OUr treatments

Obstacles Define Success!

ORTHOPAEDIC TREATMENTS-2

There are three types of deformities:

1. Knuckle – prominence of one spinal process
2. Gibbus – prominence of two or three spinal processes
3. Kyphus – diffuse rounding of vertebral column

LATERAL CURVATURE OF THE SPINE WITH VERTEBRAL ROTATION.

  • Facet joints are set of synovial, plane joints b/w articular processes of 2 adjacent vertebrae. there are 2 facet joints in each spinal motion segement.
  • Biomechanical function- to limit the motion of spinal segment & protect the segment against ant. shear forces, excessive rotation & flexion.
  •  SYMPTOMS-

  • Intermittent & unpredictable episodes of pain during all movts.
  • U/L/l pain with side bending & extension.
  • Joint instability causing impaired posture.
  • Impaired spinal extension with persistent point tenderness & stiffness.
  • Aggravating factors- sitting & travelling, bending from back, improper lifting, prone lying on soft surface, slouched sitting.

SYMPTOMS-
• Dull ache, sharp/ stabbing
• Pain- buttocks/ back of thigh/ low back
• Unilateral or bilateral
• Worst– prolonged sitting / twisting movt
• Morning stiffness
• Pain over posterior superior iliac spine
• Radiation above the knee
• Resolves with exercise generally

 

ON EXAMINATION-

• Forward bending- normal/blocked movt
• Psis on injured site moves sooner than normal
• Slr- pain inc. after 45*
• Side bending- pain inc. on i/l side
• Upslip- psis & asis higher
• Anterior rotatory fall- asis lower & psis high with tight hip flexors & weak gluteals
• Posterior rotatory fall- asis higher, psis lower with tight piriformis/gluteals/hip flexors

The spinal canal narrows & compresses the spinal cord & nerves at the level of lumbar vertebrae, may be congenital or acquired (degenerative / spondylosis/ tumor/ hypertrophy)

  • Painful extension movement.
  • Deterioration of fine motor skills if cervical involvement
  • It may be u/l or b/l with several dermatomes affected
  • Incoordination
  • Treatment is given in flexion-bias

Discomfort b/w orbit and occiput, arising from the pain sensitive structures symptoms- diffuse,dull, aching, band-like headache with dizziness.

Vertigo is not a medical condition but it is a symptom when a person feels that the objects around him are moving/spinning, a kind of dizziness, which lasts for more than a minute. it may be associated with nausea, vomiting, sweating or difficulty walking, blurred vision, falls , headache, hearing loss, sweating.

The spasm of sternocleidomastoid muscle may be idipathic/ congenital.

the muscle on one side gets fibrosed and fails to elongate as the child grows due to ischaemic necrosis at birth/ breech presentation/ hemiatlas.

 

SYMPTOMS-


  • head is tilted on one side and chin faces the opposite side
    • baby doesn’t look in one particular direction
    • flattening on one side of face due to unrated lesion
    • scm tendon becomes tight and cord-like-resisted movements away from the affected side.

A condition caused due to prolonged sustained abnormal posture , lifting heavy weight, trauma or age related degeneration changes.

Symptoms-

  • Muscle spasm causes irritation in joint capsule which is surrounded by connective tissue layer , causing restriction in movement.
  • Pain increases in neck extension, rotation, and side flexion
  • Tenderness on palpating facet joint and paraspinal muscles

When sudden force is experienced by head, either by acceleration/ deceleration, the muscles respond by contracting to splint the cervical spine and prevent injury as the cervical muscles are directly attached to the periosteum.
It is most common in athletes and in sports injuries.

Symptoms-

  • Cramping pain or dull ache.
  • Restricted side to side movement or forward bending or neck extension.
  • Local tenderness present.
  • Headache at base of skull.
  • Neck tightness due to knotted muscles.
  • Neck and shoulder pain may radiate to arm.
  • Visual disturbances.
  • Dizziness due to injury to facet joint.

A degenerative condition causing compression of the spinal cord in neck.

