scans may be necessary to arrive at a diagnosis. These additional tests are
unnecessary and redundant in more than 90 % of patients. The X- rays might show joint space narrowing,
small bone over growths such as bone spurs or deposits of calcium. At times the X- rays look completely
normal and further investigations become necessary in face of continuing symptoms.
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1.3 June
Plantar Fasciitis (2012-06-08 07:02)
Symptoms And Treatment Of Heel Spur Syndrome:
[1]Plantar Fasciitis is commonly known as ”[2]heel spur syndrome”. It is common among people who
are active in sports (i.e. running). This [3]pain generally begins as a dull pain in the heel that may come
and go. At times the pain may be sharp and persistent. The pain is usually worse after times of rest such as
sitting or sleeping; therefore, more pain is noticed in the mornings or at the start of physical activities. The
[4]plantar fascia is a thick fibrous band on the bottom of the foot. This is attached from the heel bone to the
toes and acts as a bowstring to produce the arch of the foot.
Running and other activities may place tension on the [5]fascia. This prolonged tension causes the fas-
cia to swell at the point where the fascia is attached to the [6]heel bone. Injury may also occur at the mid-sole
or near the toes. It is difficult to rest the foot; therefore, it is important to seek treatment as soon as possible
so that the problem does not progress. The [7]swelling reaction of the heel bone may produce new bone
called [8]heel spurs. They are not initially painful and do not cause the problem; however, walking on spurs
may cause sharp pain. Some contributing factors include flat feet, high arched feet, poor shoe support, toe
running, soft terrain, increasing age, sudden increase in activity level, or family tendency. Keep in mind that
plantar fasciitis may be aggravated by weight bearing sports.
Treatment for Plantar Fasciitis
Improvement may take longer if the condition has existed for a long time. It is important to wear good
shoes and to lose excess weight. During the recovery period, it would be helpful to replace weight bearing
[9]sports with non-weight bearing sports such as cycling or swimming. Weight training will help to maintain
leg strength. A sport is considered weight-bearing if the foot is repeatedly landing on the ground such as
running or jogging.
• [10]Treatment of plantar fasciitis includes rest. Pain will be the guide to let you know when you should
rest your foot.
• Ice can be applied for 30 to 60 minutes several times a day to [11]reduce swelling. The ice can be placed
in a plastic bag covered with a towel. Apply ice for “approximately 15 minutes after activity.
• Anti-inflammatory/analgesic medication may also be used to reduce swelling. If there is no help after
2-3 weeks, the [12]physician may decide to inject the tender area with cortisone or a local anesthetic.
• A heel or felt sponge can help to spread, equalize, and absorb the shock as your heel lands. This would
ease the pressure on the [13]plantar fascia. You may need to cut a hole in the sponge over the painful
area to avoid irritation.
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• [14]Surgery is rarely required for plantar fasciitis . It would only be considered if all other forms of
conservative treatment fails.
• When necessary, surgery requires the removal of the [15]bone spur and release of the plantar fascia.
After recovery, return to sports activities slowly. Pain will indicate that you are doing too much. Your
physician can give you the proper exercises to strengthen the small muscles of the foot and to support the
damaged areas. This will help prevent [16]re-injury.
1. http://www.centerforadvancedorthopedics.com/Surgeons-Information-in-Orthopedic-Therapy.aspx
2. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedic
3. http://www.centerforadvancedorthopedics.com/About-Center-for-Advanced-Orthopedic-MD.aspx
5. http://www.centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx
6. http://www.centerforadvancedorthopedics.com/Patient-Education-of-Orthopedics-Clinic.aspx
8. http://www.centerforadvancedorthopedics.com/About-Your-Visit-in-Center-For-Advanced-Orthopedics.aspx
13. http://http//www.centerforadvancedorthopedics.com/Staff-Information-Of-Advance-Orthopedic-.aspx
15. http://http//www.centerforadvancedorthopedics.com/About-Your-Visit-in-Center-For-Advanced-Orthopedics.
aspx
Does Your Shoulder keep you awake at Night? (2012-06-13 06:04)
Shoulder Pain: Symptoms, Causes and Treatment.
[1]Shoulder pain is a relatively common condition. Ordinary [2]strains and sprains produce shoul-
der discomfort. Most of the time the condition is self-limiting and resolves spontaneously.
Some shoulder pains are recalcitrant and progressive. [3]Pain may or may not follow any specific
injury; it may be spontaneous. Patients usually feel[4] stiffness and find themselves experiencing increasing
difficulty in performing day to day routine functions. Pain eventually starts to invade periods of rest.
Patients wake up several times during the night and find themselves rubbing their shoulders or popping
[5]pain medications. Some patients develop weakness and cannot raise their arms to the side or forward. In
most cases there is no visible [6]swelling or lump.
It is not uncommon for some people to discount it as [7]arthritis. They think that since there is
no lasting cure then they must suffer and learn to live with the problem. NOT TRUE! Most [8]chronic
shoulder pains are not arthritic and are relatively easy to cure.
The shoulder is a ball and socket kind of [9]joint. It is surrounded by an envelope of deep muscles
12

