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Arthritis Reversed #1 ... Biggest Myths on Arthritis
Now medical fraternity is applying a holistic and complimentary system to treat & manage chronic ailments such as arthritis, diabetes, cardiopathy, etc. For any wellness action plan to work there must be a clear understanding of the various aspects involved in so called Arthritis, which also involves clearing up the myths and setting forth the facts of the situation.
Generally the line between fact and fiction is very thin. Myths in healthcare take shape when a sound bite or piece of information is spread and made public, which may be personal experiences or individual concomitants. All these type of information are made available in web globally, making the context so called facts.
When it comes to diseases and conditions like arthritis, the pain, symptoms and joint involved can wreak havoc on a life. If left unchecked, the quality of life of the one suffering arthritis can be destroyed.
After all, a firm belief based in facts goes a long way toward beginning and maintaining a wellness program, especially when one is facing daily pain and physical and emotional debilitation. Let’s look at those myths.
MYTH #1: Rheumatoid Arthritis (RA) and Osteoarthritis (OA) are the Same
Perhaps the most pervasive myth of all is the notion that there is only one type of arthritis and it just happens to have different symptoms for different people. Arthritis for a fact is an inflammatory condition of the joint. In fact, there are over 100 different types of arthritis; the three most common being osteoarthritis (OA), rheumatoid arthritis (RA) and juvenile arthritis (JA).
While rheumatoid and juvenile arthritis are autoimmune diseases, to be precise – osteoarthritis (OA) is not a disease at all. It is a symptom of joint degeneration.
Autoimmune diseases, like rheumatoid and juvenile arthritis (and type I diabetes, lupus, multiple sclerosis, etc.), are progressive and associated with a systemic autoimmune disorder. That means the body makes antibodies that attack its own tissues and joints when triggered by some unknown event. Such triggers are known to include a reaction to a virus, the flu shot and stress. In the case of RA and JA, the joints are affected from the internal imbalance.
On the other hand, osteoarthritis is the result of any combination of several external factors, including traumatic physical injury and excessive sports or physical activities over the course of decades. This causes wear and tear of the joints, as well as of the cartilage separating the joints and the surrounding tissues (tendon and muscle).
MYTH #2: Arthritis Is a Normal Part of Aging and Only Affects the Elderly
If you look around it is easy to see how this myth formed and took hold. There are plenty of elderly afflicted with arthritic conditions with visible signs such as misshapen hands, walkers and wheelchairs, etc.
To begin correcting this myth it is important to know that rheumatoid and juvenile arthritis are autoimmune diseases and, therefore, have nothing to do with aging. Osteoarthritis, on the other hand, is a result of joint wear and tear based in injury and/or overuse, which can come on at any time – or not at all. As such, OA also is not a “normal” part of the aging process.
By keeping the immune system strong and stable, eating right, exercising right and taking care of bone and joint health, the onset and debilitating effects of arthritis need not be part of your aging process. And with better diagnosis and natural treatment remedies and therapies available, when you find you have the condition you can stop it and reduce or even reverse its symptoms, so they will not progress into your later years.
MYTH #3: If You Don’t Look “Sick,” You Don’t Have Rheumatoid Arthritis
If one is only looking to the outward signs and symptoms of RA to know if they have it, they will be amiss. Even when people do not have the visible outward signs of rheumatoid arthritis, such as red swollen joints and deformed fingers, they can still suffer symptoms, like joint pain, fatigue and a general sense of feeling unwell.
The best way to know if you have, or are at risk for, RA is speak to your primary care physician, look into family history and do some blood work.
MYTH #4: If You Have Arthritis, You Should not Exercise
This is a myth most believed by those suffering the symptoms of arthritic pain and inflammation. Decades ago patients were told not to exercise because it would rub the joints and make things worse. This is incorrect. While it is true that depending on your arthritis type and conditions certain exercises should be avoided, this is not a blanket statement about all forms of exercise. In fact certain amount and types of exercise can greatly help reduce the symptoms of arthritis. Most often, those with arthritis in the hips and hands feel pain in the joints and inflammation and/or contraction in the muscles and tissues around those joints. However, part of what is contributing to the pain and stiffness is the limited range of motion within the joint structure that has happened as a result of not exercising.
The first step is to begin exercising slowly, lightly and with limits so as not to worsen or aggravate the conditions. Moving each joint slowly at first helps lubricate the joints and stretch the muscles. Strengthening exercises can help stabilize the arthritis joint structures. This in turn helps bring fresh blood, and thus oxygen and nutrients, to the area, which decreases inflammation, stiffness and pain.
Thus the myth that one suffering arthritis must rest and not exercise, no longer holds water.
MYTH #5: Different Climates Have No Effect on Arthritis
It is necessary to understand that there is truth within the myth. There is no scientific evidence to support the notion that cold weather or environments cause arthritis or alter its course, or that warm weather can reverse or cure arthritis.
Climate does play an important role in how one experiences the symptoms of their arthritis. Say for an example, cold weather constricts muscles, tendons and blood vessels, causing constriction around the joints, and thus increased pain and restricted range of motion (ROM) and whereas, heat allows muscles to expand and blood to flow, and so relieves compression around joints and helps move fresh blood into the arthritis area. This reduces pain and stiffness and increases range of motion (ROM). And as well, damp environments (whether warm or cold) cause inflammation around joints, and thus restrict movement and cause pain.
MYTH #6: Arthritis Will Lead to Disability, Wheelchair and the Nursing Home
This myth is a hard one to bust, especially varies with the experiences one has with arthritic symptoms. As a result of our history of poor arthritis diagnosis, treatment and prevention methods, many who contracted arthritis did end up with a walker, in a wheelchair and living in assisted environments.
The first thing to understand is that arthritis is a continuum; it is not one size fits all. Rheumatoid arthritis is the more difficult of the two most common types to control, as it is an autoimmune disease. But early detection and stabilization of the immune system can help keep it from progressing too rapidly. Supplementation and change of diet and various therapies can reduce its symptoms while strengthening the affected and surrounding joint areas.
Osteoarthritis is easier to account for, stop and manage symptoms as they are mostly related to lifestyle and activity choices, bone and joint health and weight.
MYTH #7: Arthritis Sufferers Have To Live In Pain
This is a huge myth which is widely believed. This is because many arthritis sufferers do live in pain, with daily stiffness and inflammation.
By engaging in mind/body exercises to reduce stress, eating an anti-inflammatory diet, stretching, exercising, taking proper supplementation, using therapeutic lifestyle changes prescribed by health-wellness coaches, you can greatly reduce the discomfort. Inflammation decreases, blood flow increases, joint pressure reduces, joint support strengthens and pain slips away.
Even with the best treatment plan, the best healthcare providers, the best supplements and diet there are so many things to control. These include sleep patterns, stress levels, genetic makeup, health habits (smoking/alcohol) and potential slips and falls that can increase your pain.
MYTH #8: Arthritis Can’t Be Reversed
The notion that the damage done by arthritis cannot be reversed is perhaps the biggest myth of all. This view believes nothing can be done to reverse damage, and so patients need to manage their condition as best they can. In other words, symptomatic relief only. However, traditional and holistic medicines have natural methods for increasing bone density, rebuilding bone and regenerating soft tissue. In other words, a natural approach to reversing damage done by arthritis based on using supplements, topical creams and energy medicine.

