膝骨关节炎的主要病理基础是软骨的变性、破坏和丧失,最终导致软骨下骨增生、关节间隙狭窄或关节强直。骨关节炎最主要的致病因素是年龄因素、基因异常、积累性损伤及外伤、体重过大等。在无法干预不可改变因素:年龄及基因下,我们要努力去避免其他可变因素,也就是在平时生活中要保持最佳体重(不光是机械压迫的问题,肥胖还可导致诸多炎性因子的释放,而影响膝骨关节炎的进展),避免爬山、楼梯等积累性损伤,不主张跑跑步机,平地适当慢跑最佳,避免对抗性运动,减少关节损伤。 导致膝骨关节炎就诊的主要因素是疼痛,疼痛患者多伴有滑膜炎,关节周围肌腱附着点、髌下脂肪垫炎等,所以我们可以选用非甾体抗炎药物、消除滑膜炎药物,重点提示:中药汤剂(用好了)见效快于传统非甾体及市面上消除滑膜炎等药物,当然按照国际指南正规关节应用激素类药物见效更快(注意不要乱用)。顺便提一下,我的“杜氏针法”对关节炎疼痛效果可靠。 影响膝骨关节炎预后的因素是软骨的退变、骨质疏松及肌肉力量等问题导致关节畸形:内外翻畸形及强迫去取畸形。所以建议在未畸形之前规律应用促进软骨合成药物,加强股四头肌力练习防治骨质疏松。
伤寒汗后转归:或愈或出现身疼痛、四肢难以屈伸、心下悸、腹胀、欲做奔豚、奔豚、头晕、身动、振振欲扑地、渴而小便不利、振寒。总关乎:卫阳、心阳、脾阳、肾阳及膀胱气化功能。 治之以:桂枝加芍药、生姜各一两,人参三两新加汤、桂枝加附子汤、桂枝甘草汤、厚姜半甘人汤、苓桂枣甘汤、桂枝加桂汤、真武汤
Type 1 lesions are localised to the central subchondralportions of the discovertebral junction and this can occurin both ankylosed and non-ankylosed spines.Osteoporosis of vertebrae is marked in ankylosing spondylitis. This results in weakening of the subchondral bone and displacement of the discal contents through the cartilaginous end plate into the vertebral body.Apophyseal joint involvement may lead to instability and recurrent traumatic insult to the disc-bone interface. This eventually produces infarction of cartilaginous endplate allowing the discal material into the vertebral body.Inflammatory changes in subchondral bone itself may lead to osseous weakening and discal displacement .Radiologically the lesions appear as irregularity of central portion of the superior and inferior vertebral margins with surrounding sclerosis.Type2 -These are peripheral localized lesions occuring in the anterior or posterior part of discovertebral junction. The anterior lesion is attributed to collapse of osteoporotic anterior vertebral margin as occurs inosteoporotic kyphosis and also alternatively to injury to the anterior fibres of annulus fibrosus leading to invasion and replacement of discal material by vascular fibrous tissue as in senile kyphosis.The mechanism of thelocalised posterior lesions though not clear may be due to osteoporotic collapse or cartilagenous nodes. Inflammation of the outer fibres of the annulus fibrosus related to spondylitic process may also play a role.Radiologically Type 2 lesions are seen as intervertebral disc space narrowing with bony sclerosis, irregularity of discovertebral junction and anterior or posterior discovertebral erosion with intact apophyseal joints. Type3 Destruction of the whole discovertebraljunction of two adjacent vertebral bodies occurs in patients with advanced ankylosis. There may be a history of trauma and associated fracture through the ankylosed portion. There may be improper healing with callus formation, heamorrhage and minimal inflammatory changes.The adiological appearance of this type is a combination of Type1 and Type 2 lesions. The radiological features of all types of Andersson lesion including disc space narrowing, destruction of vertebral end plate and sclerosis of adjacent bone mimic infective spondylitis particularly due to tuberculosis
Pathophysiology and Clinical FeaturesSevere flatfoot and hindfoot valgus deformity may present with lateral ankle pain in the region bounded by the anterior fibula and the sinus tarsi . This lateral ankle pain has been attributed to extraarticular lateral hindfoot impingement including talocalcaneal impingement (between the lateral talus and calcaneus) and subfibular impingement (between the calcaneus and fibula) fig.12A,12B,12C). Lateral hindfoot impingement is believed to be secondary to a lateral shift of weight-bearing forces from the talar dome to the lateral talus and fibula and to talocalcaneal joint subluxation . Talocalcaneal impingement typically occurs before subfibular or combined talocalcaneal–subfibular impingements .There are several causes of lateral hindfoot impingement including PTT dysfunction , healed intraarticular calcaneal fractures , neuropathic arthropathy, and inflammatory arthritides . Clinical presentation varies on the basis of the cause of flatfoot and hindfoot valgus. In patients with PTT dysfunction, medial ankle pain is the presenting symptom during the