called [10]rotator muscles or commonly known as ”rotator cuff”. The cuff symbolizes an envelope like
configuration. The [11]cuff is further covered by a [12]bony arch which provides shape and an outer
configuration to the shoulder. The actual joint sits deeper, right below the bridge.
Causes:
Due to several reasons, the [13]muscles start to rub against the bony arch. This rubbing starts to
produce irritation of the rotator cuff. If the rubbing continues for a period of time, the cuff starts to erode.
The final outcome may be a good size tear in the cuff. The pressure and rubbing is the cause of pain.
[14]Night pain indicates probable erosion of the cuff although this is not necessarily the case in each and
every patient. This condition is also called ”[15]Impingement Syndrome”.
A simple office examination usually reveals the problem. X-rays are usually performed to obtain
further information. In some patients, special investigations are indicated to verify tears of the cuff. Local
[16]anesthetic injection, at times, is applied to confirm the diagnosis of impingement.
Another common cause of shoulder pain is degeneration of a tiny joint above the shoulder, the AC
or acromioclavicular joint. Pain from this condition is usually on the top of the shoulder. One can usually feel
a tender spot right over the shoulder. True arthritis of the [17]shoulder joint is rather an uncommon cause.
One should always remember certain serious causes of shoulder pain. Fortunately these causes are
rare. [18]Bone tumors, serious conditions in the chest or the abdomen can produce vague shoulder pain.
Nerves pinching in the neck or TMJ conditions are also relatively common but non-serious causes of shoulder
pain.
Treatment:
[19]Treatment of the problem is based upon the cause.
• Most cases are mild and relatively easily manageable.
• Medications, simple exercises, and physical therapy are the usual treatments.
• Most patients benefit from this plan. Some patients require injections, arthroscopy or [20]surgical
correction to get rid of the problem.
• For specific information on this condition, consult your[21] physician.
5. http://centerforadvancedorthopedics.com/Specialities-Center-For-Advanced-Orthopedics.aspx
7. http://centerforadvancedorthopedics.com/Patient-Education-of-Orthopedics-Clinic.aspx
9. http://centerforadvancedorthopedics.com/Current-Event-Center-For-Advanced-Orthopedics.aspx
10. http://centerforadvancedorthopedics.com/Staff-Information-Of-Advance-Orthopedic-.aspx
12. http:
13

14. http://centerforadvancedorthopedics.com/Insurances-Accepted-Advaced-Orthopedics.aspx
16. http://centerforadvancedorthopedics.com/Testimonial-Center-For-Advanced-Orthopedics.aspx
20. http:
1.4 July
Tennis Elbow (2012-07-02 10:11)
Lateral Epicondylitis: Symptoms And Treatment
[1]Tennis Elbow is an inflammation around the [2]bony knob of the outer side of the elbow. It oc-
curs when the tissue that attaches [3]muscle to the bone becomes irritated. The bony knob is called the
[4]lateral epicondyle; therefore, Tennis Elbow is also called lateral epicondylitis.
The muscles that allow you to straighten your [5]fingers and rotate your [6]lower arm and wrist are
called [7]extensor muscles. These muscles extend from the outer side of your elbow to your wrist and fingers.
A cord like fiber called a [8]tendon attaches the extensor muscles to the elbow. Overuse or an accident can
cause tissue in the tendon to become inflamed or [9]injured.
Tennis elbow can be caused by playing a racket sport or doing anything that involves extending
your [10]wrist or rotating your forearm such as twisting a screwdriver or lifting heavy objects with your palm
down. It is common for the [11]tissue to become inflamed more easily as you get older.
When the tendon is inflamed, the [12]nerves around the tendon become irritated. Then moving
your elbow is painful. Turning your hand or grasping objects can also be painful. The most common
symptom of tennis elbow is pain on the outer side of the elbow and down the [13]forearm. You may have
pain all the time or only when you lift things. The elbow may also swell, get red, or feel warm to the touch.
It may also hurt to grip, turn your hand or swing your [14]arm.
Tennis elbow can be diagnosed from hearing symptoms and from the look and feel of your elbow.
Treatment for Tennis Elbow
[15]Treatment will depend how inflamed the tendon is. The goal of treatment will be to relieve the
symptoms and regain full use of your elbow.
Rest and Medication: The doctor may prescribe a tennis elbow splint to rest the [16]inflamed ten-
don and allow it to heal. You may wish to use the other hand or change grips to reduce the amount of stress
on the tendon. Oral anti-inflammatory medications may be used to reduce [17]swelling. Heat or ice may also
14

be used to reduce swelling and relieve [18]pain.
Exercise and therapy: Exercises and [19]therapy may be prescribed to gently stretch and strengthen the
muscles around your [20]elbow.
Anti-Inflammatory Injections: An injection may be given with an [21]anti-inflammatory such as cor-
tisone to help reduce the swelling. You may have more pain at first; but, within a few days, your elbow
should feel better.
Surgery: [22]Surgery may be an option if no other treatments relieve the [23]pain or if the symp-
toms persist for a long period of time. Surgery would be used to repair the inflamed tendon.
PREVENTION
It is important to try to prevent a flare-up of [24]tennis elbow. You may wish to make a few
changes in the way you do certain things. You should grip with the palm up and lift heavy objects with both
hands. If you play racket [25]sports or golf, it is important to condition your [26]muscles, do warm-up and
cool down exercises and use the correct strokes.
1. http://www.centerforadvancedorthopedics.com/
4. http://www.centerforadvancedorthopedics.com/Staff-Information-Of-Advance-Orthopedic-.aspx
8. http://www.centerforadvancedorthopedics.com/Current-Event-Center-For-Advanced-Orthopedics.aspx
14. http://www.centerforadvancedorthopedics.com/Staff-Information-Of-Advance-Orthopedic-.aspx
16. http://www.centerforadvancedorthopedics.com/Contact-Main-Office-And-Hollywood-Office-For%
20Advanced-Orthopedics.aspx
17. http://www.centerforadvancedorthopedics.com/Location-Of-Advaced-Orthopedics.aspx
15

