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Showing posts from 2012

Entrapment of medial calcaneal nerve (MCN)

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Peripheral nerve entrapment is a rare, but important, cause of foot and ankle pain that often is underdiagnosed and mistreated. A peripheral nerve may become entrapped anywhere along its course, but certain anatomic locations are characteristic (2). The medial calcaneal nerve (MCN) The Tibial nerve is called the planter nerve in the sole. The tibial nerve passes to the sole of the foot takes a turn on the medial side of the calcaneum is called MCN. The medial calcaneal nerve arises from tibial nerve of the inner side of the ankle, perforates the laciniate ligament, travels downwards passing below the bony projection on the inner side of the ankle, and supplies the skin over the medial aspect of the heel. Hence it is the most important nerve for heel sensations. MCN have 2 branches. The anterior branch dominate the cutaneous sensation of the anterior part of the medial calcaneal and heel weight loading field, while the posterior branch dominate the sensation of the posterior an

Planter heel pain: planter fascitis, Fat pad atrophy, combined PF & FPA.

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What the following article is on? Discussion on 3 conditions with mostly similar symptom of planter heel pain. Synonyms of planter heel pain: Subcalcaneal heal pain, calcaneodynia  etc. Synonyms of Planter fascitis: Planter fasciosis, Planter fasciopathy etc. Planter foot pain is seemingly the most innocuous yet significant morbid condition affecting the adults hampering their ADLs & QOL. According to a recent research paper (1) Plantar heel pain can be provoked by PF (Planter fascitis), FPA (Fat pad atrophy), combination of PF + FPA and other causes. Patients with PF or FPA typically show different characteristics in clinical features but overall may look quite similar. Plantar heel pain requires differential diagnosis for appropriate treatment. DD of planter foot pain includes following: Planter heel pain can be sub-divided in to neural & non-neural pain. The non-neural pain can again be sub-divided into 2 bony & soft tissue pains. Bony pathology: Calcaneal stress f

Ulnar wrist pain: TFCC injury & DD of Ulnar sided wrist pain

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Many ulnar wrist pains are obscure & according to Bottke both surgical exploration and nonoperative treatment have been less than satisfying. Most of the times specific physical examination and standard radiographs were unrevealing in these cases. Even with specific diagnostics test such as arthroscopy, treatment results could not be correlated with arthrographic findings (1). Ulnar wrist pain,Distal RUJ & TFCC: The distal radioulnar joint (DRUJ) acts in concert with the proximal radioulnar joint to control forearm rotation. The DRUJ is stabilized by the triangular fibrocartilage complex (TFCC). This complex of fibrocartilage and ligaments support the joint through its arc of rotation, as well as provide a smooth surface for the ulnar side of the carpus. TFCC and DRUJ injuries are part of the common pattern of injuries we see with distal radius fractures. While much attention has been paid to the treatment of the distal radius fractures, many of the poor outcomes are due t

Differential diagnosis of Anatomic (Radial) snuffbox pain: It is not always DeQuervain’s tenosynovitis.

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Tendon, Bone & Ligament causes: 1. DeQuervain’s tenosynovitis: Swelling of tendon of APL (Abductor pollicis longus) & extensor pollicis brevis at lateral wrist near anatomic snuff box.  The primary complaint is radial sided wrist pain that radiates up the forearm with grasping or extension of the thumb. The pain has been described as a “constant aching, burning, pulling sensation." Pain is often aggravated by repetitive lifting, gripping, or twisting motions of the hand. Swelling in the anatomical snuff box, tenderness at the radial styloid process, decreased CMC abduction ROM of the 1st digit, palpable thickening of the extensor sheaths of the 1st dorsal compartment and crepitus of the tendons moving from the extensor sheath may be found upon examination. Other possible findings include weakness and paresthesia in the hand. Finkelstein’s diagnostic test will present positive provoking the patient’s symptoms. If left untreated, the inflammation and progressive narro

Carpal instability: Types, Place of VISI & DISI

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  Key word: Carpal instability, Data base: Pubmed Wrist anatomy- extrinsic & and intrinsic ligaments The extrinsic (radiocarpal) and intrinsic (intercarpal) ligaments maintain carpal stability. The major extrinsic ligaments are the radioscaphocapitate, radiolunotriquetral, short radiolunate, and dorsal radiocarpal ligaments. The scapholunate and lunotriquetral ligaments are the most important intrinsic ligaments and the primary wrist stabilizers. The most common causes of carpal instability are unstable fracture of the scaphoid, scapholunate dissociation, and lunotriquetral dissociation (7). Let us discuss the causes of carpal instability. Classification of carpal instability is presented below is based on anatomic and kinematic characteristics of the wrist. A classification of the subtle patterns of carpal instability is presented below.   Navarro's concept of the carpus (1921): Carpals of wrist are arranged in 3 vertical longitudinal columns: lateral (scaph

