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September 2015 - Capitahealth

Archives for September 2015

How to Manage Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

This is a condition of the hand affecting the nervous supply of the wrist. It comes about as a result of the median nerve getting squeezed or pinched before it supplies the palm. This affects sensation and wrist movements and may progressively get painful with time. It is the commonest cause of hand neuropathy and has to be ruled out wherever a patient comes with numbness and pain of the hand.

Symptoms

Symptoms start gradually and are progressive in nature. Early symptoms are mild and may be ignored for sometimes. Tingling and numbness in the thumb could be the first symptoms. The index and middle fingers may also be affected at this stage. Hand and wrist discomfort is also common. Other symptoms of carpal tunnel syndrome include:

  • Itchiness on the palm and especially on the thumb
  • Swollen hand and finger sensation although there is no visible swelling.
  • Numbness and tingling that is worse when constantly grasping an object.
  • Little finger spared from the symptoms affecting the rest of the palm
  • Hand weakness with a tendency to drop objects.
  • Muscle wasting.
  • Inability to differentiate temperature status of an object.
  • Can affect one or both hands.

Causes and risk factors

Carpal tunnel syndrome is caused by the compression of the median nerve as it enters the wrist from the forearm. This compression may be due to a number of factors but sometimes the exact cause cannot be pinpointed. However, there are risk factors that have been identified to increase chances of getting this condition. Some of these include:

  • Gender. Women are up to three times more likely to get the problem than men
  • Diabetic patients
  • People suffering from other metabolic disorders like hypothyroidism
  • Rheumatoid arthritis patients
  • Trauma and fractures of the wrist
  • Those working in repetitive work situations like assembly and packing lines.
  • People with anatomically small carpal tunnel
  • Edema conditions as seen in pregnancy, menopause or in various disease conditions
  • Extensive use of the computer (but this point is controversial)

Diagnosis

A detailed history of the illness and a comprehensive physical examination of the patient will very likely make the diagnosis of carpal tunnel syndrome obvious. Physical examination includes tests like the Tinel test and the Phalen (wrist flexion) test. Diagnostic tests include:

  • Wrist X-ray to rule out other wrist conditions or injuries.
  • Electromyography to test wrist muscles’ integrity
  • Nerve conduction tests
  • Ultrasound imaging
  • Magnetic Resonance Imaging – MRI

Management of carpal tunnel syndrome

The outcome is best if treatment is started as early as possible. The treatment can be surgical or non-surgical. The surgery can be open or endoscopic in nature. Non-surgical measures include:

  • Splinting the wrist
  • Use of common non-steroidal anti-inflammatory drugs – NSAIDs
  • Use of corticosteroids
  • Physiotherapy

Physiotherapy plays an important role during active management of this condition and also in the prevention stage. A physiotherapist can train those at risk on the type of exercises to perform either at hope or at their place of work. Physiotherapy measures include:

  • Stretching exercises
  • Use of corrective splints
  • Heat or ice therapy
  • Hand therapy techniques
  • Ultra-sound treatment
  • Mobilization of the carpal bone
  • Gliding exercises for tendon and nerves
  • Looking for sources of possible referred pain

Carpal tunnel syndrome can be a disabling condition if left untreated but if diagnosed early, physiotherapy can correct the condition before it gets worse.

 

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Plantar fasciitis

Plantar fasciitis

This is a common and painful condition of the foot that affects many people.The problem comes about due to inflammation and thickening of the plantar fascia of the foot. This is a band of tissue that runs on the lower side of the foot from the front to the back.

Symptoms of plantar fasciitis

Most of the symptoms are in the foot and they include:

  • Sharp foot pain close to the heel
  • Pain worse on waking up – referred to as ‘first step pain’
  • Foot joints stiffness
  • Pain that improves with exercises but returns after the exercises
  • Pain triggered by walking for long
  • Limiting foot pain on standing up after prolonged sitting.

Causes and risk factors

The exact cause of plantar fasciitis is not well understood. Some experts theorize that repeated small injuries lead to the thickening and inflammation of the fibrous tissue of the plantar fascia. There are however, situations and conditions that increase the risk of developing this condition. They include:

Anatomical factors

This includes a short calf muscle that prevents the full flexion of the foot. The other problem here is an abnormally high arch of the foot. Flat footed people and those with other problems of the feet which affect their gait are also at an increased risk.

Lifestyle factors

This includes excessive body weight that creates too much strain on the foot. People who are mostly active on their feet, like athletes and soldiers, are also more likely to develop the problem. Changing from high heels to ordinary shoes suddenly can trigger the symptoms.

Ill-fitting and poorly padded shoes also increase the risk of plantar fasciitis.

Health conditions

Rheumatoid arthritis and other types of arthritis or inflammatory conditions such as systemic lupus erythematosus can increase chances of plantar fasciitis. Calcaneal spurs are common in people with this condition but they are not the cause. For this reason each of these conditions can be treated independent of the other.

Age

Plantar fasciitis is more common in those above middle age.

Injury may, but is rare, lead to the condition.

Diagnosis

The diagnosis can be made almost conclusively based on the clinical presentation. A thorough history about the pain and its association with time of waking up, exercises, occupation and type can all help in making an accurate diagnosis. Physical examination may reveal risk factors like obesity or anatomical foot problems.

Imaging investigations like X-rays and MRIs are not used routinely to diagnose plantar fasciitis. Instead, they are for ruling out other conditions of the foot.

Treatment

Treatment can be non-surgical or surgical. Majority of patients don’t need surgery. Non-surgical treatments include:

  • Analgesics
  • Corticosteroids
  • Physiotherapy.