Knee Arthritis Treatment (2012-07-07 08:10)
Pain Relief Treatment for Knee Arthritis:
In the [1]knee, [2]arthritis treatment can take several forms. Selection of [3]treatment takes several fac-
tors into consideration and these may include but are not limited to, severity of [4]pain and disability,
response to previous treatments, number and extent of the compartments that are involved in the [5]disease
process, general health of the patient and circulation of the extremity.
Treatment:
• [6]Treatment could be as simple as modification of the physical activities and periodic utilization of
ordinary pain medications.
• Non-impact activities such as cycling and swimming can provide excellent [7]cardiovascular and aerobic
advantage while the [8]joint is undergoing other medical treatments.
• For mild misalignments, [9]heel wedges and balancing shoe inserts come in handy to alleviate [10]pain
and improve function.
• Non-steroidal anti-inflammatory medications do provide symptomatic relief without reversing the
[11]arthritis.
• Food supplements such as Glucosamine and Chondriotin sulfate also provides symptomatic relief and
do not delay the progression of the arthritis.
• These products are still under active research and their mode of action remains unknown.
Myriad of [12]injections are also utilized to provide symptomatic [13]relief. Among these injectable steroids
and lubricating type of injections are most popular. These injections if effective may provide relief for several
months. Injectable steroids are safe and effective for nasty and painful flares; however, their utilization should
be limited and never applied as a long-term [14]management strategy.
Choice of Surgery:
• [15]Surgical alternatives may be explored for resilient arthritic knees.
• [16]Surgery is an elective choice and never an absolute necessity.
• For arthritis induced loose bodies and related mechanical problems a relatively simple outpatient
procedure of [17]arthroscopy can alleviate the immediate problem without reversing the arthritis itself.
• Removal of loose bodies can extend the life of the joint and postpone the need for major invasive
procedures.
In relatively younger adults, a portion of the joint can be replaced if the disease is localized to a single
compartment. Such a procedure is known as uni-compartmental [18]knee replacement. If more than one
compartment is involved, it may become necessary to replace the entire joint through a standard total knee
replacement. Contrary to common misconception, a total knee replacement doesn’t entail removal of the
entire knee; instead the procedure replaces the uneven arthritic surface with synthetic materials and preserves
the bulk of the original [19]bones that produce the natural shape of the [20]knee joint.
16

Before any surgical procedures patients must familiarize themselves with the exact nature of [21]surgery,
alternate approaches and risks that may accompany such procedures. No one should jump into surgical
options without acquiring sufficient knowledge about the operation.
6. http://www.centerforadvancedorthopedics.com/Download-Forms-of-Orthopedics-Therapy.aspx
11. http://www.centerforadvancedorthopedics.com/Insurances-Accepted-Advaced-Orthopedics.aspx
1.5 August
INJURIES OF THE CERVICAL SPINE (2012-08-16 08:53)
Cervical Spine Injury : Causes, Symptoms and Treatment
[1]Injuries of the [2]cervical spine are dangerous; and if associated with neurological damage, the results can
be devastating. Though diagnostic and [3]treatment methods have vastly improved over years, [4]still injuries
of the cervical spine pose the greatest challenge to the skill and acumen of [5]orthopedic and neurosurgeons.
Jefferson pointed out two areas commonly involved in [6]cervical spine injuries, C1-2 and C5-7. According to
Meyer, C2 and C5 are commonly involved. Neurological damage is seen in 40 percent of cases. In 10 percent
of cases, radiographs are normal.
Causes
• Fall from Height: It is the most common cause in developing countries.
• Diving Injuries: Diving into water with insufficient depth or in an inebriated condition.
17

• Road Traffic Accidents (RTAs): Common cause in developed countries, e.g. [7]whiplash injury
• Gunshot Injuries: These injury the [8]cervical spine and the cord directly.
Mechanism of Injury
• Pure Flexion Force: For Example, compression [9]fracture of vertebral body, e.g. fall from height.
• Flexion Rotation: For Example, fall on one side of the [10]shoulder, disruption of facet capsule is seen.
• Axial Compression: For Example, fall of an object on the head results in load compression, e.g. explosive
comminuted fracture of C5 body.
• Extension Force: For Example, avulsion fracture of superior margin of [11]vertebral body, e.g. whiplash
injury.
• Lateral Flexion: For Example, fracture pedicle, fracture transverse process and [12]facet joints, etc.
• Direct Injuries: For example, fracture spinous process and body. Due to assault, [13]gunshot injury, etc.
WHIPLASH INJURY (SYN: Acceleration injury,[14] cervical sprain syndrome, soft tissue neck injury)
Definition
It is an unconventional and inconsequential ligamentous [15]injury of the cervical spine allegedly due to an
extension injury following a rear-end collision in an RTA.
Incidence
• It is seen in about 25 percent of rear-end collision of RTAs.
• Seventy percent of those affected are women.
• It is common in the 3rd or 4th decades.
Clinical Features
Symptoms
• [16]Upper neck pain that becomes worse with movement.
• Occipital headache.
• [17]Neck stiffness.
• Rarely vertigo, auditory or visual disturbances, etc.
Signs
• Decreased range of neck movements.
18

