Possibly muscular etiology. See if pain relieves with analgesics and muscle relaxant. Sos MRI shoulder joint.
No bony involvement. Muscular pain. Physio exercise. NSAID.
Bony lesion not found Give symptomatic treatment
NCS will help Check all nerves.
Take acetaminophen and ibuprofen and naproxen sodium and taking Antiinflammatory drugs to relieve the pain and cold compress reduce the patient swelling elbow muscular..
Tendonitis or Impingement Syndrome
Elbow muscular pain then patients upward and backward moves and elbow bone pain..
No bony involvement
i unable to seen x-ray properly, movement restriction---muscle spasms,malaligned joint positions,malnutrition ..!
Etiology seems to be musculotendinous Assess and manage for same using - Pain meds - Physical exercises - physical therapy
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*Rickets* ☝ Definition Rickets is a bone disorder caused by a deficiency of vitamin D, calcium, or phosphate. Rickets leads to softening and weakening of the bones and is seen most commonly in children 6-24 months of age. Vitamin D promotes the absorption of calcium and phosphorus from the gastrointestinal tract. A deficiency of vitamin D makes it difficult to maintain proper calcium and phosphorus levels in bones, which can cause rickets. History Roman descriptions of individuals with rickets can be found as early as the second century, and in the 1640s, the condition was well documented as a common bone ailment across England. Unfortunately, the scientifically proven cause of rickets was not identified until the 1920s, and by the 1930s, public-health initiatives recommended fortifying milk with vitamin D and cod-liver oil as a nutritional supplement for young infants and children. This led to a near eradication of rickets in the United States and other industrialized nations. Unfortunately, rickets has made a comeback and is still common in less-developed nations. Moreover, for a variety of reasons, rickets is seen more frequently amongst infants and children living in industrialized nations, often among more affluent populations. Epidemiology United States statistics In the United States, vitamin D deficiency rickets does not generally occur in infants fed proprietary infant formulas, because both formula and cow milk sold in the United States contain 400 IU of vitamin D per liter. Accordingly, except in pediatric patients with chronic malabsorption syndromes or end-stage renal disease, nearly all cases of rickets occur in breastfed infants who have dark skin and receive no vitamin D supplementation. International statistics The incidence of rickets in Europe is similar to that in the United States. In sunny areas, such as in the Middle East, rickets may occur when infants are bundled in clothing and are not exposed to sunlight. In some parts of Africa, deficiency of calcium, phosphorus, or both in the diet may also lead to rickets, especially in societies where corn is predominant in the diet. The frequency of rickets has been increasing internationally. Possible reasons include recommendations for children to wear sunscreen while outdoors and a tendency for children to spend more time indoors, watching television or playing electronic games, instead of playing outdoors. Rickets Types There are various types of rickets: Nutritional Rickets- Due to dietary deficiency of calcium, Vitamin D. You can correct it with including good sources of Calcium, Vitamin D, phosphorus. Sources of Vit D include sunlight, fatty fish, milk, mushrooms Sources of Calcium include Milk and products, gingelly seeds, Ragi, tofu, soy milk, figs, rajgeera (Amaranth seeds), Almonds, figs etc. Sources of phosphorus include milk and products, ricebran, pulses and legumes, rajgeera (amaranth seeds), pumpkin seeds, colocasia leaves, gingelly seeds, carrot , bajra, maize etc. Hypophosphatemic Rickets- As the name suggests this particular form of Rickets is caused due to low levels of phosphate. Bones become painfully soft and pliable. It is caused by a genetic dominant X-linked defect in the ability for the kidneys to control the amount of phosphate excreted in urine. It is not caused by Vit D Deficiency. Children suffering from this type of Ricket show obvious symptoms by the time they are 1 year of age. Treatment is generally through nutritional supplementation of phosphate and active form of Vit D. Renal Rickets- Caused by a number of kidney disorders. Persons suffering from kidney disorder have decreased ability to regulate amounts of electrolytes lost in urine which includes