Pulled elbow & dislocation of radial head at elbow

Traumatic disruption of radio-humeral architecture may take many forms & a cause of lateral elbow pain with elbow stiffness. Subluxation & dislocation occur at this joint without fracture. We are herewith presenting a small review of pulled elbow in children & radial dislocation in adults. The purpose of doing so is to present the clinician to better identify these seemingly equal entities. Pulled elbow: It is also known as nursemaid's elbow. It is a common injury in young children. It is considered a minor condition in medicine but cause mush distress to parents of a child. It results from a sudden longitudinal traumatic pull on pronated and extended forearm, usually by an adult or taller person. This sudden pull pulls the radius through the annular ligament, resulting in subluxation (partial dislocation) of the radial head. The child experiences sudden acute pain and loss of function in the affected arm. DD: It appears to be infrequently recognized or

Manage LBA & SIJ pain by Hip intervention

Crucial role of hip in Hip-spine syndrome Cervical & dorsal spine can produce lumbar spine pain along with lower extremity pain that may mimic sciatica. Similarly muscle imbalances & hip capsular problems may produce SI joint & lumbar spine pain with radiating symptoms in the lower extremity. In the following article we are trying to focus on hip producing spine & SI joint problems producing radiating & non-radiating symptoms. Concomitant presence of hip & spine problem named hip-spine syndrome is reported in medical literature but amount of research in this area is scanty. As relates to physiotherapy it becomes difficult to chuck out action plan as every bit of physical intervention must be directed to exact tissue at fault. What causes what, hip gives rise to spine fault or vice versa is yet to be concretely ascertained. Burns SA et al (2) found joint mobilization/manipulation and strengthening exercises directed at the hip alleviates both hip & lu

Chronic fatigue syndrome

Introduction: Severe fatigue is a common complaint among patients. Often, the fatigue is transient or can be attributed to a definable organic illness. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests. In these cases, the diagnosis of chronic fatigue syndrome (CFS) should be considered. According to Centers for Disease Control and Prevention (CDC, USA) Chronic fatigue syndrome (CFS) currently is defined as: (1) fatigue of at least 6 months' duration, seriously interfering with the patient's life; and (2) without evidence of various organic or psychiatric illnesses that can produce chronic fatigue. The World Health Organization classifies myalgic encephalomyelitis/chronic fatigue syndrome (ME/cfs) as a nervous system disease. Together with other diseases under the G93 heading, ME/cfs shares a triad of abnormalities involving elevated oxidative and nitrosative stress (O&NS), activat

Diagnosis of Posterior heel pain & role of eccentric exercise in mid-portion Achilles tendinopathy

Introduction: Degenerative disorders of tendons present an enormous clinical challenge. They are extremely common, prone to recur and existing medical and surgical treatments are generally unsatisfactory. Posterior heel pain is a common complaint in both athlete and non-athlete. Posterior heel pain is multifactorial and includes paratenonitis, tendinosis, tendinosis with partial rupture, insertional tendinitis, retrocalcaneal bursitis, and subcutaneous tendo-Achilles bursitis. Each of these entities is distinct, but they often occur in combination. To avoid stereotyped treatment programs and there by failure of treatment, we need to know & classify homogenous appearing clinical entities into it’s own due place. With respect to posterior heel pain we encounter similar appearing entities in the Achilles tendon itself. Hence Van dijk et al in 2011 has sought clear terminology to delineate each of pain syndromes arising out of posterior heel. Following is an outline of new termi

Entrapment of medial calcaneal nerve (MCN)

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.

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

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