• Neck muscle spasm is seen.
• [18]Symptoms appear within 48 hours of injury and 57 percent recover within three months. Final state
is reached by one year.
Investigations
X-rays are usually normal. MRI helps to make a diagnosis.
Treatment
It is mainly conservative and consists of the following:
• Drugs: NSAIDs, [19]muscle relaxants, etc. are given.
• Collars: These are recommended for the ﬁrst three days.
• Short [20]arc active movements are slowly begun.
• Active ROM exercises are slowly commenced.
• After the [21]pain subsides, isometric strengthening exercises are slowly commenced.
• Other modalities take ultrasound, traction, manipulation, [22]massage, etc. also helps.
Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-abdul-razaq-md.aspx
About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medicine-in-MD.aspx
5. http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.aspx
7. http://www.centerforadvancedorthopedics.com/Orthopedic-patients-education-related-topics.aspx
9. http:
//www.centerforadvancedorthopedics.com/About-insurances-appointments-fees-payment-structure-information.aspx
11. http:
15. http:
//www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.aspx
16. http://www.centerforadvancedorthopedics.com/Contact-Waldorf-Hollywood-MD-Best-orthopedic-doctor-surgeons.
aspx
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20. http://www.centerforadvancedorthopedics.com/MD-best-orthopedic-center-maps-and-location.aspx
Osteomyelitis (Bone Infection Disease) (2012-08-27 08:26)
Signs, Symptoms And Treatment of Bone Disease:
[1]Osteomyelitis is one of the most difficult and challenging problems encountered in [2]orthopedics.
From the life-threatening [3]acute osteomyelitis to the disabling [4]chronic osteomyelitis, it frustrates and
thwarts the best efforts of orthopedic surgeons. The ravaging effects of osteomyelitis on a [5]bone and its
neighboring joints are a tale of dismay and gloom.
Definition
Osteomyelitis is defined as a suppurative process of the bone caused by [6]pyogenic organisms or
simply a pyogenic infection of the cancellous portion of the [7]bone.
Classification
Three types are described based on duration of [8]symptoms, route of spread of infection and host
response.
Hematogenous spread with primary infection being elsewhere like [9]tonsillitis, ASOM, pyoderma,
etc. is the common mode of spread. Spread from neighboring infective sites like septic [10]arthritis and direct
inoculation of infecting organisms by way of penetrating wounds, punctured wounds, [11]trauma, etc. come
second.
Clinical Features
[12]Acute osteomyelitis is a clinical catastrophe. It presents in the following manner:
Fever
This is the most common presenting symptom. The child usually has very high [13]fever and is as-
sociated with profuse sweating, chills and rigors. Sometimes, the presentation is so acute that the child may
be in shock and [14]unconscious.
Swelling
This usually follows the fever and may affect the ends of long [15]bones. The swelling may be
acutely [16]painful and the [17]skin may appear red.
Limitation of Movement
20

The child may not move the [18]joint near the aﬀected bone due to [19]pain and swelling. In fact,
the child may lie still without moving the joint and this is sometimes called a state of pseudoparalysis.
Clinical Signs
This consists of general and local signs are :
1. General Features
2. Local Features
General Features
Symptoms:
• Fever
• Sweating
• Chills and Rigors
• Patient is usually in shock
Signs
• Increased Temperature
• Increased Pulse Rate
• Anemia
• Signs of dehydration and shock
General features of anemia, [20]dehydration, pyrexia, pulse rate, shock and toxicity may be present.
Local Features
Symptoms
• Local Swelling (80 %)
• Limitation of movement (50 %)
Signs
• Tenderness (80 %)
• Local Erthema (50 %)
21

• Raised Temperature (50 %)
• Fluctuation Present (20 %)
• Effusion (10 %)
• Decreased Movements (50 %)
The local [21]swelling may show increased temperature may be tender to touch, and the [22]skin is stretched.
Movements of the neighboring [23]joints are decreased and there may be effusion in them too.
Investigations
The investigations of [24]acute and chronic osteomyelitis is compared for easy remembrance and under-
standing. In general, in acute osteomyelitis, laboratory investigations and [25]bone scan are more useful while
radiology is of much help in chronic osteomyelitis.
Management
Acute osteomyelitis is an [26]orthopedic emergency, which needs in patient admission.
Treatment
• Rest in Bed: Protect affected part with splints to alleviate [27]pain and spasm.
• Elevation of the part: Warm and moist packs to reduce the [28]swelling.
• Systematic Treatment: Blood transfusions, intravenous fluids to correct shock and hypovolemia.
• [29]Orthopedic Treatment
• [30]Physical Therapy Treatment
Principles of Antibiotics Therapy
• Appropriate drug: Usually the drug chosen is a broad spectrum bactericidal agent.
• Appropriate Route: Intravenous for the first 2 weeks and oral for the next 4 weeks.
• Appropriate Dose: The [31]drug depending on the body weight of the patient.
• Appropriate time to stop: When the [32]disease is eradicated, controlled or resistance or side effects to
the drugs develops.
• Appropriate adjunctive measures: a combination of ampicillin and cloxacillin are found to be very
effective though pencillin G still the drug of first choice in our country.
Surgical Methods:
Depending upon the situation anyone of the following [33]surgical methods could be employed:
22

• Aspiration: It helps in decompression and the material so obtained may be used to identify the organism
and check for [34]antibiotic sensitivity.
• Incision and Drainage: Helps to drain the subcutaneous abscess.
• Multiple drill holes: If the abscess is subperiosteal, this technique helps to drain the [35]pus by making
multiple holes in the cortex.
• Small bone window: If the multiple drill holes do not drain the pus, a small window of [36]bone is
removed from the cortex and the pus is evacuated.
4. http:
7. http://www.centerforadvancedorthopedics.com/Insurances-accepted-at-orthopedic-clinic-center-in-waldorf-md.
aspx
9. http:
aspx
18. http://www.centerforadvancedorthopedics.com/Top-orthopedic-surgeons-staff-in-waldorf-hollywood-MD-USA.
aspx
21. http:
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28. http://www.centerforadvancedorthopedics.com/Maryland-top-best-board-cerified-orthopedic-surgeons-dr-shaheer-yousaf-dr-a
aspx
29. http://www.centerforadvancedorthopedics.com/About-top-orthopedic-clinic-center-for-advanced-orthopedic-and-sports-medic
aspx
aspx
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aspx
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1.6 September
Treatment of Amputation (2012-09-07 11:22)
Upper And Lower Limb Amputation Treatment:
[1]Amputation is a procedure that removes a [2]limb, partly or totally, through the level of one or more
[3]bones, whereas disarticulation is a procedure that removes a limb through the level of a [4]joint.
Amputation is one of the oldest [5]surgical procedures. Reﬁnements in amputation surgeries and advances
in prosthetic designs occurred mainly during the two World Wars. This advancement is progressive and
essential as the number of [6]amputations performed is increasing each year. This is due to an increasing
aging population with greater incidences of [7]diabetes and [8]peripheral vascular diseases as well as due to
an ever increasing incidence of accidents. Amputations are more common in men and more often in the lower
limbs.
Types of Amputation
There are two types of amputation:
(i) Open Amputation
(ii) Closed Amputation
Open Amputation
In open amputation, also called [9]guillotine amputation, the skin is not closed over the amputation stump.
Open amputation is indicated in cases where the wound is grossly contaminated or in cases of severe [10]in-
fections. After amputation the stump is left open and dressed regularly till the infection subsides and the
stump wound becomes healthy. The stump can then be covered by any of following methods:
24

