A Simple Guide to Knee cap Dislocation

A Simple Guide to Knee cap Dislocation
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What is Knee cap Dislocation?
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Knee cap Dislocation is when the knee cap (patella) moves or slides out of place. This usually occurs on the outer side of the knee.


What are the causes of Knee cap Dislocation?
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1.Dislocated knee caps most often occur in people with loose joint ligaments.

It can occur due to sudden strain on the knee ligaments causing the kneecap to protrude out of its loose ligaments.

2.Dislocation of the knee cap may also occur due to trauma.

A sudden blow to the medial part of the knee can cause the knee cap to dislocate laterally.

3.People who are prone to dislocated knee caps usually have loose ligaments with hyperflexion of the wrists or flat feet.

This condition is usually inherited and are more common in women than in men.


What are the symptoms and signs of Knee cap Dislocation?
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Symptoms:

1.Knee cap is displaced to the lateral position

2.knee swelling and effusion due to displacement of the knee cap.

3.Knee pain and tenderness is present.

4.The knee is usually held in slight flexion.

5.There is difficulty in lifting the leg

6. Patient usually walks with a limp.

Signs:

1.Tenderness and swelling of the knee

2.Knee cap is displaced to the outside or lateral part of the knee

3.In most cases the knee cap may have returned to the central position of the knee but there is still tenderness and swelling.

4.The knee cap can move excessively from right to left.(hypermobile)

How to investigate the cause of Knee cap Dislocation?
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1.examination of the knee would confirm presence of the dislocated knee cap.

There is lateral displacement of the knee cap and swelling of the knee.
Movement of the knee may be painful.

2.A knee x-ray should be done to exclude any fracture especially in the case of injury or in the elderly.

A skyline view of the knee should show the shift of the patella laterally.

3.MRI of the knee can be done to see any damage in the cartilage or meniscus of the knee.


What is the Treatment of Knee cap Dislocation?
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Conservative treatment:
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1. Most cases of knee dislocation can treated by simple reduction of the dislocated knee cap.

The heel of the leg is lifted to extend the knee and flex the hip thus relaxing the quadriceps muscles(front muscles of the thigh)

Gentle pressure is exerted on the knee cap to place it to its normal position.

The knee is then immobilized for 2-3 weeks.

Quadriceps exercises are begun as soon as possible to build back your muscle strength and improve the knee's range of motion.

Drug Therapy:
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1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

2.Muscle relaxant to relax muscles

Surgery:
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Surgery is required if:

1.the knee remains unstable

2.Injury of the knee cap cause a partial rupture of the medial retinaculum and supporting ligaments of the knee cap.
This can cause recurrent episodes of subluxation or dislocation of knee cap.

Surgery is done to stabilize the knee cap.
Reconstruction of the quadriceps extensor muscles is done to tighten the ligaments surrounding the knee cap.


What is the prognosis of Knee cap Dislocation?
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Prognosis using conservative methods is fair.

Recurrences are quite common.

Preventative measures such as knee guard, quadriceps exercises, avoidance of sudden turns and twisting of the knee may help.

Prognosis after surgery is usually good as there is tightening of the knee cap ligaments and the quadriceps muscles.


What is the Prevention of Knee cap Dislocation?
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1.proper technique when exercising.

2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.

3.Wearing a knee guard

A Simple Guide to Paronychia

A Simple Guide to Paronychia
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What are Paronychia?
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Paronychia is acute or chronic infection of the tissue surrounding the nails of fingers or feet.

What are the Causes of Paronychia?
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There are two main causes of Acute Paronychia:
1.Bacteria-pseudomonas, Proteus,staphylococus

2.Fungal- candida

Chronic Paronychia:
1.Fungal- candida

2.Bacterial-pseudomonas

Micro-organisms usually enter through injured or damaged tissues from a ingrowing nail or sharp nail.

Tissues around the base of the cuticles becomes infected and inflammed, usually on one side of the nail.

Pus may form and oozes from the infected tissues.