Dr Wilkhoo H S

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DOI: 10.4103/0019-5413.177568

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Year : 2016 | Volume : 50 | Issue : 2 | Page : 154-158

Arthroscopic management of popliteal cysts

Amite Pankaj, Deepak Chahar, Devendra Pathrot
Department of Orthopedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India

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Deepak Chahar
University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5413.177568

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Background: Management of popliteal cyst is controversial. Owing to high failure rates in open procedures, recent trend is towards arthroscopic decompression and simultaneous management of intraarticular pathology. We retrospectively analysed clinical results of symptomatic popliteal cysts after arthroscopic management at 24 month followup. Materials and Methods: Retrospective analysis of hospital database for patients presenting with pathology suggestive of a popliteal cyst from June 2007 to December 2012 was done. Twelve cases of popliteal cyst not responding to NSAIDS and with Rauschning and Lindgren Grade 2 or 3 who consented for surgical intervention were included in the study. All patients underwent arthroscopic decompression using a posteromedial portal along with management of intraarticular pathologies as encountered. Furthermore, the unidirectional valvular effect was corrected to a bidirectional one by widening the cyst joint interface. The results were assessed as per the Rauschning and Lindgren criteria. Results: All patients were followed for a minimum of 24 months (range 24-36 months). It revealed that among the study group, six patients achieved Grade 0 status while five had a minimal limitation of range of motion accompanied by occasional pain (Grade 1). One patient had a failure of treatment with no change in the clinical grading. Conclusion: Arthroscopic approach gives easy access to decompression with the simultaneous management of articular pathologies.

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Cervical spondylitis is a major cause of neck stiffness and its basic symptoms are listed below:
Pain in neck and shoulders Difficulty in movement of neck and head Neck stiffness, especially when you wake in the morning Frequent headaches, especially in the back of the head Numbness & weakness of hands, shoulder and arms

Cervical spondylitis accompanies neck stiffness that may ultimately lead to severe pain. Cervical spondylitis is characterized by neck pain that generally occurs due to degeneration of joints in our neck. Cervical spondylitis and neck stiffness are interrelated and often one leads to other. Cervical spondylitis is a critical disease that requires immediate medical care, but more than treatment it requires prevention that can be achieved with correct body postures. To live your life to the fullest prevent neck stiffness and cervical spondylitis with an improved lifestyle.

Cervical spondylitis, headaches, neck pain, Neck stiffness, Numbness or weakness, shoulders pain Neck stiffness is a medical condition characterized by soreness and difficulty in neck movements, especially when you try to turn your neck sideways. It can be quite critical as you need to move your entire body when you want to see sideways and at the back. It is a complex situation that leads to the problem with your neck movements along with pain. It is often associated with a headache but not always. The affected muscle that leads to neck stiffness is levator scapula that connects the neck with the shoulder.
Neck Stiffness Causes:
The most common causes for developing neck stiffness or strain in the levator scapula include: Doing work without changing posture for longer time such as turning the head to one side while typing, long phone calls without a headset, sleeping without proper pillow support with the neck tilted or rotated Vigorous activities which involves neck movement Weighing heavy weight on the shoulder In some circumstances, neck pain might occur due to injury, infections such as meningitis, inflammatory diseases such as rheumatoid arthritis, cervical spondylosis, etc.
Neck Stiffness Treatment:
Self treatment for the neck stiffness involves neck massage by using back massager to prevent strain Using pillow with proper neck posture Using a hot pack that covers the neck and shoulder
When to seek medical care: You should take immediate medical care under the following
situations: Severe neck pain following an injury or accident Continuous or persistent pain
Homeopathic Treatment:
Homeopathy is one of the most holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat arthritis but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several well-proved medicines are available for homeopathic treatment of arthritis that can be selected on the basis of cause, location, sensation, modalities and extension of the complaints. For individualized remedy selection and treatment, the patient should consult a Specialized homeopathic Physician at Nucleus Homeopathy.

