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peterhutch asked:




A dislocated knee cap is when the triangle-shaped bone covering the knee (patella) moves or slides out of place. The problem usually occurs toward the outside of the leg. See dislocation.

A careful vascular examination is essential, as popliteal artery injury occurs in 7-45% of all knee dislocations. The popliteal artery may be damaged severely in both closed and open dislocations, and such injury must be ruled out in knees that have relocated spontaneously. Palpation of the dorsalis pedis and posterior tibial arteries along with capillary refill evaluation is necessary. The presence of normal pulses does not rule out the presence of significant vascular injury. Coexistent peroneal nerve injury occurs in 25-35% of patients and manifests with decreased sensation at the first webspace with impaired dorsiflexion of the foot.

Causes

Dislocation may also occur as a direct result of injury. When it is dislocated, the knee cap may slip sideways and around to the outside of the knee.

The first few times this occurs, you will feel pain and be unable to walk. However, if dislocations continue to occur and are untreated, you may feel less pain and have less immediate disability. This is not a reason to avoid treatment. Knee cap dislocation damages your knee joint.

Symptoms and Signs

Swelling and muscle spasm progress over the first few hours. With 2nd-degree sprains, pain is typically moderate or severe. With 3rd-degree sprains, pain may be mild, and surprisingly, some patients can walk unaided. An audible pop suggests an anterior cruciate tear but is uncommon. An effusion suggests injury to the anterior cruciate and possibly other intra-articular structures. However, with severe 3rd-degree tears of the medial collateral ligament or anterior cruciate, no effusion may be apparent because these tears can result in an open joint capsule, allowing blood to exit the joint.

Diagnosis

X-rays may be recommended to see how the kneecap fits in its groove. Your doctor will also want to eliminate other possible reasons for the pain, such as a tear in the cartilage or ligaments of the knee. The following imaging procedures may be used to see how the include:

x-ray – a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Prevention

Use proper technique when exercising or playing sports. Maintain strength and flexibility of the knee. Some cases of knee dislocation may not be preventable, especially if anatomic factors predispose you to dislocation.

Treatment

Non-operative

Normal care of patellar dislocations, when a loose fragment has not been created is the immobilization of the knee for a short period of time (seven to 10 days). During this time, the swelling is reduced and the acute discomfort of the dislocation decreases. Slow mobilization of the knee and of the patellofemoral joint is then begun, and usually full recovery can be expected within a three to six week period. This period of time is significantly lengthened when the patellar dislocation is recurrent.

Initial treatment consists of a knee immobilizer or cylinder cast, followed by gentle active range-of-motion (ROM) exercises. Physical therapy should be involved to help regain joint and leg strength, especially the quadriceps muscles. Taping techniques have been explored with variable results.



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Dr.Bhat asked:




MANAGEMENT OF CERVICAL DISC HERNIATION WITH MARMA CHIKITSA

What is Vertebral Disc? :

The disc (or intervetebral disc) is a structure that is found in between the spinal vertebral bodies from the neck to the sacrum (tailbone). It serves as a cushion and helps the spine to move.

Each disc is composed of two parts, the nucleus pulposus (the central part) and the annulus fibrosis (the outer part). The nucleus pulposus provides the padding and it is surrounded by the annulus fibrosis which forms a ring around the nucleus pulposus. This pulposus also attaches to the vertebral bodies above and below.

The diseases frequently associated with the disc :

The diseases frequently associated with the disc are usually 2 in number, disc herniations (abnormal protrusions of a portion of the disc material) and disc degeneration (changes in the disc seen in normal aging and also in injury) respectively.

The sites usually affected by disc herniation in neck :

The most common levels for disc problems are in descending order C6-C7 (C refers to cervical and the number refers to the number of the vertebral body counting from the top), C5-C6, C7-T1 (here the T refers to the thoracic spine, the part that the ribs attach to), C4-C5 and very rarely C3-C4.