What are the Symptoms of Paronychia?
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1.Acute paronychia:
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1.swollen

2.painful

3.red nail fold

4.may dicharge pus

2.Chronic paronychia
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1.recurrent

2.painful

3.swollen tissues at base of nail

4.pus may be present

5.nail plate may rigid, distorted or invaded by micro-organism

What are the investigations for Paronychia?
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Swab for culture and sensitvity to antibiotics

Exclude Diabetes

What is the Treatment of Paronychia?
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Acute Paronychia:
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1.Systemic antibiotics

2.Incision and drainage of pus

3.Surgical excision of part of the cuticle causing tissue damage(Ingrowing toenails) and the removal of infected lateral nail folds

Chronic Paronychia:
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1.Keep hands dry and use protective gloves

2.Apply anti fungal lotions and creams such as clotrimazole, nystatin

3.Systemic anti fungals such as griseofulvin or ketoconazole

4.Treat secondary bacterial infections with antibiotics

What are the Prevention measures in Paronychia?
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1.Avoid pressure on the lateral folds of the nails

2.Footwear should not be too tight

3.Avoid biting of nails

4.Avoid constant contact with water and soaking in water

5.Cutting of nails should not be too deep

6.Good personal hygience

A Simple Guide to Beestings

A Simple Guide to Beestings
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What are beestings?
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Beestings include stings by different bees, wasps and hornets.
The most common sting is by the common honeybee.
Usually the bee stings the patient skin, leaving its stinger behind and dies.

What are the symptoms of Beestings?
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1. stinger left on the skin

2. pain and mild discomfort may last a few hours

3. swelling of the skin at the sting site in sensitive patients reacting to the venom of the sting

4. itch at the site may lasts for a week

The main component of bee venom responsible for pain is the toxin melittin.
Histamine and amines in the beesting contribute to the pain and itching.
Most beesting are acidic in nature.

What is the treatment of Beestings?
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1.Remove the barbed stinger.

2.Apply cold compress to reduce pain and swelling.

3.Use baking soda solution to conteract the acid.

4.Give paracetamol and antihistmines for pain and itch

For more severe reactions such as allergy and anaphylactic shock to the beestings, emergency treatment may be required:

1.Give adrenaline injection subcutaneously slowly over a minute peroid
followed by

2.antihistamine like diphenhydramine intravenously

3.Treat shock

4.Corticosteroids may be needed to counter allergy

Multiple beestings may cause severe reaction with shock and hemaglobinuria.
This may require hospitalisation.

Multiple beestings have been known to cause the kidneys and vital organs to shut down and should be treated urgently.

A Simple Guide to Rheumatoid Arthritis

A Simple Guide to Rheumatoid Arthritis
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What is Rheumatoid Arthritis?
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Rheumatoid arthritis is a systemic autoimmune disease that can cause chronic inflammation of the joints and other areas of the body.

Who gets Rheumatoid Arthritis?
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Rheumatoid Arthritis is one of the most common form of inflammatory arthritis.
It most commonly occurs between the 25 and 50 years.
However it can occur at any age.
Females are 3 times more likely to get Rheumatoid Arthritis than males.

What causes Rheumatoid Arthritis?
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Rheumatoid Arthritis is an autoimmune disease..
Autoimmune diseases are illnesses that occur when the body tissues are mistakenly attacked by its own immune system which consists of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections.
Patients with autoimmune diseases have antibodies in their blood that target their own body tissues .

What are the symptoms of Rheumatoid Arthritis?
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Most common symptoms are pain, swelling, stiffness, warmth and sometimes redness of the joints.

Rheumatoid Arthritis is suspected when there are:
1. Swelling in the joints especially those of the hands,elbows,knees,ankles and feet.

2. Stiffness in the joints in the mornings which can last more than an hour or after prolonged rest

3.redness and warmth in one's joints

4.Persistent pain or tenderness in a joint for more than a month

5.Inability to move or use a joint normally

6. Unexplained weight loss and appetite, fatigue, or weakness together with joint pains

What tests are done to confirm Rheumatoid Arthritis?
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Abnormal blood antibodies can be found in patients with rheumatoid arthritis.

1.A blood antibody called "rheumatoid factor" can be found in 80% of patients.