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Arthritis is a general term for numerous conditions that affect bone joints; disease is genetic-something that is inherited from your parents. Can also caused by infection, obesity, bone damage, or another disease. Regardless of the cause or type of arthritis, people with arthritis experience chronic pain and swelling in their joints.
Did you know there is more than one type of arthritis? It's a condition that affects more than 50% of adult population either of the type of arthritis a number that's expected to increase to more in adults by the year 2030. The false statement that all arthritis is same has led people to try treatments that have little effect on their arthritis symptoms. Since each type of arthritis is different, each type calls for a different approach to treatment. That means an accurate diagnosis is crucial for anyone who has arthritis. With the proper diagnosis, you'll know what causes the pain. Then, you can be sure you're taking the proper steps to relieve the pain and continue to be active.
What Are the Common Types of Arthritis?
There are two major types of arthritis osteoarthritis, which is the "wear and tear" arthritis, and rheumatoid arthritis, an inflammatory type of arthritis that happens when the body's immune system does not work properly. Gout, which is caused by crystals that collect in the joints, is another common type of arthritis. Psoriatic arthritis, lupus, and septic arthritis are other types of the condition.
What Is Osteoarthritis?
Osteoarthritis is also called degenerative joint disease or degenerative arthritis. It is the most common chronic joint condition in adult female and male. Osteoarthritis results from overuse of joints. It can be the consequence of demanding sports, obesity, or aging. If you were an athlete or dancer in high school or college, you may be wondering why your knee or hip aches when you climb out of bed in the morning. Ask your doctor about osteoarthritis. It can strike earlier in life with athletes or those who suffered an injury in young adulthood. Osteoarthritis in the hands is frequently inherited and often happens in middle-aged women.

Osteoarthritis is most common in joints that bear weight such as the knees, hips, feet, and spine. It often comes on gradually over months or even years. Except for the pain in the affected joint, you usually do not feel sick, and there is no unusual fatigue or tiredness as there is with some other types of arthritis. With osteoarthritis, the cartilage gradually breaks down. Cartilage is a slippery material that covers the ends of bones and serves as the body's shock absorber. As more damage occurs, the cartilage starts to wear away, or it doesn't work as well as it once did to cushion the joint. As an example, the extra stress on knees from being overweight can cause damage to knee cartilage. That, in turn, causes the cartilage to wear out faster than normal.

As the cartilage becomes worn, cushioning effect of the joint is lost. The result is pain when the joint is moved. Along with the pain, sometimes you may hear a grating sound when the roughened cartilage on the surface of the bones rubs together. Painful spurs or bumps may appear on the end of the bones, especially on the fingers and feet. While not a major symptom of osteoarthritis, inflammation may occur in the joint lining as a response to the breakdown of cartilage.
1Symptoms of osteoarthritis,
depending on which joint or joints are affected, may include:
Deep, aching pain
Difficulty dressing or combing hair
Difficulty gripping objects
Difficulty sitting or bending over
Joint being warm to the touch
Morning stiffness for less than an hour
Pain when walking
Stiffness after resting
Swelling of joint
Reduced movements
2. Gout
Gout is a another type of arthritis that is characterized by sudden, severe attacks of joint pain with redness, warmth, and swelling in the affected area. It usually attacks only one joint at a time. It most often strikes the joint of the big toe, where it's also known as podagra, but other toes can also be involved. Gout is typically a condition that occurs in middle age, is ten times more common in men than in women, is unusual in people under the age of 30, and is rarely seen in women before menopause
Causes of Gout
The pain and swelling of a gout attack are caused by uric acid crystals building up in the joint and leading to inflammation. The body normally forms uric acid when breaking down cells and proteins, releasing it into the bloodstream. The uric acid usually stays dissolved in the blood and ends up being flushed out by the kidneys. If there's too much uric acid in the blood, called hyperuricemia, or if the kidneys can't get rid of it quickly enough, it may begin to form crystals that collect in the joints and even the kidneys, skin, and other soft tissues.
3. What Is Rheumatoid Arthritis?
Rheumatoid arthritis is an autoimmune disease. That means that the immune system attacks parts of the body. For reasons that aren't clear, the joints are the main areas affected by this malfunction in the immune system. Over time, chronic inflammation can lead to severe joint damage and deformities. About three out of every five people who have rheumatoid arthritis develop lumps on their skin called rheumatoid nodules. These often develop over joint areas that receive pressure, such as over elbows, or heels.
Symptoms of Rheumatoid Arthritis?
Symptoms of rheumatoid arthritis can come on gradually or start suddenly. Unlike osteoarthritis, symptoms of rheumatoid arthritis are often more severe, causing pain, fatigue, loss of appetite, stiffness. With rheumatoid arthritis, you may feel pain and stiffness and experience swelling in your hands, wrists, elbows, shoulders, knees, ankles, feet, jaw, and neck.
4. Psoriatic arthritis
Do you have psoriasis? If so, it's important to pay attention to your joints. Some people who have psoriasis get a type of arthritis called psoriatic arthritis. This arthritis often begins with a few swollen joints. A single finger or toe may be get affected first. Some people feel stiff when they wake up. As they move around, the stiffness fades. Most people get psoriatic arthritis about 5 to 12 years after psoriasis. This arthritis can show up earlier. Some people get psoriatic arthritis and psoriasis at the same time. A few get psoriatic arthritis first and psoriasis later. If you have psoriasis, there is no way to tell whether you will get psoriatic arthritis. This is why it is important to pay attention to swollen joints. An early diagnosis and treatment will help. These can reduce the effect that arthritis has on your life.

Psoriatic arthritis is a chronic disease characterized by inflammation of the skin (psoriasis) and joints (arthritis). With psoriasis, there are patchy, raised, red, and white areas of skin inflammation with scaling. Psoriasis usually affects the tips of the elbows and knees, the scalp, the navel. Majority of people with psoriasis also develop an associated inflammation of their joints called psoriatic arthritis. Psoriatic arthritis can cause a sausage-like swelling of fingers and toes and is often associated with fingernails that are pitted or discolored. In some people with psoriatic arthritis, only one joint or a few joints are affected. For example, a person may be affected in only one knee. Sometimes the spine is affected, or just the fingers and toes.