electrolytes like calcium and phosphate. Thus, these individuals develop symptoms similar to those of rickets Risk factors Factors that can increase a child’s risk of rickets include: Dark skin: Dark skin doesn’t react as strongly to sunshine as does lighter skin, so it produces less vitamin D. Mother’s vitamin D deficiency during pregnancy: A baby born to a mother with severe vitamin D deficiency can be born with signs of rickets or develop them within a few months after birth. Northern latitudes: Children who live in geographical locations where there is less sunshine are at higher risk of rickets. Premature birth: Babies born before their due dates are more likely to develop rickets. Medications: Certain types of anti-seizure medications and antiretroviral medications, used to treat HIV infections, appear to interfere with the body’s ability to use vitamin D. Exclusive breast-feeding: Breast milk doesn’t contain enough vitamin D to prevent rickets. Babies who are exclusively breast-fed should receive vitamin D drops. Causes Your body needs vitamin D to absorb calcium and phosphorus from food. Rickets can occur if your child’s body doesn’t get enough vitamin D or if his or her body has problems using vitamin D properly. Occasionally, not getting enough calcium or lack of calcium and vitamin D can cause rickets. Lack of vitamin D Children who don’t get enough vitamin D from these two sources can develop a deficiency: Your skin produces vitamin D when it’s exposed to sunlight. But children in developed countries tend to spend less time outdoors. They’re also more likely to use sunscreen, which blocks the rays that trigger the skin’s production of vitamin D. Fish oils, fatty fish and egg yolks contain vitamin D. Vitamin D also has been added to some foods, such as milk, cereal and some fruit juices. Symptoms Signs and symptoms of rickets may include the following: Baby is ‘floppy.’ Bone pain. Bone tenderness. Bones break easily. Costochondral swelling – prominent knobs on the bone between the ribs and the breast plate. Harrison’s groove – a horizontal line visible on the chest, where the diaphragm attaches to the ribs. Low calcium blood levels (hypcalcemia). Older children may have knock knees (genu valgum). Soft skull (craniotabes). Low physical growth (height and weight) may be affected. There may be spinal, pelvic, or cranial deformities. Toddlers may have bowed legs (genu varum). Uncontrolled muscle spasms, which may affect the entire body (tetany). Widening wrists. Symptoms vary in severity and may be intermittent. Complications Left untreated, rickets can lead to: Failure to grow Abnormally curved spine Skeletal deformities Dental defects Seizures Diagnosis and test The diagnosis of rickets is achieved in the following ways: Blood tests – measures levels of calcium and phosphorus. Levels of alkaline phosphatase may also be high. Arterial blood gases – checks how acidic the blood is. X-rays – these may reveal calcium loss in bones, or alterations in the structure or shape of the bones. Bone biopsy – this can confirm rickets (rarely used). Physical symptoms of rickets, such as bowed legs or a soft skull, will also be checked; however, these are not reliable enough to use on their own. Treatment and medications Simply, treatment focuses on increasing the patient’s intake of calcium, phosphates, and vitamin D. This may involve exposure to sunlight, consuming fish oils, and ergocalciferol or cholecalficerol (forms of Vitamin D). Exposure to ultraviolet B light and consuming calcium and phosphorus is usually enough to reverse or prevent rickets. If rickets is caused by bad diet, the patient should be given daily calcium and vitamin D supplements, an annual vitamin D injection, as well as being encouraged to eat vitamin D rich foods. Treating genetic rickets – the patient will be prescribed phosphorus medications and active vitamin D hormones. Other medical conditions – if rickets has an underlying medical cause, such as kidney disease, that disease needs to be treated and controlled. What is the prognosis for rickets? Outcomes for children with nutritional rickets are excellent, especially if diagnosed early. Appropriate supplementation with calcium and vitamin D will lead to healing of the bony defects within days to months. Severe bowing, seen in longer-standing cases of rickets, may also resolve over a number years without requiring surgical intervention. In patients with very advanced disease, however, the bony changes may be permanent. Prevention of rickets Estimating the exact vitamin D