Why and how disc protrusions cause pain? :

Herniation of the contents of the disc into the spinal canal often occurs when the front side (stomach side) of the disc is compressed while sitting or bending forward, and the contents (nucleus pulposus) get pressed against the tightly stretched and thinned membrane (annulus fibrosis) on the rear (back side) of the disc. The combination of membrane thinning from stretching and increased internal pressure (200 to 300 psi) results in the rupture of the confining membrane. The jelly-like contents of the disc then move into the spinal canal, pressing against the spinal nerves, thus producing intense and usually disabling pain and other symptoms.

Symptoms caused by the herniation :

Pressure on a nerve root is referred to as cervical radiculopathy.Cervical disc herniations can press on the spinal cord and cause a problem called cervical myelopathyThe most common symptom of a cervical disc herniation is neck pain that radiates (spreads) down to the arm in various locations. The specific location of the arm pain depends on which disc is involved. There can also be associated paresthesias (pain as if pricked with pins and needles) and in some cases weakness of some of the arm muscles. Patients find that turning their head away from the painful side helps. Extending the head makes the pain worse so that looking up is avoided. Bending the head down usually gives some relief.

Severe neck pain radiating to the back of head and down between the shoulder blades may be present with an acute disc prolapse. There may also be an associated muscle spasm aimed at limiting the movement and relieving the pain. How ever in certain occasions the spasm itself may cause generalised neck pain.

Cervical Disc Herniation Treatment:

The treatment of cervical disc herniation can be divided into two categories, conservative and Pancha karma with Marma Chikitsa.

In general, conservative management consists of maneuvers to reduce pressure on the nerve root. Immobilization with the neck in a flexed forward position may be helpful. Straining should be avoided. Medication in the form of anti vatic or anti vata-kaphaik like Maha Rasnadi, Prasaranyadi, Gulgulu thiktam etc., may be prescribed. As these medications are selected based on the Prakruti (Constitution) of the patient, patients should consult their doctor if taking any medications for longer than a few days. Ayurveda medicines of course do not cause any side effects, only when proper medicine is selected for proper Prakruti. Other wise it may aggravate the agony, there by giving an impression like that of a side effect. Say for example a person with Pitta Prakruti suffering from Bleeding Piles if consumes a preparation with Bhallataka (Semecarpus ancardium) as it’s ingredient, he can be rest assured that his symptoms are going to get worsened, sometime leading to hospitalization. It is because Bhallataka increases the Pitta and hence will drastically increase the flow of already existing venous blood loss in the bleeding piles. Physical therapy may be prescribed. This can consist of traction, mild stretching, exercise, heat, massage etc.

Pancha karma and Marma Chikitsa :

Forty five persons suffering from cervical disc prolapse were considered for the clinical evaluation of Marma Chikitsa and Panchakarma either done separately or in combination. The details are being listed beneath for better understanding.

List – 1

No of patients with cervical disc prolapse – 45

No of Males – 33

No of Females _ 12

Protrusion in C6-7 (Inclusive for both genders) -42

Protrusion in C5-6-7(Inclusive for both genders) – 03

Patients with Neck pain alone- 28

Patients with  Neck pain radiating up to fingers of both hands – 11

Neck pain radiating to nape, chest and up to fingers of both hand – 06



List– 2

The other tenderful marmas other than the C 5, 6, 7 are listed below.

Krikatika        -06 patients

Siramatrka     -03   ‘’

Amsa              -16    ‘’

Amsaphalaka – 06 ‘’

Apalapa          -06   ‘’

Kakshadhara – 02   ‘’

Sthanarohita – 06   ‘’

Kurpara         -13     ‘’

Indrabasti     - 09     ‘’

Manibandha – 09     ‘’

Kurcha         – 05     ‘’

Talahrdaya   – 06     ‘’

Ksipra          – 09     ‘’

List – 3 Mode of treatment selected

In Males for M/C alone 28 patients were selected and for M/C & P/K 05 was selected.

In Females 09 of the patients were selected for M/C and 03 for M/C & P/K.

