Orthopedic Diseases Details

Orthopedic Disease. Mobile Phone Number. 01797522136, 01987073965. Common Orthopedic Problems and Diseases are Low Back Pain, Muscle cramps, Osteoporosis, Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis, Muscle atrophy, Bursitis, Knee pain, Frozen shoulder, Shoulder arthritis, Dislocated shoulder,

Fibromyalgia, Ankle sprains, Fracture, Carpal tunnel syndrome, Acute injuries, Musculoskeletal cancer, Hip labral tear, Tennis elbow, Rotator cuff tear, Anterior cruciate ligament injury, Scoliosis, Rickets, Gout, etc. You can study Orthopedic Disease in PDT Orthopedic Courses. These courses are PDT Orthopedics 6 Months, PDT Orthopedics 1 Year, and PDT Orthopedics 2 Years. All these courses are available at HRTD Medical Institute.

Students can study PDT Orthopedic Courses after completing the Diploma Medical Courses of Long and Short Duration. Diploma Medical Courses are DMF, DMA 3 Years, DMA 2 Years, DMA 1 Year, DMS 3 Years, DMS 2 Years, DMS 1 Year, DMDS 4 Years, etc. All the Diploma Courses are available at HRTD Medical Institute. You must have a science background for the DMF course and any background (But minimum SSC Pass) for other medical diploma courses.

Low Back Pain

Pain in the lower part of the back is called low back pain.

Causes of Low back pain

Sprains and Strains

A sprain is a common orthopedic disease. A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion

Spinal stenosis

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward

Osteoporosis

The most common orthopedic disease in elderly persons. Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and a consequent increase in fracture risk. It is the most common reason for a broken bone among the elderly.

Osteoarthritis

Osteoarthritis is an orthopedic disease. Osteoarthritis is a type of degenerative joint disease that results from the breakdown of joint cartilage and underlying bone. It is believed to be the fourth leading cause of disability in the world, affecting 1 in 7 adults in the United States alone. The most common symptoms are joint pain and stiffness.

Spinal stenosis

Osteoarthritis

Herniated disk

Herniated disk

A herniated, or bulging, disc is a disc that has “spilled out” of its lining. This happens most frequently in the lower back.

Scoliosis

Scoliosis is a condition in which a person’s spine has an irregular curve. The curve is usually S-shaped when viewed from the side.

Osteoporosis

The most common orthopedic disease in elderly persons. Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and a consequent increase in fracture risk. It is the most common reason for a broken bone among the elderly.

Causes of Osteoporosis

Osteoporosis is a common orthopedic disease. Osteoporosis occurs when too much bone mass is lost and changes occur in the structure of bone tissue.

Bone is a living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone.

Certain risk factors may lead to the development of osteoporosis.

Sex. Women have a greater risk for osteoporosis than men.

Age. As you age, bone loss happens more quickly, and new bone growth is slower.

Body size. Slender, thin-boned women and men are at greater risk of developing osteoporosis.

Skin Condition. White skin is at the highest risk.

Family history. The risk for osteoporosis and fractures may increase if one of your parents has a history of osteoporosis.

Changes to hormones. Low levels of certain hormones can increase osteoporosis. For example:

Low levels of estrogen in women ( during menopause).

Low levels of testosterone in men.

Diet. A diet low in calcium and vitamin D can increase your risk for osteoporosis and fractures.
Excessive dieting or poor protein intake may increase the risk for bone loss and osteoporosis.

Other medical conditions. Endocrine and hormonal diseases, gastrointestinal diseases, rheumatoid arthritis, certain types of cancer, HIV/AIDS, and anorexia nervosa.

Medications. Long-term use of certain medications:
Glucocorticoids and adrenocorticotropic hormone.
Antiepileptic medicines.
Cancer medications.
Proton pump inhibitors.
Selective serotonin reuptake inhibitors.
Thiazolidinediones, which treat type II diabetes.

Lifestyle.Low levels of physical activity.

Chronic heavy drinking of alcohol is a significant risk factor for osteoporosis.

Clinical features of Osteoporosis

There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include:

• Back pain is caused by a broken or collapsed bone in the spine.
• Loss of height over time.
• A stooped posture.
• A bone that breaks much more easily than expected. When to see a doctor

You might want to talk to your healthcare provider about osteoporosis if you went through early menopause or took corticosteroids for several months at a time, or if either of your parents had hip fractures.

Risk factors

Many factors can increase the likelihood that you’ll develop osteoporosis — including your age, race, lifestyle choices, and medical conditions and treatments.

Unchangeable risks

Some risk factors for osteoporosis are out of your control, including:

• Your sex. Women are much more likely to develop osteoporosis than are men.
• Age. The older you get, the greater your risk of osteoporosis.
• Race. You’re at greatest risk of osteoporosis if you’re white or of Asian descent.
• Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if your mother or father fractured a hip.
• Body frame size. Men and women who have small body frames tend to have a higher risk because they might have less bone mass to draw from as they age.

Hormone levels

Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Examples include:

• Sex hormones. Lowered sex hormone levels tend to weaken bones. The fall in estrogen levels in women at menopause is one of the strongest risk factors for developing osteoporosis. Treatments for prostate cancer that reduce testosterone

levels in men and treatments for breast cancer that reduce estrogen levels in women are likely to accelerate bone loss.

• Thyroid problems. Too much thyroid hormone can cause bone loss. This can occur if your thyroid is overactive or if you take too much thyroid hormone medicine to treat an underactive thyroid.
• Other glands. Osteoporosis has also been associated with overactive parathyroid and adrenal glands. Dietary factors

Osteoporosis is more likely to occur in people who have:

• Low calcium intake. A lifelong lack of calcium plays a role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss, and an increased risk of fractures.
• Eating disorders. Severely restricting food intake and being underweight weaken bone in both men and women.
• Gastrointestinal surgery. Surgery to reduce the size of your stomach or to remove part of the intestine limits the amount of surface area available to absorb nutrients, including calcium. These surgeries include those to help you lose weight and other gastrointestinal disorders.

Steroids and other medicines

Long-term use of oral or injected corticosteroid medicines, such as prednisone and cortisone, interferes with the bone-rebuilding process. Osteoporosis has also been associated with medications used to combat or prevent:

• Seizures.
• Gastric reflux.
• Cancer.
• Transplant rejection.

Medical problems

The risk of osteoporosis is higher in people who have certain medical problems, including:

• Celiac disease.
• Inflammatory bowel disease.
• Kidney or liver disease.
• Cancer.
• Multiple myeloma.
• Rheumatoid arthritis. Lifestyle choices

Some bad habits can increase your risk of osteoporosis. Examples include:

• Sedentary lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis than do those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are good for your bones, but walking, running, jumping, dancing and weightlifting seem particularly helpful.
• Excessive alcohol consumption. Regular consumption of more than two alcoholic drinks a day increases the risk of osteoporosis.
• Tobacco use. The exact role tobacco plays in osteoporosis isn’t clear, but it has been shown that tobacco use contributes to weak bones.

Complications

Compression fractures  

Bone breaks, particularly in the spine or hip, are the most serious complications of osteoporosis. Hip fractures often are caused by a fall and can result in disability and even an increased risk of death within the first year after the injury.