needs of each human is very difficult, because it is hard to measure how much of the vitamin is synthesized in the skin via sunlight. In countries that are not near the tropics and sunlight intensity is lower, it is important to provide a supplementary intake of vitamin D to prevent rickets. This may involve: Enriching milk, baby foods, and some other food products The administration of a daily vitamin D supplement Massive doses of vitamin D when it is impossible for socioeconomic reasons to provide a vitamin supplement In areas with a lot of sunlight, the best way to prevent rickets is to expose the child to the sun. While exposure to sunlight is a good source of vitamin D, it is important not to overdo it – excess sunlight exposure can lead to sunburn and eventually skin cancer.Dr. Shailendra Kawtikwar7 Likes22 Answers
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Man 58 yo playing tennis got pain in left upper arm. Clinical detected left biceps muscle protrusion in contraction and painful.Dr. Mahima Chaudhary4 Likes17 Answers
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27yr F c/o sever backache painful or unable forward bending . for 10days takin some otc pain killers h/o horse riding 3weeks before in j&k and soon after backe from there facing this problem o/e afebrile slr -ve wt 80kg xray posted.Dr. Shivraj Agarwal1 Like20 Answers
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A. Identify the insect ? B. Are they poisnous ? C. Any treatment necessary after the bite ?Dr. Mohammed Parvez3 Likes13 Answers
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*Paralysis* *Today about* Definition Paralysis is the inability – whether temporary or permanent – to move a part of the body. In almost all cases, paralysis is due to nerve damage, not to an injury to the affected region. For instance, an injury in the middle or lower regions of the spinal cord is likely to disrupt function below the injury, including the ability to move the feet or feel sensations, even though the actual structures are as healthy as ever. The spinal cord is like the brain’s relay system, so when something in the spinal cord doesn’t work or is injured, paralysis is often the result. These injuries can be the product of traumatic accidents, or diseases such as strokes and polio. Most spinal cord injuries are incomplete, which means that some signals still travel up and down the cord. With an incomplete injury, you may retain some sensation and movement all the time, or the severity of the paralysis may change sometimes on a highly unpredictable basis. A complete spinal cord injury, by contrast, completely compressed or severs the nerves in the spinal cord, making it impossible for the signal to travel. Types of Paralysis Temporary and permanent paralysis Paralysis can either be temporary or permanent. Bell’s palsy is a relatively common cause of temporary paralysis that causes temporary facial paralysis. Sometimes paralysis that occurs after a stroke can also be temporary. Paralysis caused by serious injury, such as a broken neck, is usually permanent. Examples of localised paralysis include: Facial paralysis – which is usually limited to one side of the face Paralysis of the hand Paralysis of the vocal cords – vocal cords are bands of tissue and muscle used to generate speech; paralysis usually only affects one vocal cord, which means the person is able to speak but their voice will be hoarse There are four generalized paralysis, however, which have to do with the portion of the body that is affected. Monoplegia Monoplegia is paralysis of a single area of the body, most typically one limb. People with monoplegia typically retain control over the rest of their body, but cannot move or feel sensations in the affected limb. Cerebral palsy, injuries and ailments can lead to this form of partial paralysis, including: Strokes Tumors Nerve damage due to injuries or diseases Nerve impingement Motor neuron damage Brain injuries Impacted or severed nerves at the affected location Hemiplegia Hemiplegia affects an arm and a leg on the same side of the body, and as with monoplegia, the most common cause is cerebral palsy. Hemiplegia often begins with a sensation of pins and needles, progresses to muscle weakness, and escalates to complete paralysis. Hemiplegia should not be confused with hemiparesis, which refers to weakness on one side of the body. Nevertheless, hemiparesis is often a precursor to hemiplegia, particularly for people with neurological issues. Paraplegia Paraplegia refers to paralysis below