Psoriatic arthritis usually strikes around the age of 30 to 50, affecting both men and women equally. But it can also start in childhood. The skin disease (psoriasis) and the joint disease (arthritis) often appear separately. In fact, the skin disease precedes the arthritis in nearly 80% of patients.
Homeopathic Management of Arthritis
Homeopathy is one of the most holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat arthritis but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several well-proved medicines are available for homeopathic treatment of arthritis that can be selected on the basis of cause, location, sensation, modalities and extension of the complaints. For individualized remedy selection and treatment, the patient should consult a Specialized homeopathic Physician at Nucleus Homeopathy. Some important remedies are given below for the homeopathic treatment of arthritis: should be taken under strict medical supervision.

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Ankylosing spondylitis (AS) is one of the many types of arthritis. "Ankylosing" means joining together or stiffening; "spondylitis" means inflammation of the vertebral bones of the spine. Inflammation of the bones in AS can lead to degeneration, pain, and loss of joint motion. AS typically affects the spine but can been seen in other areas, especially the hips. Ankylosing spondylitis can range from a mild to more severe disease in patients. Ankylosing spondylitis is approximately three times more common in males than females. It is usually diagnosed in young adults, with a peak onset between 20 and 30 years of age. Children may also be affected by a form of AS termed “juvenile ankylosing spondylitis”, seen in children younger than 16 years of age. There is evidence suggesting a strong genetic component in the development of the disease.
AS is a type of arthritis of the spine. It causes swelling between vertebrae, which are the disks that make up your spine, and in the joints between spine and pelvis. Ankylosing spondylitis is an autoimmune disease. This means immune system, which normally protects body from infection, attacks body's own tissues. The disease is more common and more severe in men. It often runs in families.

Early symptoms include back pain and stiffness. These problems often start in late adolescence or early adulthood. Over time, ankylosing spondylitis can fuse vertebrae together, limiting movement.
ETIOLOGY of Ankylosing Spondylitis
Evidence points to autoimmune etiology.
Positive family history.
CLINICAL FEATURES of Ankylosing Spondylitis Prodorme
Onset: insidious.
Pain in back, buttocks.
Morning stiffness, better with activity.
Weight loss.
No movement possible.
Gradual involvement of:
A) Whole vertebral column. B) Hips.
Tenderness at sacro-iliac joint.
Cervical, thoracic spines become tender.
Restricted movement.
Patient cannot erect spine.
Sits, walks with flexed spine.
Chest expansion diminished.
Complete rigidity of spine & involved joints.
Kyphosis (curve in spine).
COMPLICATIONS of Ankylosing Spondylitis
Aortic incompetence (calcification of valve).
Recurrent chest infection.
Atlanto-axial subluxation.
INVESTIGATIONS for Ankylosing Spondylitis
Hb% : low.
ESR: raised.
HLA-B-27: positive.
CRP: raised.
Rheumatoid factor: negative.
ANA: negative.
X-Ray findings of sacro-iliac joints
Narrowing of joint space.
Haziness of joint margins.
Marginal erosions.
Marginal sclerosis.
New bone formation.
Bridging of joint cavity.
X-Ray vertebral column
Ossification of spinal, para-spinal ligaments.
Squaring of vertebrae.
Ossification of intervertebral discs.
Bamboo spine (fusion of entire vertebral column).
GENERAL MANAGEMENT for Ankylosing Spondylitis
Before ankylosis takes place:
Provide straight back chair for sitting.
Firm bed with one pillow at night.
Encourage swimming.
Extension exercises.
Encourage lying in prone position.
Stop smoking.
Homeopathic Remedies for Ankylosing Spondylitis
Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. The symptoms listed against each medicine may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy. None of these medicines should be taken without professional advice.

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Bone is a living tissue and it needs blood supply to survive. If there is damage to one of the blood supply, bone may depend on the accessory blood supply for the survival. But certain bones in our body have precarious unidirectional blood supply like Head of femur, scaphoid, and talus.
When there is damage to blood supply to the head of femur it results in the death of cells in the femoral head. Gradually there is collapse of femoral head with loss of sphericity. This condition is referred to as Avascular necrosis of femoral head or Osteonecrosis (bone death) of femoral head.

How AVN develops in femoral head?

Hip joint is a ball and socket type of synovial joint. The socket is formed by cup shaped acetabulum which surrounds the ball (femoral head - upper end of thigh bone). The surface of femoral head and socket is lined by thick articular cartilage and then lined by synovial membrane. All together with the surrounding joint capsule and muscles form a hip joint.

The ball of hip joint receives most of its blood supply through the neck of thigh bone. If there is damage to this blood supply there is no accessory blood supply to the femoral head.
There is gradual death of cells in femoral head due to loss of blood supply. Due to death of bone cells, there is no reparative process of bone formation and resorption. Gradually the bony structure in the femoral head weakens and starts to collapse. When AVN develops in the head femur, the weight bearing area of the head is the first place to collapse. The rounded contour of the femoral head is lost and it becomes flattened causing abnormal movement in the hip joint.
Secondary osteoarthritis develops, as there is gradual wear in ball and socket of the hip joint.

Many causes have been identified

Trauma: Fractures
Damage to the blood supply of femoral head usually occurs following a trauma or fractures to the bones in and around the hip joint.
 Fracture of Femoral neck, Femoral head
 Hip Dislocations
 Bad fractures of acetabulum
AVN can develop months or some times after initial injury.

Some steroids like cortisone, prednislone or methyprednisolone are known to cause AVN. In certain conditions like bronchial asthma, skin diseases, some auto immune disorders, inflammatory arthritis and in cases of organ transplant to prevent rejection, use of steroids is must to control or treat these conditions. Orally prescribed steroid are notorious in producing AVN of femoral head. There have been studies to show that steroid given in the form of injections into the joints or bursa does not cause any AVN of femoral head.

Blood disorders:
Some blood diseases like sickle cell disease, Leukemia’s, Gauchers disease and diseases related to blood coagulation can cause AVN of femoral head.

Studies have shown that alcohol and smoking can cause AVN in femoral head. Chronic alcohol intake can damage blood vessels leading to AVN. Smoking cause narrowing of small blood vessels and thereby reducing blood supply to the femoral head.