2.Another antibody called "the antinuclear antibody" (ANA) is also frequently found in patients with rheumatoid arthritis.

3.Another blood test that is used to measure the degree of inflammation present in the body is the C-reactive protein.

4.A blood test called the sedimentation rate (ESR) is a measure of how fast red blood cells fall to the bottom of a test tube. The sed rate is used as a crude measure of the inflammation of the joints.

The rheumatoid factor, ANA, sed rate, and C-reactive protein tests can also be abnormal in other systemic autoimmune and inflammatory conditions. Therefore, abnormalities in these blood tests alone are not sufficient for a firm diagnosis of rheumatoid arthritis

How does the Rheumatoid Arthritis starts?
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Rheumatoid Arthritis may start gradually or with a sudden and severe attack.
It usually attacks many joints at one time.
Rheumatoid arthritis is a chronic disease, characterized by periods of disease flares and remissions.

Where does Rheumatoid Arthritis occur?
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In rheumatoid arthritis, multiple joints are usually affected in a symmetrical pattern.
It most commonly affects the hands and feet,often in a systemic pattern(both right and left joints are affected).
Other joints affected are the elbow,knees,and ankles.
Less common are shoulder,hip and spine.

What are the Complications of Rheumatoid Arthritis?
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Rheumatoid Arthritis can result in joint deformities and disability especially in untreated severe cases.
Daily activities such as bathing,dressing, walking and even writing may be difficult.
Besides the joints, Rheumatoid Arthritis may sometimes affect other organs such as the eyes,lungs,skin,intestines,nerves and bone marrow.
Mild fever, fatigue, loss of appetite and loss of weight may be present.
Severe Rheumatoid Arthritis is associated with an incresed risk of mortality.

How is Rheumatoid Arthritis treated?
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There is no known cure for rheumatoid arthritis.
Therefore the purpose of treatment is to:
1. improve functions and
2. reduce pain and discomfort.

Treatment of Rheumatoid Arthritis can be broadly classified into:
1. Non-drug therapy:
Weight loss is an effective way to reduce the stress on the joints and minimise the pain Walking sticks are useful ways to offload the stress on the affected weight bearing joints such as hips or knee.
Hot packs are useful aids in the morning to soften a stiff arthritic joint whereas braces and knee guards are useful supports to give some comfort to the knee.
Exercises that improve strength, agility and flexibilty are useful to minimise the disability of Rheumatoid Arthritis. A range of motion exercises is useful to keep the joints supple and mobile.
Water based exercises are a good alternative form of aerobic workout by patients afflicted by Rheumatoid Arthritis. The warm water especially is a good medium for joint mobility and together with the buoyancy of water it helps to minimse the body weight impact on the joints.
2. Drug therapy

There are 2 main types of drugs:
1. symptom modifying helps to alleviate the symptoms but do not change the natural history of the conditions. Examples are Non-steroidal Anti-inflamatory Drugs(NSAIDS) like diclofenac.

2. disease modifying drugs such as steroids, methothrexate, sulphasalazine, redaura, hydroxychloroquine have been shown to slow down the damage caused by Rheumatoid Arthritis. However they cause a lot of side effects such as anemia, abnormal white cells, kidney damage,liver damage, vision loss so the medications must be monitored all the time.
It is important that the disease should be controlled before irreversible joint damage occurs.

Newer "second-line" drugs for the treatment of rheumatoid arthritis include leflunomide (Arava), and the "biologic" medications etanercept (Enbrel), infliximab (Remicade), anakinra (Kineret), and adalimumab (Humira).

3. Surgery

Surgery is used as a last result to correct deformities and reduce disability.

The treatment of rheumatoid arthritis optimally involves a combination of patient education, rest and exercise, joint protection, medications, and occasionally surgery.

Early treatment of rheumatoid arthritis results in better outcomes.

A Simple guide to Hemorrhoids

A Simple guide to Hemorrhoids
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What are hemorrhoids?
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Hemorrhoids or piles are distended veins inside the anus which are swollen and inflamed. Hemorrhoids are either inside the anus (internal) or under the skin around the anus (external).