Physiotherapy forms an import part of treatment. This alone can lead to many patients getting relief. Physiotherapy measures include:

  • Assisted exercises that stretch the calf muscles and the plantar fascia.
  • Use of special shoes and orthotics
  • Application of specialized ice or heat therapies.
  • Use of high energy Extra-corporeal shockwave therapy
  • Use of night splints

As a part of the treatment a physiotherapist educates the patient on how to take good care of their feet and how to prevent plantar fasciitis from getting complications or recurring in the future.

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High Blood Pressure (Hypertension)

High blood pressure is defined as the force of blood in the arteries which is sustainably higher than usual under specific prevailing circumstances. If elevated for long enough this pressure can create health problems not only in the cardiovascular system but also in other organs and systems of the body. This pressure is determined by two factors:

  1. The pumping force of the heart
  2. The arterial resistance to the flow of the pumped blood.

This means if the arteries are narrowed due to any of many reasons, then the heart will have to pump more strongly to overcome this resistance and in order to supply all the body parts with enough oxygen/nutrient rich blood.

Symptoms of high blood pressure

High blood pressure can remain symptom free even when extremely high. It is a common saying in the medical field that ‘the first sign of cardiovascular disease could be the last one’. This emphasizes the fact that the first symptom of high blood pressure could be a stroke or heart attack which could be serious enough to result in death.

The only way to know if you have high blood pressure is to have your blood pressure measured. However, in some rare cases, a person with a very high blood pressure can present with the symptoms, including:

  • a persistent headache
  • blurred or double vision
  • nosebleeds
  • shortness of breath

Symptoms secondary to hypertension complications may also be observed. Such symptoms may point to problems in the lungs, liver or kidneys.

Many cases of hypertension are discovered during routine visits to the doctor or when carrying out medical examination for other purposes.

Causes of hypertension

There are two main classifications of hypertension causes.

  1. Primary hypertension refers a type whose cause is not identifiable. It follows a chronic trend over many years.
  2. Secondary hypertension. In this type there is a primary underlying cause that has precipitated the hypertension. Common causes include:
  • Kidney problems
  • Liver problems
  • Adrenal gland tumors (pheochromocytoma)
  • Medications
  • Substance abuse including smoking, alcohol and use of narcotics and other drugs.

There are many factors that increase the risk of developing hypertension. Common ones include:

  • Lifestyle choices including a sedentary lifestyle, use of tobacco products and alcohol as well as obesity
  • Genetic predisposition. It tends to run in families
  • Aging increases the risk although there is a worrying trend in many countries where younger people are getting hypertension due to dietary and other factors
  • Diet is a major determinant of risks associated with hypertension. The typical Western countries diet and that of the urban population in the developing world is typically made up of too much fat, salt (sodium chloride) and sugar not to mention highly processed packaged foods full of harmful preservatives and additives.

Diagnosis

This is made by a simple non-invasive blood pressure measuring by use of an ordinary aneroid or non-aneroid sphygmomanometer. Other electronic and imaging tests may be done for assessing related problems.

Treatment

Treatment involves the use of medications and a change in lifestyle in an attempt to gradually bring down the blood pressure to healthy levels and to prevent complications. Treating the primary cause, if known, is the best option. It also means treating any associated complications. Other measures include

  • A healthy diet. The typical Mediterranean diet is recommended.
  • Low salt (sodium) diet
  • Weight reduction and management to healthy levels.

The role of physiotherapy in the management of hypertension

  • Physiotherapy can help in guiding people on how to engage in beneficial exercises that can keep them fit and healthy.
  • A physiotherapist will take into account any present medical conditions to design appropriate exercise programme. For instance, people arthritis in their weight-bearing joints should avoid some types of exercises.
  • If complications of hypertension have already occurred, a physiotherapist plays a major role in rehabilitating the affected functions.

 

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How Physiotherapy Can Ease Your Back Pain

If you had the ability to see through the skin that covers your back, you would probably be amazed by the incredible collection of muscles, ligaments, and bones that make up that area. Of course, at the center of it all is the spine, which basically acts like a support column that keeps you upright. It goes without saying that the spinal column bears a lot of the weight for the things that you do in work and play, making it very susceptible to damage. Discs sit in between the vertebrae to cushion much of that punishment, but much like the brake pads on your car, these can deteriorate and become damaged over time.

That is not the only source of back pain, though, as trapped nerves and spinal cord issues also playing a part. The reality is that back pain is fast becoming the number one reason that people miss work, even if their job requires them to maintain a sedentary position throughout the day. Sitting at a desk for 8 hours per day can almost be just as risky as pumping iron in the gym or lifting heavy weights at work. Most people think that the pain will simply go away, and will pop pain pills in order to alleviate the pain. That can actually lead to further issues as you then tend to overextend yourself because you do not receive those warning signals of pain. The most effective method of dealing with back pain is to talk to a physiotherapist, who can get you back on your feet as quickly as is humanly possible.

Physiotherapists are called upon to treat all manner of physical ailments in just about every part of the body, but if you had to take a straw poll to find out their most common patient, it would likely be those suffering from back pain. The great thing about seeing a physiotherapist is that there is no single way to tackle your back pain that is truly unique. They have at their disposal a number of different techniques that they can employ, depending of course on what type of pain you are suffering from. The physiotherapist will ask about your level of pain, as well as where you are feeling the most discomfort, at which point they will decide which type of physiotherapy treatment will best suit your needs.

Depending on the severity of your pain, the treatment you receive can range from a series of different exercises. They can also show you a number of techniques that will help improve your posture and show you how to properly lift and handle heavy weights at work, if that is the cause of the problem. Manipulation and mobilization techniques can be used to manage the pain, and sometimes stretching exercises could be used based on clinical assessment supported with sound clinical reasoning. Additionally, core stability training could be tapped into, to strengthen core muscles so that future pains can be avoided.

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