Deep see divers and miners are more prone develop AVN. Due to high atomospheric pressure tiny air bubbles are formed inside the blood stream which can block the tiny blood vessels in the femoral head there by resulting in AVN.


What does AVN feel like?
1. Pain:
Initially patient complains of pain in the affected hip which gradually increases on weight bearing. As the disease progresses patient complains of pain at rest and at night.
2. Limping
3. Stiffness
4. Difficulty in sitting cross legged and squatting
5. Shortening of affected limb


How do doctors identify the condition?
1. History: doctor enquires about
- Occupation
- Medical problems and any medications like steroids
- Alcohol and smoking

2. Examination: doctor examines hip for
- Range of movements
- Stiffness

3. X-rays:
X - rays do not show any changes of AVN in the early stages of disease even though patient is having pain in the hip. It may take few months to observe changes of AVN and make diagnosis on X - ray.

4. MRI:
MRI can detect early changes of AVN in the femoral head that cannot be seen on X- ray. It helps to detect damaged areas of blood supply to the hip. AVN of femoral head can be graded as mild, moderate and severe depending on the size location of these damaged areas and if any collapse has occurred in the MRI images. MRI can also help to detect AVN changes in the opposite hip even though there are no symptoms.

5. Bone scan:
Bone scan involves injecting a radioactive chemical into the blood. Hours after injection a special camera is used to take pictures of your skeleton. The picture shows blank spot in the areas of femoral head which is devoid of blood supply. MRI has replaced Bone scan in diagnosing the cases of AVN of femoral head.

What are the treatment options for AVN of femoral head?
AVN of femoral head is irreversible resulting in arthritic hip. Some drugs and salvage procedures can help in delaying the progress of disease. The choice of treatment depends upon the stage of the disease. Some factors like age of the patient, general health of patient and activity level also determines the treatment methods.

Nonoperative treatment:

If avascular necrosis of femoral head is diagnosed in early stages, some of following treatment methods can help in delaying the progress

1. Protected weight bearing on the affected limb with the help of crutches or walker can help reduce pain. The idea behind it is, it permits healing and prevents further damage.
2. Exercises and stretches prevent stiffness in the hip and helps to maintain range of motion.
3. Medications:
A. Bisphosphnates : This group of drugs help to reduce the risk of femoral head collapse in patients with Avascular necrosis.
B. Blood thinners: They are given in view of improving blood circulation to the femoral head.
C. Anti-inflammatory medications / simple analgesics to reduce pain.

The above mentioned treatment modalities may delay the progression of disease, but not completely reverse the Avascular necrosis.

Surgical management:

Salvage procedures: Some surgical procedures can try to decrease the pressure in femoral head and increase the blood supply. The main prerequisite for such surgeries is that there should not be any collapse in the femoral head. Many procedures have been designed to improve the blood supply of femoral head. Your surgeon can choose and suggest appropriate procedure.

Core decompression of femoral head:

The most common surgical procedure is to drill one or several holes into the femoral neck and head trying to enter into areas of poor blood supply. The idea behind this procedure is one that it creates a new path for new blood vessels to grow into areas of poor blood supply and it relieves pressure inside the femoral head. The other advantage of this procedure is that there is pain relief secondary to relieving pressure in the femoral head.
Core decompression of femoral head can be supplemented with bone grafting with or without stem cells injection

Core Decompression and Bone grafting of femoral head:

Following core decompression procedure bone graft is packed into the dead part of femoral head and channel created in the femoral head and neck. The bone graft can be taken from the patient or from the bone bank. The bone graft is made into tiny pieces and packed into the channel created in the femoral head and neck.

Stem cells treatment:

Stem cells obtained from the patient body can be injected into the channel created for core decompression of femoral head. Stem cells injection can be done along with bone grafting also. There are studies showing that stem cells help to stimulate new bone formation in the diseased areas of the femoral head.

Postoperative rehabilitation after core decompression surgery:
This surgical procedure is done through a very small incision from the side of thigh. Surgeon guides the drill into the femoral head with help of intraoperative X - ray machine (C-Arm). This procedure is usually done as outpatient procedure and patient can go back to the house on the same day with help of crutches or walker.

Following core decompression surgery the drill holes in the femoral neck and head may weaken the bone, making it susceptible to fracture. So patients are advised to use crutches or walker to move around for six weeks. After six weeks, patient patients are advised to put full weight on operated leg and take advice of physiotherapist to regain hip range of motion and strength.

Advantages of core decompression surgery:
Core decompression of femoral head is NOT A DEFINITIVE procedure. It is a salvage procedure to delay the process of Avascular necrosis probably by increasing blood supply and also preventing further collapse.
After the core decompression procedure it is necessary to continue, the medications explained above as they also help in delaying the progress of disease.

Core decompression and Vascularized fibular grafting:

In the first step surgeons drills a hole into the femoral neck and head. In the next step surgeon removes small part of fibula (Thin bone by the side of shin bone in leg) along with its blood vessels. This is referred as vascularized fibular graft because it has its own blood supply. Fibular graft is inserted into the channel created in the neck and head of the femur. Vascular surgeon attaches the blood vessels from the fibula to one of the blood vessels in the hip. This procedure does two things
1. Fibular graft acts as structural support preventing collapse of femoral head.
2. The newly connected blood vessels try to increase blood supply to the femoral head.
This is a very complicated procedure and needs special expertise. The success of the surgery depends on the viability of newly created blood supply. It is rarely practiced nowadays.


The process of Avascular necrosis of femoral head invariably ends in arthritic hip. In arthritic hip, joint surfaces of femoral head and acetabulum becomes irregular with loss of motion in the joint. The treatment choice is total hip replacement.

Total hip replacement is procedure in which the surgeon replaces the damaged femoral head and damaged joint surface of acetabulum (socket) with prosthetic components. Damaged femoral head is removed and replaced with metallic stem and ball. Damaged cartilage of the socket of hip joint is replaced with metal socket.