In some cases, broken bones in the spine can occur even if you haven’t fallen. The bones that make up your spine, called vertebrae, can weaken to the point of collapsing, which can result in back pain, lost height, and a hunched-forward posture.

Prevention

Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life.

Calcium

Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day. This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70.

Good sources of calcium include:

• Low-fat dairy products.
• Dark green leafy vegetables.
• Canned salmon or sardines with bones.
• Soy products, such as tofu.
• Calcium-fortified cereals and orange juice.

If you find it difficult to get enough calcium from your diet, consider taking calcium supplements. However, too much calcium has been linked to kidney stones. Although yet unclear, some experts suggest that too much calcium, especially in supplements, can increase the risk of heart disease.

The Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine recommends that total calcium intake, from supplements and diet combined, should be no more than 2,000 milligrams daily for people older than 50.

Vitamin D

Vitamin D improves the body’s ability to absorb calcium and improves bone health in other ways. People can get some of their vitamin D from sunlight, but this might not be a good source if you live in a high latitude, if you’re housebound, or if you regularly use sunscreen or avoid the sun because of the risk of skin cancer.

Dietary sources of vitamin D include cod liver oil, trout and salmon. Many types of milk and cereal have been fortified with vitamin D.

Most people need at least 600 international units (IU) of vitamin D a day. That recommendation increases to 800 IU a day after age 70.

People without other sources of vitamin D and especially with limited sun exposure might need a supplement. Most multivitamin products contain between 600 and 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is safe for most people.

Exercise

Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you’ll gain the most benefits if you start exercising regularly when you’re young and continue to exercise throughout your life.

Combine strength training exercises with weight-bearing and balance exercises. Strength training helps strengthen muscles and bones in your arms and upper spine. Weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports — affect mainly the bones in your legs, hips and lower spine. Balance exercises such as tai chi can reduce your risk of falling especially as you get older.

Diagnosis

Your bone density can be measured by a machine that uses low levels of X-rays to determine the proportion of mineral in your bones. During this painless test, you lie on a padded table as a scanner passes over your body. In most cases, only certain bones are checked — usually in the hip and spine.

Treatment

Treatment recommendations are often based on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test. If your risk isn’t high, treatment might not include medication and might focus instead on modifying risk factors for bone loss and falls.

Bisphosphonates

For both men and women at increased risk of broken bones, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:

• Alendronate (Binosto, Fosamax).
• Risedronate (Actonel, Atelvia).
• Ibandronate.
• Zoledronic acid (Reclast, Zometa).

Side effects include nausea, abdominal pain and heartburn-like symptoms. These are less likely to occur if the medicine is taken properly. Intravenous forms of bisphosphonates don’t cause stomach upset but can cause fever, headache and muscle aches.

A very rare complication of bisphosphonates is a break or crack in the middle of the thighbone. A second rare complication is delayed healing of the jawbone, called osteonecrosis of the jaw. This can occur after an invasive dental procedure, such as removing a tooth.

Denosumab

Compared with bisphosphonates, denosumab (Prolia, Xgeva) produces similar or better bone density results and reduces the chance of all types of breaks. Denosumab is delivered via a shot under the skin every six months.

Similar to bisphosphonates, denosumab has the same rare complication of causing breaks or cracks in the middle of the thighbone and osteonecrosis of the jaw. If you take denosumab, you might need to continue to do so indefinitely. Recent research indicates there could be a high risk of spinal column fractures after stopping the drug.

Hormone-related therapy

Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase the risk of breast cancer and blood clots, which can cause strokes. Therefore, estrogen is typically used for bone health in younger women or in women whose menopausal symptoms also require treatment.

Raloxifene (Evista) mimics estrogen’s beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug can reduce the risk of some types of breast cancer. Hot flashes are a possible side effect. Raloxifene also may increase your risk of blood clots.

In men, osteoporosis might be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help improve symptoms of low testosterone, but osteoporosis medications have been better studied in men to treat osteoporosis and thus are recommended alone or in addition to testosterone.

Bone-building medicines

If you have severe osteoporosis or if the more common treatments for osteoporosis don’t work well enough, your doctor might suggest trying:

• Teriparatide (Bonsity, Forteo). This powerful drug is similar to parathyroid hormone and stimulates new bone growth. It’s given by daily injection under the skin for up to two years.
• Abaloparatide (Tymlos) is another drug similar to parathyroid hormone. This drug can be taken for only two years.
• Romosozumab (Evenity). This is the newest bone-building medicine to treat osteoporosis. It is given as an injection every month at your doctor’s office and is limited to one year of treatment.

After you stop taking any of these bone-building medications, you generally will need to take another osteoporosis drug to maintain the new bone growth.

Lifestyle and home remedies

These suggestions might help reduce your risk of developing osteoporosis or breaking bones:

• Don’t smoke. Smoking increases rates of bone loss and the chance of fracture.
• Limit alcohol. Consuming more than two alcoholic drinks a day may decrease bone formation. Being under the influence of alcohol also can increase your risk of falling.
• Prevent falls. Wear low-heeled shoes with nonslip soles and check your house for electrical cords, area rugs, and slippery surfaces that might cause you to fall. Keep rooms brightly lit, install grab bars just inside and outside your shower door, and make sure you can get into and out of your bed easily.

Arthritis

Osteoarthritis

The most common type of arthritis, osteoarthritis involves wear and tear damage to a joint’s cartilage — the hard, slick coating on the ends of bones where they form a joint. Cartilage cushions the ends of the bones and allows nearly frictionless joint motion, but enough damage can result in bone grinding directly on the bone, which causes pain and restricted movement. This wear and tear can occur over many years, or it can be hastened by a joint injury or infection.

Osteoarthritis also causes changes in the bones and deterioration of the connective tissues that attach muscle to bone and hold the joint together. If cartilage in a joint is severely damaged, the joint lining may become inflamed and swollen.

Rheumatoid arthritis

In rheumatoid arthritis, the body’s immune system attacks the lining of the joint capsule, a tough membrane that encloses all the joint parts. This lining (synovial membrane) becomes inflamed and swollen. The disease process can eventually destroy cartilage and bone within the joint.

Risk factors

Risk factors for arthritis include:

• Family history. Some types of arthritis run in families, so you may be more likely to develop arthritis if your parents or siblings have the disorder.
• Age. The risk of many types of arthritis — including osteoarthritis, rheumatoid arthritis and gout — increases with age.
• Your sex. Women are more likely than men to develop rheumatoid arthritis, while most of the people who have gout, another type of arthritis, are men.
• Previous joint injury. People who have injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint.
• Obesity. Carrying excess pounds puts stress on joints, particularly your knees, hips and spine. People with obesity have a higher risk of developing arthritis.

Complications

Severe arthritis, particularly if it affects your hands or arms, can make it difficult for you to do daily tasks. Arthritis of weight-bearing joints can keep you from walking comfortably or sitting up straight. In some cases, joints may gradually lose their alignment and shape.

Diagnosis

During the physical exam, doctors check your joints for swelling, redness, and warmth. They’ll also want to see how well you can move your joints.