What is the cause of hemorrhoids?
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Hemorrhoids usually result from straining to pass the stool out of anus. Other contributing factors include pregnancy, aging, chronic constipation or diarrhea.

What are the symptoms of hemorrhoids?
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The most common symptom of internal hemorrhoids is bleeding from the anus.Bright red blood may be seen covering the stool, on toilet paper, or dripping from the anus into the toilet bowl.
There may be pain too especially if the stool is hard. This could be due to the hard stools pressing on the swollen piles or due to a tear in the inner lining of the anus.

A painful swelling or a hard lump around the anus may occur when a blood clot forms. This condition is known as a thrombosed hemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching.

How common are hemorrhoids?
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Hemorrhoids are very common in both men and women. About half of the population have hemorrhoids by age 50.
Hemorrhoids are also common among pregnant women. The pressure of the fetus in the abdomen, as well as hormonal changes, cause the hemorrhoidal vessels to enlarge. For most women, however, hemorrhoids caused by pregnancy are temporary.

When are hemorrhoids diagnosed?
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A thorough examination and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer.

The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.

Closer evaluation of the rectum for hemorrhoids requires an exam with a proctoscope, useful for more completely examining the entire rectum.

To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and the entire colon with colonoscopy.
Colonoscopy is a diagnostic procedure that also involve the use of lighted, flexible tube inserted through the rectum.

What is the treatment?
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a.Medical treatment of hemorrhoids is aimed initially at relieving symptoms. Measures to reduce symptoms include:

1.tub baths several times a day in plain, warm water for about 10 minutes
2.application of a hemorroidal cream or suppository to the affected area.
3. medicines such as daflon to shrink the swollen blood vessel.

b. Surgical treatment:A number of methods may be used to remove or reduce the size of internal hemorrhoids.
These techniques include
1.Rubber band ligation. A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away within a few days.
2.Sclerotherapy. A chemical solution is injected around the blood vessel to shrink the hemorrhoid.
3.Laser coagulation. A special device is used to burn hemorrhoidal tissue.
4.Hemorrhoidectomy. Occasionally, extensive or severe internal or external hemorrhoids may require removal by surgery known as hemorrhoidectomy.
5.A new method is the Longo technique. It involve using a circular stapling device which removes a ring of tissue in the lower anus pulling the enlarged piles up within the anus. The staples also interrupt the blood supply to the piles

How do you prevent hemorrhoids?
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The best way to prevent hemorrhoids is to keep stools soft so they pass easily, thus decreasing pressure and straining, and to empty bowels as soon as possible after the urge occurs.

Drink lots of water at least eight glasses a day.

Eating the right amount of fiber result in softer, bulkier stools. A softer stool makes emptying the bowels easier and lessens the pressure on hemorrhoids caused by straining. Good sources of fiber are fruits, vegetables, bran bread, and whole grains.

Avoid food which cause local irritation of anus (spicy food,alcohol) or bowel excitation (coffee,tea)

Exercise, including walking, swimming, help reduce constipation and straining by producing stools that are softer and easier to pass.
Avoid certain sports such as cycling and horse -riding because of the pressure exerted on the anal region.

Avoid sitting in hot places for too long.

Use the toilet at a fixed time eg. after drinking a big glass of water, when you wake up.

A Simple Guide to Osteoarthritis

A Simple Guide to Osteoarthritis

Osteoarthritis
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What is Osteoarthritis ?
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Osteoarthritis
is a degenerative condition of the joints in the human body.
It is the most common form of arthritis.
The cartilage lining of the joint are worn down such that the underlying bone come in contact with each other.
In addition bone spurs may form and joint fluid is reduced.

This causes mechanical and chemical reactions giving rise to the symptoms of Osteoarthritis.

What causes Osteoarthritis ?
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1. Genetics
has found to have role in the predisposition of Osteoarthritis.
Genes on chromosome 2q,4 & 16 have been linked with Osteoarthritis.

2. Aging
is a risk factor of Osteoarthritis.
More than 80% of those above 65 years suffer from Osteoarthritis.

3. Excessive physical activity is a potentially correctable cause of Osteoarthritis.
Activities like long distance running and other high endurance sports may place
the joints under high stress for prolonged periods resulting in overuse injuries and
accelerated wear and tear.