• Skin grafting
• Secondary closure
• Revision of amputation: The amputation is done at a higher level, [11]skin flaps are designed and the
stump wound is closed
Closed Amputation
In this type of amputation, the stump is closed primarily. All elective amputations are closed amputa-
tions.
Surgical Principles
Meticulous attention to details and gentle handling of [12]tissues are essentl.al for a good outcome fol-
lowing amputations. Important principles to be followed during amputation are:
Levels of Amputation
For an amputation in a [13]limb, ideal levels were suggested which gave the stump an optimum length
to facilitate subsequent prosthetic fitting. For example, for an above-[14]knee amputation the optimum
length of the stump was taken as 25-30 cm as measured from the tip of the greater trochanter. Similarly,
for a below-knee stump the optimum length suggested was 15 cm as measured from the [15]tibial tubercle.
However, with the recent developments in the fabrication and fitting of [16]prosthesis, it is not necessary to
stick to these stump lengths. These days the prosthesis (artificial limb) can be custom-made to fit at different
stump lengths. The viability of the tissue is the main criteria for determining the level of [17]amputation.
The stump should, however, have a well-healed, non-tender, supple scar. The stump should be in proper
shape and not bulky. Availability of total contact prosthesis has further increased the option in deciding the
level of amputations. However, a joint must always be preserved, whenever possible.
In Upper Limb an Amputation could be:
• Shortening of the [18]phalanges.
• Ray Amputation of the Fingers: The whole digit is removed from the base of the corresponding
metacarpal.
• Below-Elbow Amputation: Amputation through [19]forearm bones.
• Through-elbow disarticulation.
• Above-Elbow Amputation: Amputation through the arm.
• Through-[20]shoulder disarticulation.
• Forequarter Amputation: It is carried out proximal to the [21]shoulder joint in which scapula and part
of the clavicle are removed along with the shoulder girdle muscles.
• Krukenberg Operation: This operation is usually performed in patients with bilateral below-elbow
amputations, who have sufficiently long stumps. The forearm is split between the radius and [22]ulna
to provide the pincer grip. The patient can hold a spoon or such lighter objects with this ”fork”.
25

Lower Limb: The amputation may involve a toe or it may be:
• Mid tarsal amputation.
• Through -[23]ankle disarticulation.
• Syme’s Amputation: The tibia and [24]fibula are divided just above the ankle joint. The intact skin
over the [25]heel is attached back to the end of the stump with or without a part of the calcaneum.
Because of the intact heel, it becomes an end-bearing stump and the patients generally manage very
well walking even bare [26]foot after this type of amputation.
• Below Knee Amputation: Amputation through the [27]leg bones.
• Through knee disarticulation.
• Above Knee Amputation: Amputation through the femur.
• [28]Hip disarticulation.
• Hind Quarter Amputation with excision of the hemi pelvis.
Post-Operative Treatment
The follow-up is as important in amputation surgery as the procedure itself. The aim of this [29]exer-
cise is to provide a pliable, functional non-deformed stump, which can fit prosthesis as well.
The Treatment Involves:
• Rigid Dressing: We use a plaster of Paris(PoP) stump cast at the conclusion of the [30]surgery with
care taken to pad all the bony prominences, avoid proximal constrictions and prevent postoperative
contractures.
• Soft Dressing or conventional dressing with sterile snugly fitting pads and elastic bandages can also be
used, alternatively.
• Limb Positioning: The limb should be positioned properly to prevent contractures and [31]oedema.
• Exercises: Stump [32]exercises are necessary and should be encouraged after the wound heals up. These
exercises help in reducing the oedema, preventing joint contractures and developing muscle strength.
• Crepe Bandage: The use of a crepe bandage over the stump is continued for 3-4 weeks. It helps in
shaping the stump well which is conducive for the subsequent prosthetic fitting.
• Prosthetic Fitting: The prosthetic fitting can be:
• Immediate post-surgical.
• Definitive
• Immediate post-surgical fitting: A plaster of Paris mould is applied over the amputation stump
immediately after surgery to which a temporary prosthesis-pilon is attached the next day. The patient
is then allowed partial weight bearing as early as the [33]pain permits.
26

• Deﬁnitive Prosthesis: This is usually given 3 months after the [34]surgery, when the stump has matured.
• Ambulation: This may be initiated:
(i) Immediately after [35]surgery.
(ii) Promptly when good stump healing is noticed.
(iii) Early: after stump has healed.
(iv) Late: after the stump has matured.
6. http:
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Injury To The Coccyx (Tailbone) (2012-09-29 08:56)
Causes And Treatment of Tailbone Pain:
These are relatively rare [1]injuries, but could be quite troublesome to the patients. This can lead
to the development of [2]coccydynia, which is described as a [3]chronic pain in the coccyx.
Mechanism of Injury
It is due to a direct fall on the [4]buttocks. It can also result from seat injuries while driving two
wheelers or four wheelers. Of late constant pressure due to prolonged sitting as in the case of computer
professionals can give rise to [5]coccydynia.
Clinical Features
The patient usually complains of pain in the buttocks and is unable to sit comfortably. Due to the
development of coccydynia the pain may become [6]chronic. The patient also complains of difficulty in
traveling and altered sitting postures due to the [7]pain.
Investigations
Plain X-ray of the [8]coccyx especially the lateral view helps to make the diagnosis. However, it is
difficult to position the patient for the X-rays. MRI of the sacrococcygeal region is a better option.
Treatment
1. Conservation Measures
The [9]treatment is essentially conservative in nature with periods of bed rest and symptomatic
treatment for [10]pain and inflammation.
28