Prosthetic components:
Total Hip replacement can be either cemented or uncemented.

Cemented Total hip replacement: In this procedure, cement is used for fixation of the prosthetic components into the bone.
Uncemented Total Hip replacement: In this technique, the fixation of components is by “pressfit” into the bone which allows bone to grow onto the components.

Prosthetic materials:
Total hip replacement has wide range of designs and materials.
The stem component and socket components in the total hip arthroplasty are invariably medical grade steel or titanium alloys. There is choice of material selection for the prosthetic head and liner of socket. Prosthetic heads can be metallic or ceramic. Socket liners are available in plastic, metallic and ceramic materials.
Different combinations of metal heads and liners can be made depending on needs of the patient.
Metal on plastic (Metal head / Plastic liner)
Ceramic on plastic (Ceramic head / Plastic liner)
Metal on metal (Metal head / Metal liner)
Metal on ceramic (Metal head / ceramic liner)
Ceramic on ceramic (Ceramic head / Ceramic liner)

The decision to use cemented or uncemented components and various combination of head and socket liners are based on various factors such as age, bone quality and sometimes surgeons choice.

In certain patients with limited damage to the part of femoral head surgeon may consider resurfacing arthroplasty. In this procedure surgeon replaces only damaged femoral head with metallic implant.

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Fibromyalgia and it's relation between Sleep.
It is about my passion to find a cure for Musculoskeletal Disorders, like fibromyalgia, Myofascial pain syndrome, Thoracic outlet syndrome, Complex Regional Pain Syndrome, Cubital tunnel Syndrome, Upper Cross Syndrome, Lower Cross Syndrome and many more which is related to our posture and lifestyle .Some G.Ps are still failing to recognise,they still say fibromyalgia what? Some of then think it's a psychological As they do not know what we are talking about,some rheumatologist will diagnose fibromyalgia or RSI Problems and this type of Musculoskeletal Disorders but there is no cure.Meanwhile unborn babies will still have our pains , not live through proper childhood due to fatigue and pain and it seems no one cares.
Some conditions like pain full bladder syndrome, interstitial cystitis & making compression against Fibromyalgia because we think they share tremendous overlap.
Central sensitivity syndrome is a umbrella term . conditions like 1.Irritatable Bowl syndrome ( pain in the abdomen )
2.Intestisical cystitis (pain Bladder Syndrome ).
3.Temporo mandibular Disorders.
4.Temsion Headache.
5.Complex Regional Pain Syndrome ( Neuropathic pain condition affecting the extremities ).
All of this share very common characteristics with painfully body conditions, long standing female are more effected than male.sleep disturbance, G.I disturbance, Mood disturbances, chemical sensitivity syndrome,chronic fatigue syndrome. All of them put into umbrella -centre sensitivity syndrome. And we think they may share common etiology, Common mechanism with in the Central Nervous system & immune system. The way doctors have been approaching this disease in the past has not been working. So more and more this diseases get research and study together.we are just on grant now painful bladder syndrome, interstitial cystitis & making compression against this conditions becouse we think they share tremendous overlap.
Sleep is very important to us, There is four cycle of the sleep.In the body stage 3 and stage 4 is very much important in this type of Musculoskeletal Disorders .Disruption in stage 4 sleep (alpha wave disruption )responsible for muscle fatigue and pain. It has been documented in patient with this type of Musculoskeletal Disorders never get to the stage 4 sleep . It's like they are moving stage 1 to stage 3 then again went to stage 1 , stage 2 and stage 3.Its kind of they are subconsciously wake them up.what will happen -when they wake up in the morning, they feel they didn't sleep at all. Everything hurting,aching. Patient says that they didn't dream that much that means they are not getting stage 4 sleep.According to an Irish proverb "A good night sleep and A good lough are the two best cures in a doctor's book"
Contrary to belief , sleep is a period of intense activity during which the brain processes the days event and energy is restored to the body.Sleep is a combination of two system -sleep drive (like hunger)and a biological clock (example -jetlag)-that tells you when to sleep and when to get up .When both are working well together ,you sleep best.So as to promote a good night sleep, some basic recommendations include :-
1.Fix bed time and an awakening time.
2.Allow enough time to sleep.
3.Avoid a huge calories diet/heavy meal.
4 .Comfortable sleep atmosphere.
5 . Relaxation techniques such as deep breathing exercise may help relieve anxiety and reduce the muscle tension.
6.No TV or clock in the bed room .
7.Exercise at least 20 to 30 min.aerobic exercise is the single most effective way to get a deeper sleep.

Some time people ask is it genetic problem?
The answer is -it's complicated and still research is going on.
The genes themselves are playing a role in this type of Musculoskeletal Disorders. It may not be causing Fibromyalgia or Myofascial pain syndrome or RSI Problems but it may be setting is up for it. In other words COMT gene is involved with breaking down our catacolamine, the chemicals are involved in fighter fight response. It turns out this gene at certain location, it 158 location ,It has a substitution for one amino acid -valine for methyl .It's very common,it called single nucleotide polymorphism it basically means it's a substitution for amino acid in that gene.And it's very common in the socity and turns out with that genetic change that we all have -it helps to determine our sensitivity to pain.It may play a part of predispose towards Fibromyalgia,Myofascial pain syndrome, RSI ( Repetitive Strain Injury)
It's not that you come out the wombs with this genetic variant and you got this type of Musculoskeletal Disorders. But if you get a automobile accident or you got a viral syndrome -you are more likely than to get Fibromyalgia or RSI Problems as a consequences having that genetic variant.

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Repetetative strain injury ( R.S.I )
Repetitive Strain Injury (R.S.I):
Repetitive Strain Injury is an umbrella term for physical pain in Neck, Shoulder, Arm, Wrist, Hand, Back and Leg. It’s a disorder of muscle, tendon and nerves.

R.S.I is also known as Work Related Musculoskeletal Disorders (WRMSD), cumulative Trauma disorder (CTD), Occupational Overuse Syndrome (OOS).