Laboratory tests

The analysis of different types of body fluids can help pinpoint the type of arthritis you may have. Fluids commonly analyzed include blood, urine, and joint fluid. To obtain a sample of joint fluid, doctors cleanse and numb the area before inserting a needle in the joint space to withdraw some fluid.

Imaging

These types of tests can detect problems within the joint that may be causing your symptoms. Examples include:

• X-rays. Using low levels of radiation to visualize bone, X-rays can show cartilage loss, bone damage and bone spurs. Xrays may not reveal early arthritic damage, but they are often used to track progression of the disease.
• Computerized tomography (CT). CT scanners take X-rays from many different angles and combine the information to create cross-sectional views of internal structures. CTs can visualize both bone and the surrounding soft tissues.
• Magnetic resonance imaging (MRI). Combining radio waves with a strong magnetic field, MRIs can produce more-detailed cross-sectional images of soft tissues such as cartilage, tendons and ligaments.
• Ultrasound. This technology uses high-frequency sound waves to image soft tissues, cartilage and fluid-containing structures near the joints (bursae). Ultrasound is also used to guide needle placement for removing joint fluid or injecting medications into the joint.

Treatment

Arthritis treatment focuses on relieving symptoms and improving joint function. You may need to try several different treatments, or combinations of treatments, before you determine what works best for you.

Medications

The medications used to treat arthritis vary depending on the type of arthritis. Commonly used arthritis medications include:

• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Examples include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs can cause stomach irritation and may increase your risk of heart attack or stroke. NSAIDs are also available as creams or gels, which can be rubbed on joints.
• Counterirritants. Some varieties of creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these preparations on the skin over your aching joint may interfere with the transmission of pain signals from the joint itself.
• Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage.

Corticosteroids may be given as a pill or as an injection into the painful joint. Side effects may include thinning of bones, weight gain and diabetes.

• Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. In addition to conventional DMARDs, there are also biologic agents and targeted synthetic DMARDs. Side effects vary but most DMARDs increase your risk of infections.
• Therapy Physical therapy can be helpful for some types of arthritis. Exercises can improve range of motion and strengthen the muscles surrounding joints. In some cases, splints or braces may be warranted.

Surgery

If conservative measures don’t help, doctors may suggest surgery, such as:

• Joint repair. In some instances, joint surfaces can be smoothed or realigned to reduce pain and improve function. These types of procedures can often be performed arthroscopically — through small incisions over the joint.
• Joint replacement. This procedure removes the damaged joint and replaces it with an artificial one. Joints most commonly replaced are hips and knees.
• Joint fusion. This procedure is more often used for smaller joints, such as those in the wrist, ankle and fingers. It removes the ends of the two bones in the joint and then locks those ends together until they heal into one rigid unit.

Lifestyle and home remedies

In many cases, arthritis symptoms can be reduced with the following measures:

• Weight loss. Excess weight puts extra stress on weightbearing joints. Losing weight may increase your mobility and limit future joint injury.
• Exercise. Regular exercise can help keep joints flexible. Swimming and water aerobics may be good choices because the buoyancy of the water reduces stress on weight-bearing joints.
• Heat and cold. Heating pads or ice packs may help relieve arthritis pain.
• Assistive devices. Using canes, shoe inserts, walkers, raised toilet seats, and other assistive devices can help protect joints and improve your ability to perform daily tasks.

Alternative medicine

Many people use alternative remedies for arthritis, but there is little reliable evidence to support the use of many of these products. The most promising alternative remedies for arthritis include:

• Acupuncture. This therapy uses fine needles inserted at specific points on the skin to reduce many types of pain, including that caused by some types of arthritis.
• Glucosamine. Although study results have been mixed, some studies have found that glucosamine works no better than placebo. However, glucosamine and the placebo both relieved osteoarthritis pain better than taking nothing, particularly in people who have moderate to severe pain from knee osteoarthritis.
• Chondroitin. Chondroitin may provide modest pain relief from osteoarthritis, although study results are mixed.
• Fish oil. Some preliminary studies have found that fish oil supplements may reduce the symptoms of some types of arthritis. Fish oil can interfere with medications, so check with your doctor first.
• Yoga and tai chi. The slow, stretching movements associated with yoga and tai chi may help improve joint flexibility and range of motion.
• Massage. Light stroking and kneading of muscles may increase blood flow and warm affected joints, temporarily relieving pain. Make sure your massage therapist knows which joints are affected by arthritis.

Gout

Gout is a painful form of arthritis. When your body has extra uric acid, sharp crystals can form in your joints (usually your big toe). Flare-ups of symptoms like pain and swelling come and go in periods called gout attacks. Treatment is usually a combination of symptom management and changing your diet.

What is gout?

Gout is a form of inflammatory arthritis that causes pain and swelling in your joints. Gout happens when there’s a buildup of uric acid in your body.

Gout most commonly affects your big toe joint. But it can affect other joints, including your:

• Knees.
• Ankles.
• Feet.
• Hands and wrists.
• Elbows.

Gout symptoms come and go (recur) in episodes called flares or gout attacks. A healthcare provider will suggest medications and changes to your diet that will lower your uric acid levels and minimize how often you experience gout attacks in the future.

Symptoms and Causes

What are gout symptoms?

Gout attacks are very painful and can happen suddenly, often overnight. During a gout attack, symptoms in your affected joints may include:

• Intense pain.
• Discoloration or redness.
• Stiffness.
• Swelling.,
• Tenderness, even to a light touch (like a bedsheet covering your affected joint).
• Warmth, or a feeling like the joint is “on fire.”

How long does a gout attack last?

Gout attacks usually last a week or two. You might have some flares that last longer than others, and some might cause more severe symptoms. Between attacks, you might not experience any gout symptoms.

What causes gout?

A buildup of excess uric acid in your body causes gout. Your body naturally makes uric acid when it breaks down chemicals called purines found in certain foods and drinks. Your kidneys usually filter uric acid out of your blood, and then it leaves your body when you pee. Sometimes your body makes too much uric acid, or your kidneys don’t remove it from your blood fast enough. When your body has high levels of uric acid (hyperuricemia), uric acid crystals can build up and settle into your joints. The sharp crystals clump together and cause sudden episodes of pain, swelling and other symptoms.Having temporarily high uric acid levels doesn’t mean you’ll definitely develop gout. Many people with hyperuricemia never get gout.

Gout risk factors

Gout can affect anyone. People assigned male at birth (AMAB) are three times more likely to develop gout. People assigned female at birth (AFAB) usually don’t experience gout until after menopause. People with certain health conditions are more likely to develop gout, including:

• Overweight or obesity.
• Congestive heart failure.
• Diabetes.
• Hypertension (high blood pressure).
• Kidney disease.
• Blood cancer.

You’re more likely to experience gout if you:

• Have a biological parent or grandparent who has gout.
• Eat a lot of animal proteins — especially animal flesh, shellfish and foods that contain organ meat.
• Drink alcohol regularly.
• Take a diuretic medication (water pills).
• Take immunosuppressants.

Which foods cause gout?