early stages of PTT dysfunction, whereas lateral ankle pain related to hindfoot valgus and lateral impingement predominates in long-standing PTT dysfunction . Regardless of the initial cause of flatfoot, patients with rigid flatfoot deformity experience decreased range of motion at the midfoot and hindfoot and decreased ankle dorsiflexion . Lateral ankle pain may develop because of lateral hindfoot impingement. With progressive deformity, secondary osteoarthrosis of the subtalar, talonavicular, and calcaneocuboid articulations contribute to pain symptoms . On physical examination, flatfoot and hindfoot valgus deformity are evaluated with the patient sitting and standing. There may be decreased range of motion of the ankle, hindfoot, midfoot, and forefoot and lateral ankle pain on palpation. The Achilles tendon may show contracture and tightness .The goal of conservative treatment early in the course of the disease is to prevent further disability and progressive deformity. Acute synovitis is treated with rest and NSAIDS to reduce inflammation. Physical therapy and orthotics relieve stress and pain in the ankle. In patients with advanced PTT dysfunction, soft-tissue balancing procedures alone are inadequate for restoring the longitudinal arch . Osseous correction of hindfoot deformity is required and consists of calcaneal osteotomy, either at the body (medial calcaneal displacement osteotomy) or at the anterior calcaneus (lateral column lengthening). Finally, marked deformity associated with arthritis and fixed osseous deformity are best managed with arthrodesis. These include talonavicular arthrodesis, double arthrodesis at Chopart joints, a subtalar arthrodesis, and a triple arthrodesis. The extent of arthro desis should be limited to minimize the stress transfer to proximal and distal joints .Fig. 12A—Schematic drawings show lateral extraarticular talocalcaneal and subfibular hindfoot impingements. (Reprinted from [10]) Normal hindfoot valgus (< 6°) and no lateral impingement. Hindfoot valgus angle is measured at intersection of line along medial calcaneal wall and line parallel to longitudinal axis of tibia. Fig. 12B—Schematic drawings show lateral extraarticular talocalcaneal and subfibular hindfoot impingements. (Reprinted from [10]) With progressive hindfoot valgus, abnormal contact between lateral talus and calcaneus (red) occurs first and results in talocalcaneal impingement. Fig. 12C—Schematic drawings show lateral extraarticular talocalcaneal and subfibular hindfoot impingements. (Reprinted from [10]) Subsequent abnormal contact between both lateral talus and calcaneus (red) and abnormal contact between calcaneus and fibula (orange) subsequently develop and produce combined talocalcaneal and subfibular impingement. Fig. 13A—66-year-old woman with talocalcaneal and calcaneofibular impingement due to pes planus and hindfoot valgus. Sagittal inversion-recovery image shows marrow edema of opposing lateral talar process (solid arrow) and calcaneus (open arrow) Fig. 13B—66-year-old woman with talocalcaneal and calcaneofibular impingement due to pes planus and hindfoot valgus. Sagittal T1-weighted (B) and coronal fat-suppressed proton density–weighted (C) images depict edema and scarring (arrowheads,B) surrounding thickened, entrapped calcaneofibular ligament (arrow). Hindfoot valgus angle, formed by intersection of line along medial calcaneal wall and line parallel to long axis of tibia, is increased (30°). Fig. 13C—66-year-old woman with talocalcaneal and calcaneofibular impingement due to pes planus and hindfoot valgus. Sagittal T1-weighted (B) and coronal fat-suppressed proton density–weighted (C) images depict edema and scarring (arrowheads,B) surrounding thickened, entrapped calcaneofibular ligament (arrow). Hindfoot valgus angle, formed by intersection of line along medial calcaneal wall and line parallel to long axis of tibia, is increased (30°).Fig. 14A—61-year-old woman with talocalcaneal and calcaneofibular impingements related to severe hindfoot valgus. Sagittal inversion-recovery image depicts contact between calcaneus and fibula with opposing marrow edema and subchondral cysts (arrows).Fig. 14B—61-year-old woman with talocalcaneal and calcaneofibular impingements related to severe hindfoot valgus. Coronal proton density–weighted image depicts neocalcaneal facet (solid arrow) articulating with distal fibula. Lateral subluxation of calcaneus and subchondral changes in posterior subtalar facet (arrowheads) are compatible with talocalcaneal impingement. Peroneal tendons (open arrow) are minimally laterally subluxed