the waist, and usually affects both legs, the hips, and other functions, such as sexuality and elimination. Though stereotypes of paraplegia hold that people with this condition cannot walk, move their legs, or feel anything below the waist, the reality of paraplegia varies from person to person and sometimes, from day to day. Spinal cord injuries are the most common cause of paraplegia. These injuries impede the brain’s ability to send and receive signals below the site of the injury. Some other causes include: Spinal cord infections Spinal cord lesions Brain tumors Brain infections Rarely, nerve damage at the hips or waist; this more typically causes some variety of monoplegia or hemiplegia. Brain or spinal cord oxygen deprivation due to choking, surgical accidents, violence, and similar causes. Stroke Congenital malformations in the brain or spinal cord Quadriplegia Quadriplegia, which is often referred to as tetraplegia, is paralysis below the neck. All four limbs, as well as the torso, are typically affected. Some quadriplegics spontaneously regain some or all functioning, while others slowly retrain their brains and bodies through dedicated physical therapy and exercise. Spinal cord injuries are the leading cause of quadriplegia. The most common causes of spinal cord injuries include automobile accidents, acts of violence, falls, and sporting injuries, especially injuries due to contact sports such as football. Traumatic brain injuries can also cause this form of paralysis. Other sources of quadriplegia include: Acquired brain injuries due to infections, stroke, and other disease-related processes. Loss of oxygen to the brain and spinal cord due to choking, anesthesia-related accidents, anaphylactic shock, and some other causes. Spinal and brain lesions Spinal and brain tumors Spinal and brain infections Catastrophic nerve damage throughout the body Congenital abnormalities Early brain injuries, especially pre-birth or during-birth injuries that lead to cerebral palsy, which can produce a range of symptoms, including varying degrees of paralysis Allergic reactions to drugs Drug or alcohol overdoses Partial or complete paralysis Paralysis can be: Partial – where there is some muscle function and sensation; for example, if a person can move one leg but not the other, or feel sensations such as cold and heat Complete – where there is complete loss of muscle function and sensation in affected limbs Spastic or flaccid paralysis Paralysis can be: Spastic – where muscles in affected limbs are unusually stiff or display spasms, and movements are not under the control of the individual (read about spastic paraplegia) Flaccid – where muscles in affected limbs are floppy and weak; muscles in flaccid paralysis may shrivel Epidemiology about paralysis in US Paralysis is dramatically more widespread than previously thought. Approximately 1.7 percent of the U.S. population, or 5,357,970 people were living with some form of paralysis, defined as a central nervous system disorder resulting in difficulty or inability to move the upper or lower extremities. The leading cause of paralysis was stroke (33.7 percent), followed by spinal cord injury (27.3 percent) and multiple sclerosis (18.6 percent). Causes The nerve damage that causes paralysis may be in the brain or spinal cord (the central nervous system) or it may be in the nerves outside the spinal cord (the peripheral nervous system). The most common causes of damage to the brain are: Stroke Tumor Trauma (caused by a fall or a blow) Multiple sclerosis (a disease that destroys the protective sheath covering nerve cells) Cerebral palsy (a condition caused by a defect or injury to the brain that occurs at or shortly after birth) Metabolic disorder (a disorder that interferes with the body’s ability to maintain itself) Damage to the spinal cord is most often caused by trauma, such as a fall or a car crash. Other conditions that may damage nerves within or immediately adjacent to the spine include: Tumor Herniated disk (also called a ruptured or slipped disk) Spondylosis (a disease that causes stiffness in the joints of the spine) Rheumatoid arthritis of the spine Neurodegenerative disease (a disease that damages nerve cells) Multiple sclerosis Damage to peripheral nerves may be caused by: Trauma Compression or entrapment (such as carpal tunnel syndrome) Guillain-Barré syndrome (a disease of the nerves that sometimes follows fever caused by a viral infection or immunization) Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) (a condition that causes