Please Note: – M/C indicates (Marma Chikitsa) &P/K (Pancha karma)

Course of treatment:

A course of 10 days or 14 days of Marma Chikitsa alone or in combination with Panchakarma was done.

Improvements observed during the course of treatment.

Amongst the 45 cases, in almost 36 patients the symptoms started receding from 3rd day onwards. In 6 of them pain relief happened from 5th day onwards and the remaining 3 cases felt the difference from either 6th or 7th day. However all the 45 subjects (patients) felt completely relived from the pain caused by cervical disc prolapse on completing their course of treatment of 10 or 14 days, subjected to. Periodical evaluations for the next 1 year revealed that the re-occurrence of pain never happened in their case.

Conclusion:

The year long study of the above 45 cases indicates that when persons suffering from the cervical disc prolapse, when subjected to Marma Chikitsa in combination or without that of Panchakarma, depending on the discretion of the physician, yields very good result in controlling and eradicating the annoy some pain, from which the patients had been suffering with. I hope this research of mine enlightens the readers with a wider and deeper knowledge of the subject dealt with.

– Sarve Janaah Sukhinoh Bhavanthuh.





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Dr. Pamela Dassenko, DDS asked:




When people talk about TMJ symptoms or problems they are referring to issues related to the working of the hinge in the jaw – which is called the Temporo Mandibular Joint (TMJ). When this hinge that is made of bones and held in place thanks to the tension provided by cartilage and muscle and other connective tissues gets out of whack, it can cause discomfort. The discomfort may range from mild to extreme pain, and the symptoms may run the gamut from a clicking sensation to the complete lack of ability to properly use the jaw and bite down or hold the bones of the jaw and the rows of teeth in a proper natural alignment.

As we learned as little children in the song “the knee bone is connected to the thigh bone” all parts of the body are interdependently connected. So if your jaw hinge is out of synch, that can lead to symptomatic issues elsewhere. One example is that many people who experience problems with the TMJ also feel muscular pains that might crop up in the neck, in the shoulders, or even in the back. They might get headaches because the painful seizing up of those groups of muscles that are supposed to hold the jaw assembly in place are fighting to get it back into its right position. By doing so they clench and grab, often cramping up and creating knots of muscle that can be painful and tiring. With one bunch of muscles knotted up tight, the muscles connected to that tight or muscle spasm plagued part of the body will also lock up or tighten, in what is referred to as a sympathetic reaction. In worst case scenarios what starts off as a seemingly minor TMJ problem can radiate from one muscle or group of tendons and muscles to others, and as it spreads the symptoms become more and more painful and debilitating.

When TMJ trouble persists, one of the most uncomfortable symptoms is migraines. Along with these exceptionally bad headaches one might also experience sleeplessness, nausea, and an aversion to bright lights. The recommendation is that those who even suspect that they have a TMJ issue surfacing should seek immediate help. If your jaw locks up sometimes, if it makes an audible clicking noise when you chew – the kind of noise that you might hear if you pop your knuckles, for instance – or if you feel the muscles of the jaw getting stiff, sore, and tight – then you should make an appointment to have the situation evaluated by a qualified and trained professional like a massage therapist with TMJ experience, a medical doctor, a chiropractor, or your family dentist.

Generally speaking, those who are plagued by TMJ problems are best treated by going to the dentist, who will be able to diagnose the problem and then takes steps to remedy the situation. Many times a dentist will, for example, work with the joint or hinge to try to massage or realign it back into place so that it again functions like normal. Repeated visits are usually needed for those who have experienced chronic TMJ symptoms, whereas those with only mild problems can sometimes have the TMJ put back into its proper working position – and get cured – with just one or two visits.



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Kacy Carr asked:




Does size really matter, well this would depend on what we refer too. If we talk of a young child in a fight, then yes, because no toddler is able for the teen, or if you`re hungry, then a small size food portion will not fill your belly. What on earth has this got to do with vagina`s you may well ask, “satisfaction” that`s what. Both instances are “unsatisfying” situations for the toddler and the tummy rumbler due to size restricting them from achieving, so this can apply to the size of the vagina also? If a person can get satisfaction from being well fed – or from beating their opponent, then why wouldn`t a person want satisfaction from their love making. Does the size of the vagina matter; yes it does if it interferes with, or stops you pleasuring in sex. If you or your partner gets no enjoyment while having sex because of looseness, then of course it matters. If you`re sure the problem is in your department and not about your partner having a small willy, then you need to look for a way to tighten your vagina.

