DEGENERATIVE DISC DISEASE

Degenerative disc disease is part of the natural process of growing older. Unfortunately, as we age, our intervertebral discs lose their flexibility, elasticity, and shock absorbing characteristics. The ligaments that surround the disc called the annulus fibrosis, become brittle and they are more easily torn. At the same time, the soft gel-like center of the disc, called the nucleus pulposus, starts to dry out and shrink. The combination of damage to the intervertebral discs, the development of bone spurs, and a gradual thickening of the ligaments that support the spine can all contribute to degenerative arthritis of the lumbar spine.

Degenerative disc disease is as certain as death and taxes, and to a certain degree this process happens to everyone. However, not everyone who has degenerative changes in their lumbar spine has pain. Many people who have "normal" backs have MRIs that show disc herniations, degenerative changes, and narrowed spinal canals. Every patient is different, and it is important to realize that not everyone develops symptoms as a result of degenerative disc disease.

When degenerative disc disease becomes painful or symptomatic, it can cause several different symptoms, including back pain, leg pain, and weakness that are due to compression of the nerve roots. These symptoms are caused by the fact that worn out discs are a source of pain because they do not function as well as they once did, and as they shrink, the space available for the nerve roots also shrinks. As the discs between the intervertebral bodies start to wear out, the entire lumbar spine becomes less flexible. As a result, people complain of back pain and stiffness, especially towards the end of the day.

CALCANEAL SPUR

A bony spur projecting from the back or underside of the heel bone (the calcaneus) that often makes walking painful. A calcaneal spur is also called a heel spur.

Spurs at the back of the heel are associated with inflammation of the Achilles tendon (Achilles tendinitis) and cause tenderness and pain at the back of the heel that is made worse by pushing off the ball of the foot.

Spurs under the sole (plantar area) are associated with inflammation of the plantar fascia (the "bowstring-like" tissue stretching from the heel underneath the sole) and causes  localized tenderness and pain made worse by stepping down on the heel.

Not all heel spurs cause symptoms. Some are discovered on X-rays taken for other purposes.
Heel spurs and plantar fasciitis can occur alone or be related to underlying diseases which cause arthritis (inflammation of the joints) such as Reiter's disease, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis.

A plantar calcaneal spur is an outgrowth from the bone at the back of the foot known as the calcaneus. This outgrowth is the cause of severe discomfort on the sole of the foot (plantar surface) and pain and is commonly known as heel spur pain. These spurs may develop over a long period of time and are initially unidentifiable, even upon x-ray, although the symptoms are present. Calcaneal spurs may be mistaken for plantar fasciitis, which is the inflammation of the thin fibrous layer between the skin on the sole of the foot and the bones of the foot.

Tennis Elbow

Tennis Elbow Overview

Tennis elbow is a condition caused by inflammation of the tendons on the outside (lateral side) of the elbow at a bony prominence (lateral epicondyle) of the upper arm. Certain repetitive movements of the wrist can cause this condition. It is not limited to tennis players.

Tennis Elbow Causes

• Any repetitive motion of the wrist, including tennis, hedge clipping, excessive use of a hammer or screwdriver, painting, or any activity that requires excessive constant gripping or squeezing can cause the condition known as tennis elbow.
• In the game of tennis, the following maneuvers can lead to tennis elbow:
• One-handed backhand with poor form
• A late forehand swing resulting in bending the wrist significantly
• Snapping and turning the wrist while serving with full power

FROZEN SHOULDER

Frozen shoulder is characterized by pain and loss of motion or stiffness in the shoulder. It affects about two percent of the general population. Frozen shoulder most commonly affects patients between the ages of 40 and 60 years, with no clear predisposition based on sex, arm dominance, or occupation

Cause:-

The process involves thickening and contracture of the capsule surrounding the shoulder joint.

Frozen shoulder occurs much more commonly in individuals with diabetes, affecting 10 percent to 20 percent of these individuals. Other medical problems associated with increased risk of frozen shoulder include: hypothyroidism, hyperthyroidism, Parkinson's disease, and cardiac disease or surgery.
Frozen shoulder can develop after a shoulder is immobilized for a period of time. Attempts to prevent frozen shoulder include early motion of the shoulder after it has been injured.

Symptoms:-

Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion. The pain is usually located over the outer shoulder area and sometimes the upper arm.
The hallmark of the disorder is restricted motion or stiffness in the shoulder. The affected individual cannot move the shoulder normally. Motion is also limited when someone else attempts to move the shoulder for the patient.
Some physicians have described the normal course of a frozen shoulder as having three stages:

·  Stage one: In the "freezing" stage, the patient develops a slow onset of pain. As the pain worsens, the shoulder loses motion. This stage may last from six weeks to nine months.