Eating or drinking foods high in purines are more likely to lead to high uric acid levels in your body that cause gout, including:

• Sugary drinks and sweets: Standard table sugar is half fructose (fruit sugar), which breaks down into uric acid. Any food or drink with high sugar content can trigger gout.
• High fructose corn syrup: This is a concentrated form of fructose. Packaged food products and processed snacks can contain lots of high fructose corn syrup.
• Alcohol: Even though not all alcoholic drinks are high in purines, alcohol prevents your kidneys from eliminating uric acid, pulling it back into your body, where it continues to accumulate.
• Organ meats: These include liver, tripe, sweetbreads, brains and kidneys.
• Game meats: Specialties such as goose, veal and venison all contain high levels of purines.
• Certain seafood: Herring, scallops, mussels, codfish, tuna, trout and haddock.
• Red meat: Beef, lamb, pork and bacon.
• Turkey: Especially processed deli turkey.
• Gravy and meat sauces.

Diagnosis of Gout

A healthcare provider will diagnose gout with a physical exam. They’ll ask you about your symptoms and examine your affected joints. Tell your provider when you first noticed symptoms like pain and swelling in your joint and how often the symptoms come and go.

What tests will be done to diagnose gout?

Your healthcare provider might use a few imaging tests to take pictures of your affected joints. These tests can also show if gout has caused any changes in your joints. You might need:

• X-rays.
• Ultrasound.
• Magnetic resonance imaging (MRI).
• A CT (computed tomography) scan — specifically a dual-energy CT scan.

Other common tests to diagnose gout include:

• Blood tests to measure the uric acid in your blood.
• Joint aspiration — using a needle to remove a sample of fluid from inside a joint.

Management and Treatment

How is gout treated?

Treating gout is usually a combination of managing your symptoms during a flare and reducing how often you consume high-purine foods and drinks.

Gout medication

Your healthcare provider might suggest medications to help manage your symptoms, including:

• NSAIDs: Over-the-counter (OTC) NSAIDs, like ibuprofen and naproxen, can reduce pain and swelling during a gout attack. Some people with kidney disease, stomach ulcers and other health problems shouldn’t take NSAIDs. Talk to your provider before taking NSAIDs.
• Colchicine: Colchicine is a prescription medication that can reduce inflammation and pain if you take it within 24 hours of a gout attack.
• Corticosteroids: Corticosteroids are prescription medications that reduce inflammation. Your provider might prescribe oral (by mouth) pills. They may also inject corticosteroids into your affected joints or into a muscle near your joint (intramuscularly).

Your provider might prescribe medications to help lower your uric acid levels. The most common medications that lower uric acid include:

• Allopurinol.
• Febuxostat.
• Pegloticase.
• Probenecid.

Low purine diet for gout

Your healthcare provider may suggest you follow a low-purine diet. A low-purine diet encourages you to consume fewer foods and drinks with high purine content. This will help reduce uric acid in your body. It also encourages you to eat some select foods that may reduce your uric acid levels.

Can gout be cured?

There’s no cure for gout. You’ll experience fewer attacks once you work with a healthcare provider to find treatments that manage your symptoms and lower your uric acid levels.

Prevention of Gout

The best way to prevent gout is to limit how often you consume high-purine foods and drinks. Make sure you drink plenty of water to help your kidneys function better and avoid dehydration.

Getting regular exercise can help reduce stress on your joints and reduce your risk for obesity and other health conditions that make you more likely to develop gout.

Outlook / Prognosis

What can I expect if I have gout?

If you have gout, you should expect to have flares of symptoms that come and go. Flares can happen more frequently if you don’t get gout diagnosed and treated by a healthcare provider.

Some people with gout experience more severe or more frequent attacks right after starting treatment as the uric acid in their body adjusts to new medications or changes in their diet.

What’s the outlook for people with gout?

Most people with gout eventually find a combination of treatments and lifestyle tweaks to manage their symptoms and reduce how often they experience gout attacks. Gout is treatable, People who have a blood uric level lower than 6 mg/dL are much less likely to experience gout attacks.

Untreated gout can lead to permanent joint damage. The buildup of uric acid in your joints and soft tissue is called tophus. Some people with gout can also develop other health problems, including:

• Severe arthritis and changes to the shape of your joint (joint deformity).
• Tophi (the plural form of tophus — a buildup of uric acid in the joints and soft tissue).
• Kidney stones.
• Heart disease.

Management of Gout

When we have a gout attack, we can manage symptoms by:

• Avoiding alcohol and sweet drinks.
• Drinking plenty of water.
• Elevating your affected joints above the level of your heart as often as you can.
• Icing your joints. Wrap an ice pack in a thin towel or put a cold compress on your joint for 15-20 minutes at a time a few times a day.
• Limiting stress on your joint by avoiding intense exercise or physical activities.

Frozen Shoulder

Frozen Shoulder

Frozen shoulder or adhesive capsulitis is a shoulder condition causing limited range of motion. This condition occurs when the tissues in the shoulder joint become thicker and tighter. The common signs and symptoms of frozen shoulder may include stiffness and pain in the shoulder joints which usually get worsened within one to three years. Treatment for the frozen shoulder may include physical therapy, medications, surgery and other procedures.

Symptoms

Signs and symptoms of frozen shoulder are normally worsened and developed over time. They are divided into three stages including:

• Freezing stage

People with this stage of frozen shoulder usually have pain when moving the shoulder that limits the range of motion.

• Frozen stage

During this stage, the pain may be relieved but the shoulder becomes stiffer and more difficult to use.

• Thawing stage

The range of motion is more limited. Moving the shoulder is obviously more difficult for people with this final stage of frozen shoulder.

Causes

A capsule of connecting tissue encases the shoulder joint. When these connecting tissues become thicker and tighter, the movement of the shoulder is restricted. The reason why the tissues get thicken and tighten are still unclear. However, systemic diseases and immobilizing the shoulder for a long period, such as in people after a surgery or arm fracture tend to be involved with the development of this condition.

Risk factors

There are several factors that might increase the risk of frozen shoulder including:

• Age and gender

Women at the age of 40 and older tend to have more risk of frozen shoulder.

• Immobilized or less mobilized shoulder

The risk of frozen shoulder is increased in people who have prolonged immobility or less mobility of the shoulder. The cause of immobility or less mobility of the shoulder may include broken arm, recovery after a surgery, injury or stroke.

• Systemic diseases

Some systemic diseases may encourage the development of frozen shoulders. For example:

• • Diabetes
  • Hypothyroidism
  • Hyperthyroidism
  • Cardiovascular disease
  • Parkinson’s disease
  • Tuberculosis

Diagnosis

The doctor may conduct a physical exam to check for the pain and evaluate active and passive range of motion since either of them can be affected. A numbing medicine might be injected in some cases. Normally, a frozen shoulder can be diagnosed by the physical exam and reviewing of signs and symptoms. However, to seek for other problems, the doctor may require to use some image tests, such as X-rays or MRI.

Treatment

The aims of the treatment are to control the pain and improve a better range of motion. Medications, therapy, surgery and some procedures are the common treatments of frozen shoulders.

• Medications

The doctor may prescribe several medications, such as pain reliever and anti-inflammatory drugs to relieve the pain and inflammation.