Is there a way of telling whether the vagina is either big or small, and of a natural size? Vaginal size is not a topical subject, so chances of finding out anything from friends and family through girlie gossip, is zilch. The vaginal wall is elasticity so exact size can never really be ascertained. If the vagina is relaxed the vaginal walls collapse into each other. The diameter is less than one inch and the length will be around 3 to 4 inches. Vagina size alters when ready for intercourse. At this time the diameter of the vagina is not the same throughout the vaginal tunnel.

The narrowest part of the vagina is the opening which widens as it goes in deeper. Normally the front part of vagina has a size of one and a half inches. The deeper into the vagina you go the bigger the diameter. The back end is usually a diameter of 2 1/2 inches. The front vagina wall has the length of 2 inches and the back end is 3 totaling approximately 6 inches.

Some pregnant women after giving birth find there vagina may have stretched through intense expansion. Most of these women turn to Kegel exercises to bring back vaginal tightness. Issues in relation to a loose vagina and vulva size are common, so no need to be embarrassed. Go along and speak with your GP if you`re worried over this. If you’ve never experienced giving birth, then it’s highly unlikely that your vagina or vulva is too big. If you have been put off having sex because you have heard it stretches the vagina and makes it big, then you have heard wrong. What a load of codswollop, yes the vagina can stretch to accept the penis, but soon returns to normal size. Childbirth is a regular cause for vaginal looseness because it can affect dimensions, meaning, damaged muscles and other supporting tissues of the vaginal walls. Don`t be put off having children thinking this is a natural happening for women having baby`s, because it`s not, just ask the millions of moms the whole world over. There are things you can do to help prevent widening of the vagina by doing postnatal exercises that physiotherapists teach.

If the vaginal ‘barrel’ gives a feeling of largeness it can lead to the following effects:

” Unsatisfactory sexual intercourse.

” Likelihood of air getting into the vagina – known as ‘fanny farting’.

” Lax muscles and ligaments can lead to a prolapsed womb

If you want to tighten a loose vagina start by doing pelvic floor muscle exercises. Practice includes you tense the muscles at the front of the lower part of your body – as if preventing yourself from weeing, hold this contraction for 10 seconds then relax and repeat and keep up for 5 minutes. If possible do this 4 times a day. You can speak to a gynecologist to discuss the possibility of a ‘repair’ operation. This draws the weakened pelvic tissues together and firms everything up resulting in a tight vagina.

Some women on a huge scale tend “not” to worry over size as much as they do of appearance. These same women believe they have an abnormal vagina because their vulva is either too large or the labia too long, or that bits of it protrude unevenly. If you are one of these women it does not mean you have an abnormal vagina, what it means is, is you have one slightly different from others. Getting back to vagina size, we have women who think their vagina too small. Statistically this is most unlikely. Symptoms that show smallness: is

” Sexual intercourse pain

” Not able to have sex

” Discomfort inserting a tampon

Many women who feel vaginal tightness find it hard to accept that their vagina is normal-size after seeking medical advice. Vaginismus is a condition and the primary reason why women get mixed up for the smallness. Vaginismus causes the vaginal muscles to contract when intent on making genital contact. An internal examination is normal procedure carried out to clarify that this is the problem. Unfortunately with vaginismus a woman can do nothing to prevent the condition from happening because symptoms are entirely involuntary. Vaginismus can have a woman experience burning, pain, penetration problems, or complete inability to have intercourse.