·  Stage two: The "frozen" stage is marked by a slow improvement in pain, but the stiffness remains. This stage generally lasts four months to nine months.

·  Stage three: The final stage is the "thawing," during which shoulder motion slowly returns toward normal. This generally lasts five months to 26 months.

SLIPPED DISC

What is a slipped disc?

A slipped disc occurs when the outer part of your disc ruptures, allowing the gel inside to bulge and protrude outwards from in between your vertebrae. The damaged disc can put pressure on your whole spinal cord or on a single nerve fibre. This means that a slipped disc can cause pain both in the area of the protruding disc and in any part of your body that is controlled by the nerve the disc is pressing on.
A slipped disc is most common in the lower back, but it can also occur in the neck and upper back.

Causes and risk factors

Pain-Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Tissue-Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Spine-The spine supports the skeleton, and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.

Spinal cord-The spinal cord is a column of nervous tissue located in the spinal column. It sends messages between the brain and the rest of the body.

Ruptures-A rupture is a break or tear in an organ or tissue

Slipped Disk Symptoms

The nerves of the body exit the spine at each spinal level. A herniated disk can therefore produce symptoms anywhere along the course of that nerve, though the injury and irritation of the nerve are at the spine itself (this is known as referred pain). A slipped disk can produce varying degrees of pain in the back or neck along with numbness or weakness.

• For slipped disks in the neck - Numbness, tingling, weakness, or pain in the shoulder, neck, arm, or hand
• For slipped disks in the lower back
• Numbness, tingling, weakness, or pain in the buttocks, back, legs, or feet
• Numbness and tingling around the anus or genitals
• Pain down the back of each leg from the buttocks to the knee (this is called sciatica)
• Pain with movement, straining, coughing, or doing leg raises
• Difficulty controlling bowel movements or bladder function

FIBROMYALGIA

What is Fibromyalgia?

Fibromyalgia produces widespread pain, disturbed sleep, and exhaustion from head to toe. Fibromyalgia means pain in the muscles, ligaments, and tendons—the soft fibrous tissues of the body. Although the muscles hurt everywhere, they are not the only cause of the pain. Instead, the diffuse, body-wide symptoms are greatly magnified by malfunctions in the way the nervous system processes pain.

Regional muscle pain not related to arthritis or the nervous system also occurs in the majority of people with fibromyalgia.Patients describe this as firm knots in the belly of muscles, often causing restricted movement and radiating pain.⁵ These muscle nodules

are myofascial trigger points and we suspect that these painful areas overlap with the tender points used to diagnose fibromyalgia.
The symptoms of fibromyalgia are unpredictable and most patients are frustrated by their physical limitations and inability to make plans. You may feel as though you have to "push yourself" to get things done.⁷
Most patients with fibromyalgia say that their muscles feel like they have been pulled or overworked, and sometimes they twitch or cramp. Even the skin may feel badly sunburned. To help your family and friends relate to your fibromyalgia symptoms, have them think back to the last time they had a bad flu. Every muscle in their body shouted out in pain. In addition, they felt devoid of energy as though someone had unplugged their power supply.
Given that the symptoms may be similar to a viral flu, experts in the field of fibromyalgia and chronic fatigue syndrome believe that these two illnesses may be one and the same.Gulf War syndrome also overlaps with these two conditions.

Common symptoms:

Pain - Fibromyalgia pain has no boundaries. People describe the pain as deep muscular aching, throbbing, shooting, stabbing, or intense burning. Quite often, the pain and stiffness are worse in the morning, and muscle groups that are used repetitively may hurt more. In addition, the severity of regional pains (particularly those in the head, neck, shoulders and lower back) are a strong predictor of a person's overall pain rating. The muscles in these painful areas can feel tight, knotted and rope-like. Pressing on the firm, knotted region hurts and often causes the pain to shoot to other muscles when a myofascial trigger point is present.
Sleep Disorders - Patients report trouble falling asleep and more importantly staying asleep, but the unrefreshing quality is what makes the disorder much worse than insomnia. Repeat arousals prevent patients from reaching deep, restorative sleep.¹⁶ As a result, the night is spent in "quasi-sleep" and patients wake up feeling as though they have been run over by a Mack truck. An overnight sleep study will likely show repeat arousals with bursts of awake-like brain activity occurring throughout the night, but a specific sleep disorder may not be identified
Fatigue - This symptom can be one of the most incapacitating for people with fibromyalgia. Patients may feel as though concrete blocks weight down their arms and legs and their bodies may be so drained of energy that every task is an effort.
Memory and Concentration - Difficulty concentrating and retaining new information may seriously interfere with everyday mental tasks. This symptom is referred to as "fibro fog" and may hinder job opportunities. In particular, fibromyalgia patients have serious difficulty retaining new information if they are distracted.
Exercise Difficulties - Moderate intensity exercise activates a powerful pain-relieving system in healthy people, but it makes the pain of fibromyalgia worse. This is why initiating an exercise program may make you achy and tired. However, if you do not exercise on a regular basis, the performance of normal daily living activities will start to cause more pain. Rather than give in to the increased pain sensitivity related to exercise, patients are advised to do mild exercise in short intervals (such as five minutes at a time) to keep the muscles fit while not over-taxing them. A study in Sweden revealed that half of the fibromyalgia patients found it impossible or difficult to climb stairs and a majority of patients could not run. Just standing for five minutes was extremely taxing to one-fourth of the patients.¹⁹
Irritable Bowel Syndrome - Constipation, diarrhea, frequent abdominal pain and bloating, abdominal gas, and nausea represent symptoms commonly found in roughly 40 to 70 percent of fibromyalgia patients.
Chronic Headaches - Recurrent migraine or tension headaches are experienced by 50 to 70 percent of fibromyalgia patients. Most headaches are rated as severe, occur at least two times per week, and often have a migraine component. Referred pain from myofascial trigger points in the shoulder, neck, and head muscles are suspected to be responsible for most tension-type headache and also play a role in migraines.
Jaw Pain - Temporomandibular joint dysfunction causes tremendous jaw-related face and head pain and affects one-quarter of fibromyalgia patients. Typically, the problems are related to the muscles and ligaments surrounding the jaw joint and not necessarily the joint itself.²³
Other Common Symptoms - Non-cardiac chest pain, acid reflux, irregular heart beat or palpitations, shortness of breath, numbness and tingling sensations, the feeling of swollen extremities, chemical sensitivities, nasal congestion, premenstrual syndrome and painful periods, irritable bladder, interstitial cystitis, vulvodynia (vulvar pain), difficulty focusing eyes, dry or burning eyes and mouth, dizziness or feeling faint, profuse sweating, muscle weakness and balance issues can occur.^24,25,26 Fibromyalgia patients are often sensitive to odors, loud noises, bright lights, some foods, and often the medications that they are prescribed.
Aggravating Factors - Changes in weather, cold or drafty environments, hormonal fluctuations (premenstrual and menopausal states), stress, depression, anxiety, and over-exertion can all contribute to fibromyalgia symptom flare-ups.

Cervical & Lumbar Spondylosis

Spondylosis
A very common disorder of the spine is spondylosis. It is primarily a condition of age. The condition reduces mobility of the intervertebral joints and there is a consequent development of abnormal bone around the vertebrae. What happens is that projections called osteophytes appear from the vertebral margins. Osteophytes are small, bony spurs and they cause the bone to become denser and the disks to degenerate. The degenerated disk extrudes both forward and backward. When the extrusion is backward, the spinal canal is narrowed.

Cervical Spondylosis:-

Cervical Spondylosis is also known as Cervical Osteoarthritis. Cervical Spondylosis is characterized by chronic degeneration of the bones of the neck and the vertebrae discs. Degeneration of the facet joints, spinal nerves and spinal cord also causes Cervical Spondylosis.
It is observed that age, sports injuries and accidents are the most common causes that lead to wear and tear of bones around the neck region. Cervical Spondylosis is known to affect people above 40 years of age. Men are susceptible to Cervical Spondylosis at an earlier age as compared to women.

Symptoms:-

The common symptoms associated with Cervical Spondylosis are:

• Severe pain in the neck region
• Neck pain leads to pain in shoulders and arms
• Loss of sensation in neck, shoulders, arms and fingers
• Instability
• Lack of bowel or bladder control

If Cervical Spondylosis is left untreated it can cause severe damage to the spinal cord and spinal nerves which can impair mobility and the ability to function normally.

 
Lumbar Spondylosis and Cervical Spondylosis:-
 
When there is a marked narrowing of the canal over a few segments and when the bone, disk and the ligaments protrude into it, the condition is called lumbar spinal stenosis. Here the nerve roots of the cauda equina are compressed. When the misalignment of the vertebrae causes stretching of the joint capsules at sites where the vertebrae are adjacent, there is pain.
A more common occurrence in the event of backward protrusion of an intervertebral disk is distortion of the local ligaments. In this case, the emerging nerve root is compressed and there results pain, weakness and numbness in the area.