2. Physiotherapy Management
Consists of the following steps:
• To [11]relieve pain, thermotherapy likes ultrasound and TENS.
• To relieve prolonged pressure on the buttocks, sitting on a ring cushion and sitting on alternate buttocks
is adviced.
• Isometric exercises to the glutei maximus [12]muscle in sitting lying and prone positions are advisable.
• Sitz bath helps to relieve pain.
3. Injection Therapy
If the pain is unrelieved by the usual conservative and [13]physiotherapy measures, injection therapy consisting
of a mixture of local steroids(Depomedorol, Kenacort, etc.) and xylocaine gives excellent [14]relief of pain.
4. Surgical Excision of the Coccyx
In extreme situations if all the above measures fail then [15]surgical removal of the coccyx may be con-
sidered.
5. http:
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1.7 October
Rickets (Deficiency of Vitamin D, Calcium and Phosphate) (2012-10-09 07:24)
Symptoms, Types and Treatment of Rickets Disease:
[1]Rickets is a metabolic disorder of childhood where the osteoid formation in the [2]bones is normal but its
mineralization is defective. This results in softening of bones and deformities.
Nutritional Rickets:
[3]Nutritional rickets is the most common type of rickets seen in the developing countries. It is caused
by deficiency of vitamin D in the diet and by inadequate exposure of the body to sunlight. Sunlight promotes
the synthesis of vitamin D in the body. Nutritional rickets occur in children below 4 years of age.
Path Physiology:
The absorption of [4]calcium and phosphate from the intestine is reduced due to the deficiency of vita-
min D. The subsequent fall in the serum calcium level stimulates hyper secretion of [5]parathyroid hormone.
this, in turn, mobilizes calcium from the bone, making then soft and easily malleable to the pressure of
weight bearing and other stresses. It also results in the formation of uncalcified bone matrix. The disorderly
proliferation of the cartilage cells in the zone of proliferation, in the region of [6]metaphysis, results in
”cupping” of the metaphysis and widening of the epiphyseal plates.
Signs and Symptoms:
In the florid stage, the general health is affected; the child is irritable and stunted in growth. The fol-
lowing features may be seen:
1. Skull
• Craniotabes: The [7]fontanelle remains open even after 2 years of age.
• Frontal bossing: bossing (prominence) of the frontal and parietal bones.
1. Chest
• Pigeon Chest: The [8]sternum is prominent and thrusted forwards.
• Rickery Rosary: Prominence (beading) at the junction of [9]ribs with cartilages anteriorly gives an
appearance of a “rosary.”
• Harrison’s Sulcus: It is a transverse groove in the anterior part of the lower chest; due to the [10]muscular
pull of the diaphragm.
1. Abdomen: The abdomen is protuberant and gives a ”pot-belly” appearance. This is largely due to
muscular hypotonia.
30

2. Extremities: There is widening at the epiphyseal regions of the [11]wrist, knee and [12]ankle. Deformities
like coxa vara, genu valgum or varum, deformity of the [13]tibia due to compressive forces of the body
weight on the soft decalcified bones. Occasionally a peculiar deformity called wind- swept deformity
may be seen.
Types of Rickets:
• Vitamin D -Resistant Rickets (familial hypophasphataemia): There is inability of the renal tubules to
reabsorb phosphate from the glomerular filtrate, leading to hypophasphataemia.
• Fanconi Syndrome: This is due to the inability of the proximal tubules to reabsorb phosphates, glucose
and amino acids.
• Renal Rickets (renal osteodystrophy): The skeletal changes are associated with [14]chronic impairment
and manifest between 5 and 10 years of age.
• Coeliac Rickets: Diminished absorption of calcium from the intestines in steatorrhoea, sprue and
[15]coeliac disease results in skeletal changes like those of nutritional rickets
Investigations:
[16]Serum calcium level may be normal or low but the serum phosphate is low. Serum alkaline phos-
phatase is markedly raised during the active stage of the [17]disease.
Radiographs:
In a suspected case of nutritional rickets, radiographs of both wrists and both [18]knees (AP view only)
should be done. The width of the [19]epiphyseal plate is increased markedly with fluffy and irregular edges.
There is ”cupping” of the metaphysis. There may be bending of the long bones. The bones show generalized
rarefaction with thinning of the cortices.
Treatment:
1. Drug Treatment: Administration of high doses of vitamin D with calcium supplements is the mainstay
of the [20]treatment. Six lac units of vitamin D is given as a single dose initially; which may be repeated
weekly for 3 weeks. After a favorable response, a maintenance dose of 400 units of vitamin D with
calcium is given.
2. Orthopaedic Treatment: Mild deformities of the [21]limbs should be treated by the use of splints
(mermaid Splint). Weight bearing should be avoided till there is evidence of calcification in the bones
following vitamin D and calcium [22]therapy. Marked deformities need [23]surgical correction by
corrective osteotomy.
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1.8 November
Meniscal (Cartilage) Tear (2012-11-03 12:07)
Symptoms and Treatment of Meniscal Tear:
What is a Meniscal (cartilage) Tear?
The [1]meniscus is a piece of cartilage in the middle of your [2]knee. [3]Cartilage is tough, smooth,
rubbery tissue that lines and cushion the surface of the joints. There is a meniscus on the inner side of your
knee (the medial meniscus) and a meniscus on the outer side (the lateral meniscus). They attach to the top
of the [4]shin bone ([5]tibia), make contact with the thigh bone (femur), and act as shock absorbers during
weight-bearing activities.
How does it occur?
A meniscal tear can occur when the knee is forcefully twisted or occasionally with minimal or no
[6]trauma, such as when you are squatting.
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What are the symptoms?
You may have [7]pain in your knee joint. You may have immediate swelling with fluid in the joint,
called an effusion. You may be unable to fully bend or straighten your [8]leg. Your knee may lock or get
stuck in one place. You may hear a snap or pop at the time of the [9]injury. A chronic (old) meniscal tear
may give you pain on and off during activities, with or without swelling. Your knee may occasionally lock
and you may have [10]stiffness in the knee.
How is it diagnosed?
Your [11]doctor will examine your knee and find that you have [12]tenderness along the joint line.
Your doctor will move your knee in several ways that may cause pain along the injured meniscal surface.
Your doctor may order X-rays to see if there are injuries to the bones in your knee but [13]meniscal tear will
not show up on a x-ray. An MRI (magnetic resonance imaging) is sometimes useful in diagnosing a meniscal
tear.
How is it treated?
Treatment may include:
• Applying ice to your knee for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days or until the pain and
[14]swelling are gone.
• Elevating your knee by placing a pillow underneath your leg.
• Wrapping an elastic bandage around your knee to keep the swelling from getting worse.
• Wearing a [15]knee immobilizer or other brace to prevent further injury.
• Using crutches
• Taking anti-inflammatory or [16]pain medication prescribed by your doctor.
[17]Surgery is needed to repair or remove large torn pieces of cartilage.While you are recovering from your
[18]injury, you will need to change your sport or activity to one that does not make your condition worse.
For example, you may need to swim instead of run.
When can I return to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return
too soon you may worsen your injury, which could lead to permanent [19]damage. Everyone recovers from
injury at a different rate. Return to your sport or activity will be determined by how soon your knee recovers,
not by how many days or weeks it has been since your injury occured. In general, the longer you have
[20]symptoms before you start [21]treatment, the longer it will take to get better. You may safely return to
your sport or activity when, starting from the top of the list and progressing to the end, each of the following
is true:
• Your injured knee can be fully straightened and bent without pain.
• Your knee and leg have regained normal strength compared to the uninjured [22]knee and leg.
33