The question is "Do you feel" your :-
• Muscles are sensitive to pressure.
• Stiff and tight feeling.
• Headache.
• Dull, aching, burning pain in muscles.
• Pain going down to arms and legs.
• Numbness or tingling.
• Muscle weakness.
• Unpredictable, erratic symptoms.
• Heat eases the pain.

If you checked many of this then you most likely have some R.S.I problems.
Consult with a R.S.I specialist.

RSI injuries are coupled with:-
4.Eventually limited movement

R.S.I is a progressive disorder; the longer you wait for the treatment the longer the recovery will take.
When don’t you treat the R.S.I complained then the complained continue in three stages
The three stages are –

Phase 1:- Pain is easy to locate During work you suffer pain that disappear quickly after you stopped working. After sometime you move into the second phase

Phase 2:- Pain is less easy to locate.Pain radiates to other part of the body.Appear quickly and disappears more slowly.

Phase 3:- Pain is almost present all the time and more extensive in nature.Pain is very demobilizing.

Example of RSI is
Carpal Tunnel Syndrome (pain in wrist joint and radiate up to fingers)
Tennis Elbow (pain in the elbow ).
Thoracic outlet syndrome ( T.O.S ).
Temporo mandibular Disorders etc.

Avoiding R.S.I complains = Avoiding Strain

• Reading, watching TV, using computer for prolong time without taking any break put a lot of pressure on muscles.
• Tense muscle has very low blood circulation so they are not providing enough oxygen (O2), nutrition, and metabolic waste is not removed.
This results are: – weary muscles, cramps, cold hands and pain.

To prevent R.S.I:-

1.Take some micro break regularly, take 20-30 sec break after 30 min or 45 min. that’s give enough time to the muscle for recovery (remove the static loading)
2.Do some stretch of the hands, arms, shoulder and neck regularly that help to

Increase blood circulation Prevent shortening of the muscle fibres Reduce stiffness

The cause of RSI (Repetitive Strain Injury):
1.Repetitive activity.
2.Awkward posture or poor working posture.
3.Working continuously without taking break.
4.Impaired sleep.
5.Nutritional inadequacies.

Treatment for R.S.I :Physiotherapy/physical therapy, Chiropractic ,Myofascial Release Therapy,Alexander technique,Feldenkrais,Manual therapy,Taping.

The successful and failed therapy depends on perpetuating factors which are commonly overlooked and neglected.Perpetuating factors are numerous and often require a special knowledge to recognize their injury to RSI (Repetitive Strain Injury ) .

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I Assist knee replacement India
Tailor made knee replacement, now in Chennai

Knee replacement surgery can now give perfectly aligned knees, thanks to the new technology of movement sensors: A palm-sized electronic device, called ‘I-Assist’ is being used to personalize and support knee replacement intra-operatively. “This revolutionary device helps orthopedic experts align new knee joins more accurately and gives the best possible fit during surgery, “says orthopedic surgeon Dr.A.K.Venkatachalam, who performed this novel procedure on a fifty five year old woman in Chennai, India.
The ‘I-Assist’ is a surgical guidance system designed to improve the accuracy of a total knee replacement. It not just assists the surgeon in aligning knee implants to each person’s unique anatomy but also provides a personalized fit and truly tailor-made total knee replacement. The outcome is very predictable as perfect alignment is achieved intra operatively. The implants themselves are not custom built.
How it works:
This electronic device incorporates latest guidance technologies into a half palm sized electronic display. Some of these technologies are also inbuilt in latest smart phones. The LED lights on the display are similar to traffic signals. A green light means the position is acceptable and a red one indicates scope for improvement. Thus the surgeon can align and validate implant positioning during total knee replacement. As the device is anchored in the operating field itself, it doesn’t require shifting of the surgeon’s gaze. He doesn’t have to remove his visual focus from the operating field. Earlier navigation systems require the back and forth transfer of the surgeon’s gaze from the operating field to a computer monitor elsewhere, several times intra-operatively.
The device integrates into the operation by requiring no complex imaging equipment and additional surgical incisions. It is compatible with the company’s own product line of primary knee replacements.
History of navigation systems in total knee replacement
The goal of the surgeon during a total knee replacement is to get neutral alignment.. However, studies have shown that even experienced surgeons don’t always achieve this perfection.
Hence computer navigation systems were introduced about a decade ago to achieve perfect alignment. In this system, pins were drilled in the thigh and leg bones away from the knee. These pins were attached to sensors. The sensors relayed information to a processor located elsewhere. The monitor of the processor displayed the accuracy of the bony cuts and bony alignment. Based on these, the surgeon could intra-operatively fine tune the cuts and positioning to get perfect alignment. As mentioned previously the surgeon had to shift his gaze back and forth from the operating field to the computer monitor located elsewhere. This computer navigation system also requires intensive capital investment.
A different approach toward this goal was adopted with ‘Patient specific instruments (PSI) ’. This was pioneered by the author in Jan 2012 in Chennai. This required additional pre-operative imaging. The images were transferred electronically to engineers elsewhere. The engineers used Computer aided design to manufacture custom fit cutting tool for each patient. These patient specific instruments were shipped to the surgeon after an interval of a few weeks. Hence there is a time lag involved between the planning and execution in this process. Many patients don’t want to wait . This is where the new technology comes into picture.

The I Assist system improves on previous navigation technology.
The main component of the I-Assist knee guidance system is a disposable device that can be procured as needed. No capital equipment investment by the hospital is necessary.
Its features are
• It intuitively integrates with the surgeons’ conventional instrumentation for total knee replacement.
• No pre-operative imaging is required.
• No wait time for the patient and the hospital.
• Less invasive procedure to the patient.

Who benefits?

It benefits everybody involved :
• Surgeons’ benefit as it saves them more time unlike prior navigation technology.
• Hospitals save on additional costs by eliminating pre-operative imaging and capital investment.
• For the patient, it is less invasive and guarantees accuracy.