The tightness is actually caused by involuntary contractions of the pelvic floor muscles surrounding the vagina. The tightness can be so restrictive that the opening to the vagina shuts altogether making penetration near to impossible for the man. As like with most conditions there can be several specific types, and this applies to vaginismus also. If a woman has always experienced pain while having intercourse due to this muscle spasm it is called “primary vaginismus.” Recognized suffering from this type is not able to wear tampons. Another type is the “secondary vaginismus” more known more for developing later in life. Women can have this after years of uncomplicated sexual intercourse. It is normally hurried along by a medical condition, traumatic event, childbirth, or menopause.

Vaginismus is curable and a condition not to be ashamed of. Your doctor is the person with all the answers if you need to know more. It is not a concern to deeply worry over, as treatment is pretty much straight forward. Vaginismus treatment does not require drugs, surgery, or any other complex persistent methods, so no need to hold back on seeking treatment and suffering any longer.

Symptoms of vaginismus can include:

” Unintentional uncontrolled spasms of the muscles in the vagina

” Dread of pain

” Fear of penetration

” Loss of sexual yearning near to penetration

” Difficulty and pain, inserting a tampon, or penis

The quicker you address the issue about your tight vagina, then the quicker it will give you back the confidence to enjoy and have a wonderful sex life again.



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Paul Miller asked:




Imagine the surprise a woman must feel while dealing with the physical symptoms and discomforts of pregnancy, to suddenly develop severe back pain. This is not the usual low back pain that is often experienced during pregnancy; it is sciatica. This sharp, shooting pain usually starts in the buttocks and radiates down the back or side of the thigh to the calf and possibly the heel. There may be paralyzing numbness, in addition to the pain, which can be severe enough to limit mobility.

Sciatica can occur at any time in a normal pregnancy but it is most common during the second and third trimester, when the baby is larger and carried lower in the abdomen. Known as Pregnancy-Related Sciatica, it is caused by the pressure of the baby on the sciatic nerve. This is the largest nerve in the body, about the diameter of a finger. Its fibers branch off the spinal cord at the 4th and 5th lumbar vertebra (L4, L5) and the first few segments of the sacrum.

As the pregnancy develops, the abdominal tendons and ligaments become looser to prepare for childbirth. The backs of some women become quite unstable and prone to injury. Medical evaluation should always be sought. In some cases, sciatic pain is due to pressure on the nerve that is caused by damage to the disc between the vertebrae of the spine. This creates inflammation and pain and requires specific treatment.

Most physicians avoid prescribing medications for pregnant patients suffering from sciatica but there are several steps that can be taken to relieve or decrease the discomfort. This includes:

• Massage to reduce muscle tension. Some experts believe that tightness in the gluteus and psosas muscles contribute to sciatic pain. Treatment once or twice a week can help relieve stress on weight-bearing joints.

• Moist heat alternated with ice packs

• Chiropractic treatments may be helpful. Be sure to select a practitioner experienced in treating prenatal patients.

In addition, these helpful habits may decrease the chances of developing sciatica:

• Avoid hours of sitting slumped at a computer or standing with a baby on one hip. Both can contribute to lower back pain.

• Maintain proper posture and try to stand straight.

• Wear flat shoes or ones with a very low heel. Avoid shoes that throw your weight backwards.

• Williams Exercises have been developed specifically for use during pregnancy. They may temporarily relieve sciatica pain as they help strengthen the muscles of the pelvic floor, the back and abdomen.

• Swimming and walking are excellent exercises if not contra-indicated by the physician.

• Avoid walking on an incline as this can cause joint irritation and lead to problems.

• Try to avoid significant weight gain.

• Try sleeping on a firm mattress, lying on one side. A pillow rolled up under the knees may be helpful.

• When getting out of bed, try rolling onto your side first, letting the weight of your feet and legs dangling over the edge of the bed, pull your body into a sitting position. This puts less stress on the lower back, helping you to avoid triggering a painful muscle spasm.

• Bedrest may be necessary at times.

• See your physician if the pain becomes unmanageable.

Sciatica is unique to a pregnancy and may gradually disappear on its own. Just because you had sciatica in one pregnancy does not mean it will appear in a subsequent one.



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