4. Gender plays a role in Osteoarthritis. Osteoarthritis is more common in men for a
cohort of under 50 years and more common in women in the cohort of 50-80 years.

5.Trauma is a common cause of Osteoarthritis in the younger age groups.

What are the symptoms of Osteoarthritis?
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Most common symptom are pain and swelling:

Stiff,painful and swollen joints after a workout

Stiffness in the joints in the mornings which can last about half an hour

Loss of flexibility in one's joints

Bony lumps at the base of the thumb or on the middle of the end joints of the fingers

Pain in the joints after repeated use

Osteoarthritis is often associated with joint surgery or related injury

What are the complications of Osteoarthritis ?
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Osteoarthritis is the top cause of disability in older women and ranks second in older men.

Besides pain and swelling, quality of life suffers in patients with Osteoarthritis due to their loss of mobility and depression.

The loss of mobility is progressive with age.


Where does Osteoarthritis occur ?
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It can affect the any joint of the body although the most commonly affected joints are the weight bearing joints:
knee
hip
ankle
spine.
Other non-weight bearing joints such as
shoulder ,
elbow,
fingers
can also be affected.

How do you treat Osteoarthritis ?
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Osteoarthritis is not curable and the purpose of treatment is to:
1. improve functions and
2. reduce pain and discomfort.

Treatment of Osteoarthritis can be broadly classified into:
1. Non-interventional

a. non-pharmaceutical

Weight loss is an effective way to reduce the stress on the joints and minimise the pain
Walking sticks are useful ways to offload the stress on the affected weight bearing
joints such as hips or knee. The walking aids should be used on the opposite side.
It can be in the form of a sturdy umbrella instead of a crutch.
Hot packs are useful aids in the morning to soften a stiff arthritic joint whereas braces
and knee guards are useful supports to give some comfort to the knee.
Exercises that improve strength, agility and flexibility are useful to minimise
the disability of Osteoarthritis.
A range of motion exercises is useful to keep the joints supple and mobile .
Water based exercises are a good alternative form of aerobic workout by patients afflicted
by Osteoarthritis. The warm water especially is a good medium for joint mobility and
together with the buoyancy of water it helps to minimise the body weight impact
on the joints.

b. pharmaceutical
There are 2 main types of drugs:

1. symptom modifying drugs help to alleviate the symptoms but do not change the
natural history of the conditions.
Examples are Non-steroidal Anti-inflammatory Drugs(NSAIDs) like diclofenac.

2. disease modifying drugs such as glucosamine has been shown to slow down the
wear and tear of the cartilage but it does have the ability to grow new cartilage.
It has also being found to work better with chondroitin.

2. Interventional:

a. non-surgical

Joint aspiration is a procedure where fluid from the swollen joint is removed,
helping to decompress the tension and bring relief for a while .

Vasosupplementation is a procedure whereby a lubricant is injected into the affected
joint thus reducing the the frictional wear of the joint surfaces.
In addition the lubricant has anti inflammatory properties to reduce the inflammation in the
lining of the joints and may ease the pain for months in early osteoarthritic cases .

b.surgical

Surgical intervention is usually the last resort when all other above treatment fail and in
advanced cases:

Debridement is an arthroscopic (keyhole) procedure to clean the joint of torn cartilages,
loose pieces of bones, etc.
Its main use is to remove the worn out debris which may cause pain and can mechanically
cause friction.

High tibial Osteotomy is a procedure to correct the alignment of deformed legs which
then reduce the stress on the joint.

Prosthetic joint replacement is a procedure to replace the diseased portion of the joint
with a prosthesis or artificial joint allowing painless good range of movement.
It is more suitable for older patient because there is a shelf life to these implants.

Unicondylar joint replacement can now be performed in which part of one of
the bone of the diseased joint is removed instead of a total joint replacement which
involved removal of part of both bones of a joint.

The choice of treatment depends on the stage of the disease and whether there are associated complication.

In general non-interventional methods are more suitable at the early stage of the illness and interventional modalities are more suitable for the later stage of Osteoarthritis.