Which type of knee replacement patients’ benefit most from this technology?

Dr.Venkatachalam says that it is of great value primarily to young patients undergoing total knee replacement. The durability of a knee replacement is dependent upon among other factors, the alignment. As younger patients will survive longer after a knee replacement, it is crucial to get the first knee replacement right. This will reduce the need for a redo or revision knee replacement. Revision operations are difficult and expensive.
A sizeable number of young patients have additional complications in the leg that make a knee replacement difficult. Patients from Asia and Africa present with malunited thigh and leg fractures secondary to a previous accident. They have developed post traumatic knee arthritis as a result of these accidents. Bony deformities within the knee and outside preclude use of all previous modes of instrumentation.
• The use of conventional instruments which rely on intact straight bones is impossible.
• Conventional computer navigation is also inapplicable as it requires intact bone within the knee joint.
• PSI is also impossible to design with bone loss and extra articular deformities.
It is vital to get perfect alignment as there is a positive correlation between accuracy and long term survivorship of the implant.
The ‘I-Assist’ system is the only system that allows accurate alignment in these complicated and difficult cases.

About the author:
Dr.A.K.Venkatachalam performed this procedure on two knees in Chennai for the first time. He specializes in joint replacements and key hole surgery. He has performed knee replacement in several patients with durable materials and advanced techniques.

For more information, visit

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Durable knee replacement India
I-Assist guided Verilast Knee replacement- Knee replacement that lasts for 30 years
Knee replacement in young patients can now last for a long time, thanks to the novel combination of a smart device, ‘I-Assist’ and a durable implant, the ‘Verilast knee’.A procedure involving an I-assist device to implant a Verilast knee, was performed for the first time in the world on a thirty two year old woman in Chennai, India by noted orthopaedic surgeon, Dr.A.K.Venkatachalam.
Case Report-
Ms Payal, a thirty two year lady from Gujarat was suffering from a rare condition called ‘Avascular necrosis’ of the knee and had suffered extensive damage. Although, she was very young for a knee replacement, the extent of the damage left no option for Dr.A.K.Venkatachalam. He had recently introduced the I-Assist device for another patient and was working with Verilast knee technology that had shown to reduce up to 81% of wear as compared to traditional materials.
He decided to go ahead with a knee replacement procedure for Ms Payal using the Verilast CR knee and the I-Assist. It was first time in the world that the I-Assist tool was used to implant a Verilast knee. The I-Assist tool uses electronic components in a palm sized device. With this, the surgeon can align and validate implant positioning during the knee replacement.
After the procedure, the patient was very happy with the results.
About the Verilast Knee Technology
The durability of the Legion CR knee with Verilast technology is based on laboratory testing.
In a laboratory, the LEGION CR knee with VERILAST Technology was compared with a similar knee made from conventional materials (cobalt chrome and standard plastic). The results showed that after five million cycles, or simulated steps, the LEGION CR knee reduced 98 percent of the wear experienced by the other knee made of conventional materials. After 45 million cycles,it was noted with the LEGION CR knee with Verilast technology, that the wear reduced to 81% in comparison to the conventional knee implant. That's equal to around 30 years of actual use.
VERILAST technology uses advanced, low-friction surfaces on both sides of the joint, the femur bone of the thigh, and the tibia bone of the leg. It combines Smith & Nephew’s award-winning OXINIUM™ Oxidized Zirconium metal alloy and a “cross-linked” plastic component (XLPE), which together has been proved in the laboratory to double the wear of a conventional knee.
OXINIUM™, Oxidized Zirconium is a tough, smooth metal with a ceramic surface 4,900 times more abrasion resistant and 20 percent lighter than the cobalt chrome metal used in conventional implants.
• The ceramic surface is created through a manufacturing process where oxygen is naturally diffused into the zirconium metal as it is heated in air. The original metal surface is transformed into a ceramic coating which is integrated with and part of the underlying metal ; It is not an externally applied coating
• With no detectable amount of nickel, the metal most associated with allergies, OXINIUM™ is a biocompatible material for implants.
• This proprietary material has been used in more than 250,000 knee implants.

About the I-Assist Smart Tool
‘I-Assist’ is a smart tool designed to improve the accuracy of a total knee replacement. It assists the surgeon in aligning knee implants to each person’s unique anatomy. The outcome is very predictable as perfect alignment is achieved intra operatively and raises the chances of favorable outcomes. Perfect alignment correlates positively with survivorship or durability of the implant.
Which type of knee replacement patients’ benefit most from this combined technology?

It is of great value primarily to young patients undergoing total knee replacement. The durability of a knee replacement is dependent upon the alignment. As younger patients will survive longer after a knee replacement, it is crucial to get the first knee replacement perfectly aligned. There is a correlation between the alignment and survivorship of the implant. This will reduce the need for a redo or revision knee replacement. Revision operations are difficult and expensive.
In addition, a sizeable number of these young patients have additional complications that make a knee replacement difficult. Mal-united thigh and leg fractures secondary to previous accidents rule out the use of traditional instruments. Bony deformities within and outside the knee preclude use of all other modes of instrumentation and navigation.
Before this novel procedure, surgeons including Dr.Venkatachalam used “Patient specific instruments’ and ‘computer navigation’ to implant the Verilast knee. These are not applicable to difficult primary knees with bone loss.
The ‘I-Assist’ system is the only system that allows accurate alignment in these complicated and difficult cases.

In summary, the I-Assist tool allows the full survivorship potential of the Verilast CR Oxinium™ knee to be harnessed in primary and difficult cases. Young patients can return to their normal lives without the fear of a redo or revision surgery later on in their lives.

About the author:
Dr. A.K. Venkatachalam specializes in joint replacements and keyhole surgery. He has performed knee replacement in several patients with durable materials and advanced techniques. With numerous surgeries and years of experience combined with innovative and pioneering technologies, he has helped many patients to regain full mobility of knees and hips.

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