• Therapy

The doctor or a physical therapist may advise you on some range-of-motion exercise to promote the mobility of the shoulder.

• Surgical and other procedures

Other treatment for frozen shoulder may include:

• • Steroid injection. To reduce pain and promote shoulder mobility
  • Joint distension. To stretch the connecting tissues and to promote an easier movement
  • Shoulder manipulation. To loosen the tighten tissue
  • Surgery. The doctor may perform a surgery to remove a scar tissue and adhesions inside the shoulder joint in people who do not react to other treatment.

Muscle Atrophy

Muscle Atrophy

Muscle atrophy is the wasting or thinning of muscle mass. It can be caused by disuse of your muscles or neurogenic conditions. Symptoms include a decrease in muscle mass, one limb being smaller than the other, and numbness, weakness and tingling in your limbs. Disuse atrophy can be reversed with exercise and a healthy diet.

What is muscle atrophy?

Muscle atrophy is the loss or thinning of your muscle tissue. If you have atrophied muscles, you’ll see a decrease in your muscle mass and strength. With muscle atrophy, your muscles look smaller than normal. Muscle atrophy can occur due to malnutrition, age, genetics, a lack of physical activity or certain medical conditions. Disuse (physiologic) atrophy occurs when you don’t use your muscles enough. Neurogenic atrophy occurs due to nerve problems or diseases.

Symptoms and Causes

What are the symptoms of muscle atrophy?

The symptoms of muscle atrophy differ depending on the cause of your condition. The most obvious sign of muscle atrophy is reduced muscle mass. Other signs of muscle atrophy may include:

• One arm or one leg is smaller than the other.
• Weakness in one arm and or one leg.
• Numbness or tingling in your arms and legs.
• Trouble walking or balancing.
• Difficulty swallowing or speaking.
• Facial weakness.
• Gradual memory loss.

What does muscle atrophy feel like?

If you have muscle atrophy in your limbs, you may feel tingling, numbness or weakness in your arms and legs. If you have atrophied muscles in your face or throat, your facial muscles may start feeling weak and you may find it difficult to speak or swallow.

What causes muscle atrophy?

The cause of muscle atrophy depends on the type you have. Disuse (physiologic) atrophy is caused by not using your muscles enough. If you stop using your muscles, your body won’t waste the energy it needs to take care of them. Instead, your body will start to break your muscles down, which causes them to decrease in size and strength. Disuse atrophy may affect you if you:

• Lead a sedentary lifestyle.
• Are malnourished.
• Don’t get enough exercise.
• Sit at a desk job all day.
• Are on best rest.
• Have a genetic disorder such as muscular dystrophy or Charcot-Marie-Tooth disease.
• Can’t move your limbs due to a stroke or other conditions such as dermatomyositis.
• Have age-related atrophy (sarcopenia).

Neurogenic atrophy is caused by an injury or disease affecting nerves that connect to your muscles. When these nerves are damaged, they can’t trigger the muscle contractions that are needed to stimulate muscle activity. When your muscles don’t contract, your body thinks you don’t need them anymore. So your body starts breaking them down, which causes them to decrease in size and strength. Diseases and other conditions that can affect these nerves include:

• Amyotrophic lateral sclerosis (ALS).
• Guillain-Barre syndrome.
• Carpal tunnel syndrome.
• Polio.
• Spinal cord injury.
• Multiple sclerosis.

How long does it take muscles to atrophy?

The amount of time it takes for your muscles to atrophy depends on your age, fitness level and cause of atrophy. If your muscle atrophy is due to disuse (physiologic), the process can start within two to three weeks of not using your muscles. Neurogenic muscle atrophy may develop sooner depending on your health condition.

Diagnosis and Tests

How is muscle atrophy diagnosed?

To diagnose muscle atrophy, your healthcare provider will give you a physical exam and ask you about your symptoms. They’ll look at your arms and legs and measure your muscle mass. In addition, your healthcare provider may order tests, including:

• Blood test.
• Muscle or nerve biopsy.
• Electromyography (EMG).
• Nerve conduction studies.
• X-rays.
• Computed tomography (CT) scan.
• Magnetic resonance imaging (MRI) scan.

Management and Treatment

Disuse (physiologic) atrophy can sometimes be reversed with exercise and a healthy diet. Your healthcare provider may start you on a program that includes exercises in the pool. Working out in the water can reduce your muscle workload. Neurogenic atrophy typically can’t be reversed because of the physical damage that’s been done to your nerves.

Treatment for muscle atrophy depends on the type. Disuse (physiologic) atrophy can be treated with regular exercise and better nutrition. Your healthcare provider may recommend physical therapy or an exercise plan. Even if you can’t actively move certain joints in your body, you can do still exercises wearing a splint or brace. Your healthcare provider may have you work with a dietitian on a healthy eating plan. They may suggest nutritional supplements as well.

Neurogenic atrophy can sometimes be treated with a special kind of physical therapy called electrical stimulation. Your physical therapist will place electrodes on your skin over your muscles. The electrodes send small electrical impulses to your nerves and muscles. The electrical impulses try to artificially exercise or contract your muscles. This can help you maintain your muscle mass and strength.

Your physical therapist may also recommend ultrasound therapy. Ultrasound therapy uses sound waves to promote muscle healing.

If you develop a contracture due to your muscle atrophy, your healthcare provider may perform surgery to correct it. A contracture occurs when your muscle tissues become fibrous. This tissue makes it hard for you to stretch the muscle and prevents movement.

Bone Fracture

A broken bone or bone fracture occurs when a force exerted against a bone is stronger than the bone can bear. This disturbs the structure and strength of the bone, and leads to pain, loss of function and sometimes bleeding and injury around the site.

There are different types of bone fractures. Some are more severe than others, depending on the strength and direction of the force, the particular bone involved, and the person’s age and general health. Common bone fractures include:

• wrist
• ankle
• hip – hip fractures occur most often in older people.

Broken bones take around 4 to 8 weeks to heal, depending on the age and health of the person and the type of break.

Causes of bone fractures

Causes of bone fractures can include:

• traumatic incidents such as sporting injuries, vehicle accidents and falls
• conditions such as osteoporosis and some types of cancer that cause bones to fracture more easily, meaning even minor trauma and falls can become serious.

Symptoms of bone fractures

Fractures are different from other injuries to the skeleton such as dislocations, although in some cases it can be hard to tell them apart. Sometimes, a person may have more than one type of injury. If in doubt, treat the injury as if it is a fracture.

The symptoms of a fracture depend on the particular bone and the severity of the injury, but may include:

• pain
• swelling
• bruising
• deformity
• inability to use the limb.