• Your knee is not swollen.
• You are able to jog straight ahead without [23]limping.
• You are able to sprint straight ahead without limping.
• You are able to do 45-degree cuts.
• You are able to do 90-degree cuts.
• You are able to do 20-yard ﬁgure-of-eight runs.
• You are able to do 10-yard ﬁgure-of-eight runs.
• You are able to jump on both legs without pain and jump on the injured leg without pain.
If you feel that your knee is giving way or if you develop pain or have swelling in your knee, you should see
your [24]doctor.
How can a Meniscal Tear be prevented?
Unfortunately, most injuries to knee [25]cartilage occur during accidents that are not preventable. However,
you may be able to avoid these injuries by having strong thigh and hamstring [26]muscles, as well as by
maintaining a good leg- stretching routine. When skiing, be sure that your ski bindings are set correctly by a
trained professional so that your skin will release when you fall.
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How to get relief from Pelvic Pain Injuries? (2012-11-20 12:14)
Classiﬁcation, Symptoms and Treatment of Pelvic Fracture:
[1] Stability of the Pelvis
Stability of the pelvis depends on both [2]bony and ligamentous structures. Anterior portion of the
[3]pelvic ring neither participates in normal weight bearing nor is it essential for maintenance of pelvic
stability. The posterior arch is formed by the sacrum, SI joints and ilia and is the weight-bearing portion of
the pelvis. The posterosuperior SI ligaments provide most of the ligamentous stability of the SI [4]joints.
Stable Pelvic Fracture
These [5]fractures do not involve the pelvic ring and they are minimally displaced.
Unstable Pelvic Fracture
They involve the [6]pelvic ring and are widely displaced. Pelvic fractures pose a problem diﬀerent
from others. Here the emphasis is on recognition of potential complications associated with these fractures,
the notable ones being [7]injuries to the major vessels and nerves of the pelvis and major viscera like
intestines, bladder and the [8]urethra, severe intrapelvic hemorrhage from fracture of pelvic ring.
Mortality from pelvic fracture varies from 10-50 percent. Proper fracture [9]management decreases
the blood loss and controls the hemorrhage. A to F management as proposed by Mac Murthy in multiple
35

[10]trauma patients is important in management of the pelvic fractures.
History
Pelvic fractures usually occur due to high-velocity trauma following a road traffic accident (RTA)
or due to fall from a height.
The relative incidences are as follows;
• RTA-80.7 percent.
• Fall-16.1 percent.
• [11]Compression fracture-rest.
Mechanism of injury
There are four mechanisms by which pelvic ring fractures are produced:
• Lateral compression.
• Anteroposterior compression.
• Vertical shears forces.
• Inferior forces (e.g. fall on [12]buttocks).
The first two mechanisms are common in RTA and may cause stable or unstable fractures. Vertical shear
forces are due to fall from a height and will cause grossly unstable fractures. Fortunately, most pelvic fractures
are stable and respond to non operative [13]treatment. Unstable [14]fractures need manipulative reduction
and stabilization by external fixators and sometimes by internal fixation. A proper evaluation of the fracture
by radio-graph and CT scan helps to determine the best course of management.
Classification
Broadly speaking, the pelvic fractures can be placed under two categories.
Fractures not Affecting the Integrity of the Pelvic Ring
Direct blow fractures, which are commonly seen in iliac bone and avulsion fractures frequently encoun-
tered in the young, come under this group. Avulsion fractures are commonly seen in antero-superior and
inferior iliac [15]spines and ischial tuberosity .
Fractures Affecting the Integrity of the Pelvic Ring
These are single or double break fractures in the pelvic ring and could be stable or unstable. A stable
fracture is one, which resists displacing forces. Obviously, fractures, which cannot resist usual forces, are
called unstable fractures and these pose a major [16]therapeutic challenge.
36