pain and swelling in the protective sheath covering nerve cells) Radiation Inherited demyelinating disease (a condition that destroys the protective sheath around the nerve cell) Toxins or poisons Symptoms Usually paralysis are occur along with some of the following symptoms – Loss of consciousness (could be brief) or confusion Clumsiness and numbness Severe headache Difficulty breathing Drooling Cognitive difficulties, difficulty writing or speaking Changes in mood or behavior Loss of bladder or bowel control Loss or changes in vision and/ or hearing Nausea with or without vomiting Complications Because paralysis causes immobility, it has a rather significant effect on the other systems in the body. These include: Changes to circulation and respiration Changes to the kidneys and gastrointestinal system Changes to muscles, joints, and bones Spasticity of the limbs Muscle spasms Pressure sores Edema Blood clots in the lower limbs Feelings of numbness or pain Skin injury Bacterial infection Disruption of the normal working of the tissues, glands, and organs Constipation Loss of control of urination Sexual difficulties Abnormal sweating Abnormal breathing or heart rate Balance problems Difficulty thinking Behavioral issues Difficulty speaking or swallowing Vision problems Diagnosis The first step in diagnosis of paralysis is physical exam by the doctor. Next the doctor will talk about the symptoms and family history. Diagnosing will not be difficult if the cause of paralysis is obvious, for example, paralysis after a stroke. If the cause is not obvious, then the physician will order specialized tests such as: X-ray CT scan (Computed tomography) MRI (Magnetic Resonance Imaging) scans Electromyography (usually used to diagnose Bell’s palsy) If required the patient will then be referred to a neurologist. Treatment and Medications A wearable electronic device that helps recover arm function by delivering tiny electrical currents to the nerves thereby activating hand and arm muscles. This method is called Functional Electrical Stimulation or FES. If cure or recovery from paralysis is not possible, various mobility aids such as wheelchairs and orthoses are available for people with paralysis. Prosthetics and orthoses: Prosthesis is a device that replaces or extends a limb, extremity, or other body part. Orthoses are external mechanical devices which support, prevent, correct and assist body segments in neuromuscular skeletal conditions. Medication and aids for managing paralysis In most cases, spinal cord injury and paralysis result in the loss of normal bowel and bladder function. So, a catheter is used to empty urine from the bladder. Bowel retraining, enemas, and sometimes colostomy (surgery of the bowel) are done to help people with paralysis empty their bowel. Pain caused by nerve damage is normally relieved through medicines such as amitriptyline or pregabalin, since common painkillers like paracetamol or ibuprofen are ineffective in such type of pain. Breathing difficulties that arise through spinal cord injury to the upper neck is often treated using positive pressure ventilators that are either invasive or non-invasive. For abnormally stiff muscles (spasticity) and involuntary muscle spasms, treatment involves use of muscle relaxants such as Baclofen, Tizanidine or Dantrolene. Sometimes, Botox is given for localised spasms. A relatively new treatment for management of spastic paralysis is the intrathecalbaclofen (ITB) therapy in which consistent optimal dosage of Baclofen is delivered via a programmable drug pump implanted in the fluid-filled space around the spinal cord. It is important to note that pressure ulcers can develop if a person is unable to move regularly due to paralysis. Care must be taken to ensure that preventive measures such as changing position regularly or pressure relieving devices are used. Rehabilitation may involve: Physiotherapy – to improve mobility Speech therapy – to improve communication Occupational therapy – to improve daily functions such as eating, cooking, toileting and washing. Prevention Reducing the number of controllable risk factors is the best way to prevent a stroke. This can include: Stopping smoking Losing weight Eating a balanced diet low in sodium and saturated and trans fat Moderating alcohol intake (no more than 2 small drinks per day) Exercising regularly in order to stay physically fit Maintaining good control of existing medical conditions such as diabetes, high blood pressure and high cholesterolDr. Shailendra Kawtikwar8 Likes10 Answers