       Spondylosis usually affects men more than women. Usually, the lumbar and cervical spine are more frequently affected than the thoracic spine, because the curvature of the latter prevents spondylosis from impinging on the spinal cord. Another important point is that lumbar and cervical spondylosis frequently occur simultaneously in the same individual. The onset of the symptoms is generally very slow and gradual. However, if ignored, spondylosis may lead to disabling tingling pain, limited motion, and partial paralysis in affected areas of the body.

Spondylolisthesis and other conditions
Another condition that can affect the spine is spondylolisthesis. It is a condition where there is a slipping forward of one vertebra onto another. It is usually a congenital deformity or it may be caused due to trauma.
Besides spondylosis and spodylolisthesis, infections, tumors and bone diseases may also cause vertebral disorders, causing pain and signs of damage to the roots and perhaps to the cord as well. Direct infections of the spinal cord are very rare. Tumors are usually secondary to such malignancies as lymphomas or carcinomas of the breast, prostate or kidney. Benign or non-cancerous tumors may also occur.

 

Ankylosing Spondylitis

What is ankylosing spondylitis?

Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. The sacroiliac joints are located in the low back where the sacrum (the bone directly above the tailbone) meets the iliac bones (bones on either side of the upper buttocks). Chronic inflammation in these areas causes pain and stiffness in and around the spine. Over time, chronic spinal inflammation (spondylitis) can lead to a complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis. Ankylosis leads to loss of mobility of the spine.
Ankylosing spondylitis is also a systemic disease, meaning it can affect other tissues throughout the body. Accordingly, it can cause inflammation in or injury to other joints away from the spine, as well as to other organs, such as the eyes, heart, lungs, and kidneys. Ankylosing spondylitis shares many features with several other arthritis conditions, such as psoriatic arthritis, reactive arthritis, and arthritis associated with Crohn's disease and ulcerative colitis. Each of these arthritic conditions can cause disease and inflammation in the spine, other joints, eyes, skin, mouth, and various organs. In view of their similarities and tendency to cause inflammation of the spine, these conditions are collectively referred to as "spondyloarthropathies." Ankylosing spondylitis is considered one of the many rheumatic diseases because it can cause symptoms involving muscles and joints.
Ankylosing spondylitis is two to three times more common in males than in females. In women, joints away from the spine are more frequently affected than in men. Ankylosing spondylitis affects all age groups, including children. The most common age of onset of symptoms is in the second and third decades of life.

HOW DO YOU KNOW IF YOU HAVE ANKYLOSING SPONDYLITIS?                                         Seventy-five percent of patients with ankylosing spondylitis most commonly complain of lower back pain. 

Although lower back pain is a common complaint overall and can be caused by many other factors, back painassociated with ankylosing spondylitis is unique in part because of the following features:

-       Disease starts in early adulthood, often before 40 years of age.

-       Gradual onset of symptoms rather than a history of sudden onset such as after an injury

-       Symptoms persist for three months or longer.

-       Pain is worse after rest or prolonged sitting, such as pain upon waking in the morning.

-       Pain improves with activity and exercise. 

-       Rib cage pain; especially while taking a deep breath or coughing.

-       Stiffness or decreased movement of the back and neck. Ordinary tasks such as putting on sock and shoes may become difficult and painful. AS is an inflammatory process that involves other  areas of the body in addition to bones, including the eyes and spinal cord. 

Eyes — Uveitis, or inflammation of part of the eye, occurs in 25-40% of patients with AS. Symptoms of uveitis include sudden onset of severe eye pain, blurring of vision and difficulty tolerating bright light.  Uveitis requires immediate medical attention and treatment.

Spinal Cord — Vertebrae, or bones of the spine, serve as the structural support to protect the spinal cord and nerves, and they provide motion, and function to the skeleton.  Patients with AS often develop fused vertebral spines. 

Fused vertebral bones increase the chance of damaging the bones and place-increased stress on surrounding structures such as ligaments, tendons, and muscles.  A fused spine creates not only pain but loss of motion, and can become more brittle with mechanical stresses.  If vertebrae become fractured and dislodge, there is an increased risk of damage from impingement of surrounding spinal cord structures and nerves.  Damage to the spinal cord, roots and nerves cause symptoms such as changes in sensation, strength and movement below the level of injury.  For example, decreased leg strength with numbness and tingling in a patient complaining of back pain may be a sign of spinal nerve compromise.  If symptoms such as these occur, immediate medical attention should be sought.  Other symptoms that should prompt emergent medical attention include saddle area numbness and/or new changes in bowel and bladder habits (e.g. constipation, loss of continence).