Symptoms-

  • Incoordination, difficulty in walking or climbing stairs
  • Abnormal reflexes
  • Motor weakness of legs more than arms
  • Tinnitus
  • Vertigo
  • Muscle spasm
  • Bladder and bowel incontinence
  • Tingling, numbness of arms, hands, leg and feet
  • Wide based gait
  • Loss of proprioception

The condition when the intervertebral disc damages and bulges abnormally or gets ruptured due to age related wear and tear of disc, heavy lifting or twisting force, trauma

Symptoms-

  • Sudden onset of pain with radiation to one or both arms.
  • Numbness and tingling sensation in arms or hands.
  • Shooting pain during coughing, sneezing.
  • Pain increases on neck forward bending .

ROTATOR CUFF TENDON IS COMPRESSED DURING SHOULDER MOVEMENT CAUSING PAINFUL MOVEMENT (60* – 120* FORWARD FLEXION)

 

SYMPTOMS:-
• CHARACTERISED BY PAINFUL & STIFF GH JOINT D/T LOSS OF RESILIENCE OF JOINT CAPSULE , POSSIBLY WITH ADHESIONS B/W ITS SYNOVIAL FOLDS.
• DENSE ADHESIONS, CAPSULAR THICKENING, CAPSULAR RESTRICTIONS IN FOLDS OF JOINT CAPSULE
• GLOBAL LOSS OF ACTIVE & PASSIVE GH MOTION.
• LOSS OF ER *HALLMARK*
• GREATER UPWARD ROTATION

The tear in the superior glenoid labrum where the long head of the biceps tendon is attached, the tear will extend from anterior to posterior from the biceps tendon. this is most commonly seen in throwers, weight lifting, baseball players.

The injury to the rotator cuff muscles – supraspinatus, infraspinatus, terres minor, subscapularis, either partial or full, leading to the shoulder dysfunction.

CLINICALLY,
• Patient is unable to lift his arm and feels pain in overhead abduction.
• Disturbed activities of daily living.
• Swelling and tenderness in shoulder joint.
• Painful resisted upward movements

SIGNS & SYMPTOMS
• Pain along the arm with numbness
• Restricted abduction & external rotation
• Prominent acromion
• Arm locked in place
• Space below acromion appears empty
• Abnormal shoulder contour
• Instability in shoulder joint
• Patient is unable to touch the opposite shoulder
• Damage to the axillary artery

Characterised by painful & stiff gh joint d/t loss of resilience of joint capsule , possibly with adhesions b/w its synovial folds.
• Dense adhesions, capsular thickening, capsular restrictions in folds of joint capsule
• Global loss of active & passive gh motion.
• Loss of er *hallmark*

The compression of the radial nerve results in wrist drop or saturday night palsy, characterized by the weak extensors of the wrist, loss of gripping, and sensation loss over back of forearm & lateral side dorsum of hand.

The condition caused due to resting elbows on the hard surfaces such as unpadded tables/ armrests. the ulnar nerve, which feeds the ring & little fingers, can become impaired from pressure near the elbows.

  • Inflammation of the tendon sheath of abductor pollicis longus & extensor pollicis brevis tendons.
  • Pain and tenderness over radial styloid process due to twisting and forceful gripping.
  • Clinically, pain increases by adducting thumb across palm & forcing ulnar deviation & radial deviation against resistance

 

It is a deformity caused due to the compression of ulnar nerve. the hand will show hyper-extension of the metacarpophalangeal joints and flexion of the distal & proximal interphalangeal joints of the ring and little finger. patients are unable to spread or pull togerther the fingers against resistance. also, a prominent hollowing between the thumb and forefinger is seen. sensory loss over the ring and little fingers.

The degenerative condition of cervical spine characterised by reduced intervertebral disc space due to wear and tear of cartilage.
It is most common in post menopausal women due to osteoporosis,
Occupational hazards like prolonged working on computers, working with lot of neck bending and twisting movements.

Symptoms-

  • Neck stiffness and pain over the shoulder blade.
  • Headache may originate in neck
  • Restricted movements mainly flexion and neck rotation.
  • Pain increases during night.
  • Paraesthesia in region of nerve root especially at base of thumb.
    Giddiness.

A slowly progressive condition causing narrowing of spinal canal which pinches spinal cord in the neck.
Symptoms-

  • Shooting Pain may radiate to one or both hands.
  • Pain increases on neck extension and reduces on neck flexion and rest.
  • Inability to walk at brisk pace.
  • Deterioration of fine motor skills like handwriting.
  • Neck stiffness
  • Incoordination
  • Burning sensation or Numbness and motor weakness in arms, neck