Types of bone fracture

Different types of fracture include:

• Closed (simple) fracture – the broken bone has not pierced the skin.
• Open (compound) fracture – the broken bone juts out through the skin, or a wound leads to the fracture site. Infection and external bleeding are more likely.
• Greenstick fracture – a small, slender crack in the bone. This can occur in children, because their bones are more flexible that an adult’s bones.
• Hairline fracture – the most common form is a stress fracture, often occurring in the foot or lower leg as a result of repeated stress from activities such as jogging or running.
• Complicated fracture – structures surrounding the fracture are injured. There may be damage to the veins, arteries or nerves, and there may also be injury to the lining of the bone (the periosteum).
• Comminuted fracture – the bone is shattered into small pieces. This type of complicated fracture tends to heal more slowly.
• Avulsion fracture – muscles are anchored to bone with tendons, a type of connective tissue. Powerful muscle contractions can wrench the tendon free and pull out pieces of bone. This type of fracture is more common in the knee and shoulder joints.
• Compression fracture – occurs when 2 bones are forced against each other. The bones of the spine, called vertebrae, can have this type of fracture. Older people, particularly those with osteoporosis, are at higher risk.

Not all fractures are of a person’s arm or leg. Trauma to the head, chest, spine or pelvis can fracture bones such as the skull and ribs. These fractures are further complicated by the underlying body structure that the bone normally protects.

Some of these fractures can be very difficult to manage using first-aid principles only, as they may represent life-threatening injuries. Always seek emergency assistance if you suspect this type of fracture.

Complications of bone fractures

Other problems caused by bone fracture can include:

• Blood loss – bones have a rich blood supply. A bad break can make you lose a large amount of blood.
• Injuries to organs, tissues or surrounding structures – for example the brain can be damaged by a skull fracture. Chest organs can be injured if a rib breaks.
• Stunted growth of the bone – if a child’s long bone breaks close to the joint where the growth plates are found.

First aid for bone fractures

Good first-aid care of fractures is important. Moving the broken bones can increase pain and bleeding and can damage tissues around the injury. This can lead to complications in the repair and healing of the injury later on.

First aid for fractures is all about immobilising (limiting movement of) the injured area. Splints can be used for this. Control any external bleeding.

Complicated breaks where a limb is very deformed may need to be realigned before splinting – only paramedics or medical staff should do this.

Fractures of the head or body such as skull, ribs and pelvis are all serious and should be managed by paramedics.

If you suspect a bone fracture, you should:

• Keep the person still – do not move them unless there is an immediate danger, especially if you suspect fracture of the skull, spine, ribs, pelvis or upper leg.
• Attend to any bleeding wounds first. Stop the bleeding by pressing firmly on the site with a clean dressing. If a bone is protruding, apply pressure around the edges of the wound.
• If bleeding is controlled, keep the wound covered with a clean dressing.
• Never try to straighten broken bones.
• For a limb fracture, provide support and comfort such as a pillow under the lower leg or forearm. However, do not cause further pain or unnecessary movement of the broken bone.
• Apply a splint to support the limb. Splints do not have to be professionally manufactured. Items like wooden boards and folded magazines can work for some fractures. You should immobilise the limb above and below the fracture.
• Use a sling to support an arm or collarbone fracture.
• Raise the fractured area if possible and apply a cold pack to reduce swelling and pain.
• Stop the person from eating or drinking anything until they are seen by a health care professional in case they need surgery.
• In an emergency, call triple zero (000) for an ambulance.

Diagnosis of bone fractures

Doctors can diagnose bone fractures with x-rays. They may also use CT scan (computed tomography) and MRI scans (magnetic resonance imaging).

Treatment of bone fractures

Broken bones heal by themselves – the aim of medical treatment is to make sure the pieces of bone are lined up correctly. The bone needs to recover fully in strength, movement and sensitivity. Some complicated fractures may need surgery or surgical traction (or both).

Depending on where the fracture is and how severe, treatment may include:

• splints – to stop movement of the broken limb
• braces – to support the bone
• plaster cast – to provide support and immobilise the bone
• traction – a less common option
• surgically inserted metal rods or plates – to hold the bone pieces together
• pain relief – to reduce pain.

Operation procedure for bone fractures

A cast made from plaster of Paris is one of the most common ways of immobilising a limb. This cast is made from a preparation of gypsum that sets hard when water is added. Depending on the location and severity of the fracture, the operation procedures can include:

• Closed or simple fractures – the 2 ends of the broken bone are lined up and held in place. The limb is thoroughly bandaged, then the wet plaster is applied. Sometimes, once the plaster is dry, the cast is split into 2 and the 2 halves are re-bandaged on the outside. This allows for any swelling that may occur.
• Open or compound fractures – these are thoroughly cleaned in the operating room to remove debris before being set, because a broken bone exposed to the open air may become infected.
• Long bones – long bones such as the bone of the thigh (femur) are difficult to keep aligned. In adults these are often treated by internal nailing. A child may need traction for a couple of days before setting the bone in a cast. Once the 2 ends of bone start to show signs of healing, the leg and hip joint are immobilised in plaster of Paris. In other cases, pins are inserted above and below the fracture and secured to an external frame or ‘fixator’. This is done under a general anaesthetic.

Immediately after an operation on a bone fracture

After surgery, your doctor will check that you have full feeling in the area. For example, if you have a broken arm in plaster, they may ask you to wiggle your fingers. They will also check your limb for tingling, pallor (pale colour) or coolness. These tests check whether the splint is affecting your limb’s nerve and blood supply. The injured part is kept as still as possible in the first few days.

Nurses will offer you pain-relieving medication. They will determine the difference between the pain of your fracture and any pain that could be caused by the splint, traction, plaster cast, poor alignment of the limb or swelling of the limb.

Healing process for bone fractures

Blood clots that form on the broken ends of bone are the start of the healing process. Over about 5 weeks, the body joins the 2 bone portions together with a combination of fibrous cells and cartilage.

This temporary bone (callus) is not as strong as real bone. It can break easily until it is slowly replaced with real bone. For this reason the doctor may remove your cast or splint after a few weeks, but you still need to treat the bone with care for at least one more month.

Other treatments for bone fractures

Some bones, such as the collarbone or bones of the toes, are immobilised with a sling or splint (instead of plastered) and rested for about 2 months.

Complications of bone fractures

Possible complications of a bone fracture may include:

wrongly fitted plaster cast (for example, too tight or too loose).

poor alignment of the limb

infection

Muscle Cramp

A muscle cramp is an uncontrollable and painful spasm of a muscle. Any muscle can be affected, but the muscles of the calf and foot are particularly prone. A cramp can last for varying periods of time and generally resolves by itself. The exact cause of cramps is unknown but risk factors may include poor physical condition, mineral and electrolyte imbalances, and tight, inflexible muscles.

Cramps are usually harmless but may sometimes be symptomatic of an underlying medical disorder, such as atherosclerosis (narrowing of the arteries). Regular cramping or severe cramping that lasts longer than a few minutes should always be investigated by your doctor.

Symptoms of muscle cramps

The symptoms of a muscle cramp include:

• sudden sensation of uncontrollable and painful spasms in the muscle
• muscle twitching.

Minerals and electrolytes

Muscle tissue relies, in part, on a range of minerals, electrolytes, and other chemicals in order to contract and relax. Some of these important substances include calcium, magnesium, potassium, and sodium. Inadequate diet, dehydration, vomiting and diarrhoea are just some of the factors that are thought to disturb the body’s balance of minerals and electrolytes, and make muscles more susceptible to cramping.

Tetany is a special form of cramping – it can be brought on by overbreathing, which results in a low level of carbon dioxide in the blood. It is usually caused by anxiety.