LASER therapy in physiotherapy

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Synonyms:   •    Therapeutic Laser •    Low Level Laser Therapy •    Low Power Laser Therapy •    Low Level Laser •    Low Power Laser •    Low-energy Laser •    Soft Laser •    Low-reactive-level Laser •    Low-intensity-level Laser •    Photobiostimulation Laser •    Photobiomodulation Laser •    Mid-Laser •    Medical Laser •    Biostimulating Laser •    Bioregulating Laser 4 categories of lasers –    Crystal & Glass (solid - rod) •    Synthetic ruby & others (synthetic ensures purity) –    Gas (chamber) – 1961 •    HeNe, argon, CO2, & others –    Semiconductor (diode - channel) - 1962 •    Gallium Arsenide (GaAs under investigation) –    Liquid (Dye) - Organic dyes as lasing medium –    Chemical – extremely high powered, frequently used for military purposes Types of laser: Lasers are of 3 different type soft laser, mid laser, power laser. Soft lasers are used for dermatological purposes where depth of penetration is only superficial, Physiotherapy lasers are mid las

Classification of spondyloarthritides (SpA) & USpA

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Classification of spondyloarthritides (SpA) & USpA Definition: The spondyloarthritides (SpA) are an interrelated group of rheumatic diseases that are characterized by common clinical symptoms and genetic similarities. For clinical purposes, 5 subgroups are differentiated: 1.    AS (ankylosing spondylitis) 2.    Psoriatic SpA (PsSpA) 3.    Reactive SpA (ReSpA) 4.    SpA associated with inflammatory bowel disease (SpAIBD) and 5.    Undifferentiated SpA (uSpA) Features of SpA: Important clinical features of the SpA are 1.    inflammatory back pain (IBP) 2.    asymmetric peripheral oligoarthritis predominantly of the lower limbs 3.    enthesitis 4.    specific organ involvement such as anterior uveitis (eye) , psoriasis (skin) and chronic inflammatory bowel disease The most important subtype of SpA is ankylosing spondylitis (AS), which is now considered part of axial spondyloarthritis. ASAS Classification: ASAS stands for Assessment of SpondyloArthritis International Society.  AS

Eosinophilic Fascitis: 300 cases in 35 years

All people dealing with soft tissue pain & dysfunction "Eosinophilic Fascitis" is rearrest of the rare condition to encounter. Take a note of it. It is a matter of debate for all fascia researchers & people involved in "Fascia research congress" Pubmed link to "Eosinophilic Fascitis":   http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001483/

Lumbar Retrolisthesis: Introduction, types, physiotherapy treatment

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A retrolisthesis is a posterior displacement of one vertebral body with respect to the adjacent vertebrae to a degree less than a luxation (dislocation). Retrolisthesis is relatively rare but when present has been associated with increased back pain and impaired back function. Clinically speaking, retrolisthesis is the opposite of spondylolisthesis (anterior displacement of one vertebral body on the subjacent vertebral body). Retrolistheses are most easily diagnosed on lateral x-ray views of the spine. Views, where care has been taken to expose for a true lateral view without any rotation, offer the best diagnostic quality. Retrolisthesis may occur more commonly than initially believed. However retrolisthesis (backwards slippage of one vertebral body on another) has historically been regarded as an incidental finding, one which doesn’t cause any symptoms, and is considered to be of little or no clinical significance. But there is a possible association between retrolisthesis and

Sitting ergonomics: Different sitting postures & analysis of chair sitting muscle work

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Different varieties sitting postures: A. Common sitting postures: 1.    Chair sitting 2.    Crossed sitting 3.    Crossed sitting with arms wrapped around both knees & locked in front 4.    Half crossed sitting 5.    Crook sitting 6.    Inclined sitting (to back) 7.    Inclined sitting (to sides) 8.    Inclined long sitting 9.    Side sitting 10.    Stoop sitting 11.    Fall out sitting 12.    Ride sitting 13.    Kneel sitting 14.    Crouch sitting B. Activities in sitting: 1.    Twisting in sitting 2.    Bending & reaching in sitting (sidewise- office works & in front- driving) 3.    Hitching & Hiking (to relieve pressure on buttocks in prolonged sitting) C. Co-existing unavoidable stress factors in sitting: 1.    Whole body vibration (driving) 2.    Noise stress 3.    Visual stress 4.    Psychological stress Analysis of muscle work in sitting posture: Ideal sitting posture: The following discussion is in the context of a quiet id