Many classifications have been proposed for pelvic fractures. Key and Conwell’s classification is by far
the simplest and commonly used classification. It has prognostic importance too.
Key and Conwell Classification
Fracture of Individual Bones without a Break in the Pelvic Ring.
• Avulsion fracture of the: Anterosuperior iliac spine, Antero inferior iliac spine, Ischial tuberosity.
• [17]Fracture of pubis or ischium.
• Fracture wing of ilium (Duverney).
• Fracture sacrum.
• Fracture or dislocation of [18]coccyx.
Single Break in the Pelvic Ring
• Fracture of both ipsilateral rami.
• Fracture near or subluxation of symphysis pubis.
• Fracture near or subluxation of [19]sacroiliac joints.
Double Breaks in the Pelvic Ring
• Double vertical fracture or dislocation of pubis (Straddle fracture).
• Double vertical fracture or dislocation of pelvis (Malgaigne’s fracture).
Acetabuium Fractures
• Undisplaced.
• Displaced.
Tile’s Classification
This is a mechanical classification based on the injury forces.
1. Type A Stable.
2. Type A1 Fracture Pelvis not involving ring.
3. Type A2 Stable, but minimally displaced.
4. Type B Rotationally unstable but vertically stable.
37

5. TypeB1 Open book [20]injury.
6. Type B2 Lateral compression Ipsilateral.
7. Type B3 Lateral compression-Contralateral.(Bucket handle).
8. Type C Rotationally and vertically unstable.
9. Type C1 Rotationally and vertically unstable.
10. Type C2 Bilateral.
11. Type C3 Associated with [21]ace tabular fractures.
Clinical Features
Symptoms
The patient most often gives a history of high-velocity trauma and usually presents in a state of hypo-
volaemic shock. Features of intra-abdominal [22]injuries and genitourinary injuries are frequently present.
Clinical Signs
The patient may present with all signs of shock. Tenderness over the fracture site and one has to look
for three important signs described by Milch.
Quick facts
Look for the signs of shock in pelvic fracture
• Pale look
• Cold nose
• Sweating
• Tachycardia
• Hypotension
• Cold and clammy skin
• [23]Unconsciousness.
Clinical Tests
• Compression test: When a compressive force is applied through the two iliac bones, the patient
complains of [24]pain in pelvic fracture.
• Distraction test: When distraction force is applied to the two iliac bones at the anterosuperior iliac
spine, the patient complains of pain.
• Direct pressure test: Direct pressure over the [25]symphysis pubis elicits pain.
38

Following this, an examination for abdomen and [26]pelvis injuries is carried out and next urethral catheteri-
zation or urethrogram is done.
Investigations
Radiography
Different radiographic views are recommended to study the fracture configuration, displacements, etc. in
pelvic fractures:
• Plain AP view.
• Oblique view-45 degree oblique projections.
• Internal and external rotation view.
• Inlet view- 40 degree caudad views.
• Outlet view-40 degree cephalad view.
CT scan
Further radiographic studies include CT scans and 3-dimensional imaging. This is the gold standard
in the evaluation of pelvic fractures.
Management
One should remember that pelvic fractures are usually due to high-velocity trauma and is associated with
multiple fractures and multiple system injuries. Resuscitation and correction of [27]hypovolemic shock takes
precedence over the management of fracture per se. nevertheless, once the general condition is stabilized
attention should be given to treat the fracture, which will prevent further blood loss and damage to visceral
organs.
Different types of pelvic fractures, their clinical features and [28]treatment are listed.
Treatment points
Three main pitfalls in the treatment of pelvic fracture
• Treating only fracture overlooking visceral injuries.
• Over treating a stable fracture.
• Treating an unstable fracture.
Treatment Methods
Initial [29]treatment is carried out as follows:
Resuscitation and other general measures, to improve the general condition of the patient.
39

Blood transfusion and other medical and [30]surgical emergency measures are carried out.
Avulsion fractures: Conservative treatment like bed rest, traction, [31]physiotherapy, etc. gives good
results. They rarely need surgery.
Undisplaced fractures: Respond to bed rest, traction, pelvic slings, non steroidal anti-inflammatory
drugs (NSAIDs), etc.
Displaced fractures: Reduction by [32]lateral compression methods as described by Watson Jones is
very helpful. Retention is by Spica cast, canvas sling or external fixators.
Role of external and internal fixators: The above methods usually suffice, but the fractures asso-
ciated with multiple system injuries need to be stabilized either by external fixators or by open reduction
and internal fixation (ORIF). These two methods have the following advantages:
• Gives firm stability.
• Helps [33]early mobilization.
• Reduces period of bed rest.
• Helps early control of osseous bleeding.
Complications
Pelvic fracture is a dreaded injury as it is associated with a [34]plethora of complications. The follow-
ing are some of them.
The [35]Center for Advanced Orthopedics represents two board certified orthopedic surgeons with com-
bined experience in bone & joint problems of over 45 years.Our Services include are Total Joint Replacement
Surgery – Hip and Knee,Hip Resurfacing & Partial Knee Resurfacing, Arthroscopic Surgery – Shoulders,
Knees and Ankles, Sports Medicine, Musculoskeletal Conditions, Arthritis of the Hip, Knee and Shoulder,
Osteoarthritis, Computer Assisted Surgery, Fracture Management, Sports Medicine. We severe two locations.
For More Information Call Now at : [36](301) 645-5410
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