Risk factors for muscle cramp

The exact cause of muscle cramp is not known, but risk factors may include:

• tight, inflexible muscles
• poor physical condition
• poor muscle tone
• inadequate diet
• physical overexertion
• physical exertion of cold muscles
• muscle injury
• muscle fatigue
• excessive perspiration
• dehydration – caused by, for example, a bout of gastroenteritis
• reduced blood supply (ischaemia)
• wearing high-heeled shoes for lengthy periods.

Muscle cramps associated with medical conditions

Certain diseases or conditions may increase the risk of muscle cramp, including:

• Atherosclerosis – a condition characterised by narrowed arteries due to the formation of fatty plaques. Muscles are more likely to cramp if their blood supply is inadequate.
• Sciatica – pain in the buttock and leg caused by pressure on nerves in the lower back. In some cases, the irritated nerve may prompt the associated muscles to contract.
• Medications – some medical conditions require the regular use of fluid pills (diuretics). These drugs can interfere with the body’s mineral balance and contribute to cramping.

Treatment options for muscle cramps

Most muscle cramps resolve after a few seconds or minutes. There has been very little research done to work out which treatment works best, but treatment options include:

• Stretch and massage – lengthen the cramping muscle using a gentle, sustained stretch then lightly massage the area until the cramp subsides. If you are unsure how to stretch leg muscles, see your physiotherapist for advice.
• Ice pack – in cases of severe cramp, an ice pack applied for a few minutes may help the muscle to relax.
• Medication – some medications can be helpful to control muscle cramps. See your doctor for further information.
• Further treatment – see your doctor if you experience regular muscle cramping or if cramps last longer than a few minutes. You may have an undiagnosed medical condition that requires treatment.

Prevention strategies

Suggestions on how to reduce the likelihood of muscle cramp include:

• Increase your level of physical fitness.
• Incorporate regular stretching into your fitness routine.
• Warm up and cool down thoroughly whenever you exercise or play sport.
• Drink plenty of water before, during and after exercise.
• Make sure your diet is nutritionally adequate, and include plenty of fruits and vegetables.
• A regular massage may help to reduce muscle tension.
• Wear properly fitted shoes and avoid high heels.

Fibromyalgia

Fibromyalgia causes pain in your muscles and joints throughout your body. It can also make you feel fatigued and cause mental symptoms like memory problems. Experts don’t know what causes fibromyalgia — and there’s no cure for it — but a healthcare provider will help you find treatments to manage your symptoms.

Fibromyalgia is a long-term (chronic) health condition that causes pain and tenderness throughout your body. It causes musculoskeletal pain and fatigue.

People with fibromyalgia usually experience symptoms that come and go in periods called flare-ups. Sometimes, it can feel exhausting and challenging to navigate living with fibromyalgia. The peaks and valleys between feeling good and suddenly having a flare-up of symptoms can feel overwhelming. Fibromyalgia is real, and so is how you feel.

Experts don’t know what causes fibromyalgia, but studies have found that certain health conditions, stress and other changes in your life might trigger it. You might be more likely to develop fibromyalgia if one of your biological parents has it.

Any new pain in your body is often the first sign of fibromyalgia — especially in your muscles. Trust your instincts and listen to your body. Visit a healthcare provider if you’re experiencing new pain, fatigue and other symptoms — even if it feels like they come and go.

Who is affected by fibromyalgia?

Anyone can develop fibromyalgia. It affects people of any age, including children. Around 4 million people in the U.S. are living with fibromyalgia.

People assigned female at birth (AFAB) and people older than 40 are more likely to be diagnosed with fibromyalgia.

Symptoms and Causes

What are fibromyalgia symptoms?

The two most common symptoms of fibromyalgia are pain and fatigue. You may experience:

• Muscle pain or tenderness.
• Fatigue.
• Face and jaw pain (temporomandibular joint disorders).
• Headaches and migraines.
• Digestive problems, including diarrhea and constipation.
• Bladder control issues.

Fibromyalgia can cause mental and emotional symptoms, including:

• Memory problems (sometimes called “fibro fog” or “brain fog”).
• Anxiety.
• Depression.
• Insomnia and other sleep disorders.

What causes fibromyalgia?

Experts don’t know what causes fibromyalgia.

Certain genes you inherit from your biological parents might make you more likely to develop fibromyalgia. Studies have found a link between biological parents who have fibromyalgia and their children — this might mean it’s passed down through families.

People with fibromyalgia are usually more sensitive to pain than most people. Experts haven’t found the direct link yet, but they think genetic mutations in the genes responsible for forming the neurotransmitters in your brain that broadcast and receive pain signals to your body might cause fibromyalgia.

What are the risk factors for fibromyalgia?

Even though experts can’t say for sure what causes fibromyalgia, some health conditions and other issues are risk factors for developing it. Fibromyalgia risk factors include:

• Your age: People older than 40 are more likely to develop fibromyalgia. But it can affect anyone, including children.
• Your sex assigned at birth: People assigned female at birth are twice as likely to experience fibromyalgia.
• Chronic illnesses: People with conditions like osteoarthritis, depression, anxiety disorders, chronic back pain, and irritable bowel syndrome are more likely to develop fibromyalgia.
• Infections: Some people develop fibromyalgia after having an infection, especially if they experience severe symptoms.
• Stress: The amount of stress you experience can’t be measured on a test, but too much stress can affect your health.
• Traumas: People who’ve experienced a physical or emotional trauma or a serious injury sometimes develop fibromyalgia.

What triggers a fibromyalgia flare-up?

Certain events or changes in your life can trigger a fibromyalgia flare-up. Everyone is different, and what triggers symptoms for some people might not for you. In general, anything that increases your stress can trigger a flare-up, including:

• Emotional stress caused by your job, financial situation or social life.
• Changes in your daily routine.
• Changes in your diet or not getting enough nutrition.
• Hormone changes.
• Not getting enough sleep or changing when you sleep.
• Weather or temperature changes.
• Getting sick.
• Starting new medication or treatments, or changing something in your usual fibromyalgia treatment routine.

Diagnosis of Fibromyalgia

A healthcare provider will diagnose fibromyalgia with a physical exam and discussion of your health history. They’ll ask about your symptoms and when you first noticed them.

There’s no test that can diagnose fibromyalgia. Usually, diagnosing it is part of a differential diagnosis — a medical process of elimination. Your provider will make a diagnosis by comparing several conditions with related symptoms. This process leads to your final diagnosis.

Your provider might use blood tests to rule out other common causes of fatigue like anemia or issues with your thyroid gland.

Management and Treatment

There isn’t a single treatment that works for every person with fibromyalgia. Your provider will work with you to find a combination of treatments that relieve your symptoms. Tell your provider which symptoms you’re experiencing and when they change (including when they’re improving or getting worse).

Treatments you might need include:

• Over-the-counter (OTC) or prescription medicine to relieve pain.
• Exercises like stretches or strength training.
• Sleep therapy.
• Cognitive behavioral therapy.
• Stress management therapy.
• Antidepressants.

Four stages of fibromyalgia

Fibromyalgia is a dynamic condition. This means you won’t experience symptoms in any specific order — there’s no roadmap to know when or how fibromyalgia symptoms will affect you.

Your provider might treat your fibromyalgia in stages based on how you feel. These stages aren’t a step-by-step treatment plan. Every person is different, and how fibromyalgia affects your body will be unique. The stages are more like loose categories that can help you understand which treatments you’ll need to manage your symptoms. The four stages of treating fibromyalgia include:

• Non-pharmacological treatments: Your provider or a physical therapist will give you stretches and exercises to loosen, relax and strengthen your muscles and joints.
• Psychological treatments: A mental health professional will help you identify ways to maintain a healthy self-image. They’ll suggest strategies to manage symptoms that affect your mental and emotional health.
• Pharmacological treatment: Taking medicine to manage your symptoms.
• Daily functioning: An occupational therapist can help you navigate your daily routine if you’re experiencing severe symptoms that make it hard to participate in your regular activities.

Prevention of Fibromyalgia

Because experts don’t know what causes fibromyalgia, you can’t prevent it.

Maintaining your overall health can help reduce the severity of fibromyalgia symptoms:

• Manage stress as well as you can.
• Follow a diet and exercise plan that’s healthy for you.
• Get enough sleep and practice good sleep hygiene.

Outlook / Prognosis

What can I expect if I have fibromyalgia?

You should expect to manage fibromyalgia symptoms for a long time — maybe for the rest of your life. Some people with fibromyalgia experience fewer flare-ups with milder symptoms after they find treatments that work for them. Ask your provider how often you need follow-up appointments to adjust your treatments or to adjust any medications you’re taking.

Complications of fibromyalgia

People with fibromyalgia are more likely to be hospitalized because of pain, fatigue or mental health symptoms. You’re also more likely to experience memory problems and have trouble concentrating.

Talk to your provider as soon as you notice any changes in your symptoms, especially if you feel like they’re affecting your memory or mental health.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is when the median nerve is compressed as it passes through the carpal tunnel. The carpal tunnel is an opening in your wrist that is formed by the carpal bones on the bottom of the wrist and the transverse carpal ligament across the top of the wrist. The median nerve provides sensory and motor functions to the thumb and 3 middle fingers. If it gets compressed or irritated, you may have symptoms.

What You Need to Know

• Carpal tunnel release is one of the most common hand conditions requiring surgery.
• Symptoms may include tingling, pain, numbness or weakness in the thumb through ring fingers of the affected hand.
• Women get carpal tunnel syndrome three times more often than men.
• Carpal tunnel syndrome is a progressive condition that can worsen without proper care.
• Symptoms of carpal tunnel syndrome often occur during pregnancy and can be alleviated with nonsurgical treatments. Symptoms often improve after delivery, but such patients are at higher risk of developing carpal tunnel syndrome later in life.

Carpal Tunnel Syndrome Causes and Risk Factors

Carpal tunnel syndrome is caused by an increase in pressure within the carpal tunnel, which leads to compression of the median nerve as it travels across the wrist into the palm through the carpal tunnel.

In most cases, this increase in pressure inside the carpal tunnel is difficult to attribute to one cause. Typically, multiple factors are at play that result in the pressure on the nerve:

• Anatomical changes and differences: The carpal tunnel opening is too narrow
  • Some people may have smaller than average carpal tunnel size, which could run in families
  • Women, on average, have smaller carpal tunnel size than men and are more likely to develop carpal tunnel syndrome
  • Bones and joints could change shape over time due to diseases such as osteoarthritis or trauma to the wrist
• Swelling and inflammation: When tissues in and around the carpal tunnel swell up, they could press on the median nerve. Swelling and inflammation could result from:
  • Frequent, repetitive movements with the hands
  • Extending or flexing the wrist for long periods of time
  • Rheumatoid arthritis and other conditions that cause inflammation in the joints
  • Hormonal or metabolic changes (for example, menopause, pregnancy or thyroid imbalance)
• Other contributing factors:
  • Changes in blood sugar levels (may be seen with type 2 diabetes)
  • Other conditions or injuries of the wrist (for example, strain, sprain, dislocation or break)
  • Obesity

What are the symptoms of carpal tunnel syndrome?

These are the most common symptoms:

• Weakness when gripping objects with one or both hands
• Pain or numbness in one or both hands
• “Pins and needles” feeling in the fingers
• Swollen feeling in the fingers
• Burning or tingling in the fingers, especially the thumb and the index and middle fingers
• Pain or numbness that is worse at night, interrupting sleep

The symptoms of carpal tunnel syndrome may be similar to other medical conditions or problems. Always see your health care provider for a diagnosis.

How is carpal tunnel syndrome diagnosed?

Your provider will check your medical history and give you a physical exam. He or she may recommend that you have electrodiagnostic tests on your nerves. These tests are the best way to diagnose carpal tunnel syndrome. Electrodiagnostic tests stimulate the muscles and nerves in your hand to see how well they work.

Treatment of carpal tunnel syndrome

Your health care provider will figure out the best treatment for you based on:

• Your age
• Your overall health and medical history
• How bad your wrist is right now
• How well you tolerate specific medications, procedures, or therapies
• How bad the disease is expected to get
• Your opinion or preference

Treatment may include:

• Splinting your hand. This helps keep your wrist from moving. It also eases the compression of the nerves inside the tunnel.
• Anti-inflammatory medication. These may be oral or injected into the carpal tunnel space. These reduce the swelling.
• Surgery. This eases compression on the nerves in the carpal tunnel.
• Worksite changes. Changing position of your computer keyboard or making other ergonomic changes can help ease symptoms.
• Exercise. Stretching and strengthening exercises can be helpful in people whose symptoms have gotten better. These exercises may be supervised by a physical or occupational therapist.

Surgery for carpal tunnel syndrome

Surgery for carpal tunnel syndrome is usually done as an outpatient. Two types of carpal tunnel surgery are done: open surgery and endoscopic surgery. You may have local or general anesthesia, or both, for either surgery.

During open surgery, the surgeon cuts open your wrist. The tissue that is pressing on the nerves is cut. This relieves the pressure on the nerve.

During endoscopic surgery, the surgeon puts a long, thin rod through a tiny cut on the wrist. The rod, or scope, contains a camera and a light. The scope lets the surgeon to see inside your wrist. He or she cuts the tissue using tiny surgical tools.

After the surgery, your hand and wrist are wrapped and put into a splint. This will help to keep you from moving your wrist during your recovery. You will need to wear the splint for a week or two. You will probably have some pain after your surgery. It’s usually controlled with pain medication taken by mouth. You may also be told to sleep with your hand elevated to help ease swelling.

Recovery from carpal tunnel surgery is different for each person. If your nerve has been compressed for a long time, recovery may take longer. You will be encouraged to move your fingers and wrist a few days after surgery to help prevent stiffness.

You may need to adjust your work or home activities while you recover. Talk with your healthcare provider about what you need to change.

Bursitis

Knee pain

Dislocated shoulder

Shoulder arthritis

Ankle sprains

Carpal tunnel syndrome

Acute injuries

Hip labral tear

Tennis elbow

Rotator cuff tear

Anterior cruciate ligament injury

Scoliosis

Musculoskeletal cancer