FABER (flexion, abduction, external rotation) or Patrick test: This test is frequently used to differentiate lumbar spinal problems from primary hip pathology. This comprehensive maneuver elicits anterior hip or groin pain. If there is significant loss of ROM from a mechanical means (ie, not pain-inhibited), consider an intra-articular problem, such as hip arthritis or avascular necrosis. If groin pain is elicited and yet the range of motion is relatively normal, suspect iliopsoas tendinitis. If the FABER/Patrick test produces posterior hip pain, consider a disorder of the sacroiliac (SI) joint. To perform this test, the patient's affected hip is moved into flexion, abduction, and external rotation while he or she lies supine with one ankle placed over the opposite knee ("figure 4" position). If pain is elicited when the examiner presses down on the flexed knee, this test may indicate an SI joint pathology or adductor muscle and tendon pain.FABER(屈曲、外展、外旋) 或Patrick test:本试验经常用于将腰脊问题同原发髋部病变鉴别开来。此综合动作会引起髋关节前部或腹股沟疼痛。如果髋关节明显的活动受限而无疼痛,考虑关节内问题,比如髋关节关节炎或(股骨头)缺血性坏死。如果腹股沟区疼痛而关节活动范围相对正常,怀疑髂腰肌肌腱炎。如果FABER/Patrick引发髋关节后部疼痛,考虑骶髂关节紊乱。此试验完成:患者平卧,患侧髋关节屈曲、外展并外旋,踝关节置于对侧膝部。如果检查者下压患膝而引发疼痛,表明骶髂关节病变或内收肌或肌腱疼痛。
Somatoform DisordersThe somatoform disorders are a group of psychiatric disorders that cause unexplained physical symptoms. They include somatization disorder (involving multisystem physical symptoms), undifferentiated somatoform disorder (fewer symptoms than somatization disorder), conversion disorder (voluntary motor or sensory function symptoms), pain disorder (pain with strong psychological involvement), hypochondriasis (fear of having a life-threatening illness or condition), body dysmorphic disorder (preoccupation with a real or imagined physical defect), and somatoform disorder not otherwise specified (used when criteria are not clearly met for one of the other somatoform disorders). These disorders should be considered early in the evaluation of patients with unexplained symptoms to prevent unnecessary interventions and testing. Treatment success can be enhanced by discussing the possibility of a somatoform disorder with the patient early in the evaluation process, limiting unnecessary diagnostic and medical treatments, focusing on the management of the disorder rather than its cure, using appropriate medications and psychotherapy for comorbidities, maintaining a psychoeducational and collaborative relationship with patients, and referring patients to mental health professionals when appropriate.The somatoform disorders are a group of psychiatric disorders in which patients present with a myriad of clinically significant but unexplained physical symptoms. They include somatization disorder, undifferentiated somatoform disorder, hypochondriasis, conversion disorder, pain disorder, body dysmorphic disorder, and somatoform disorder not otherwise specified.1These disorders often cause significant emotional distress for patients and are a challenge to family physicians.Up to 50 percent of primary care patients present with physical symptoms that cannot be explained by a general medical condition. Some of these patients meet criteria for somatoform disorders.2,3Although most do not meet the strict psychiatric diagnostic criteria for one of the somatoform disorders, they can be referred to as having “somatic preoccupation,”4a subthreshold presentation of somatoform disorders that can also cause patients distress and require intervention.The unexplained symptoms of somatoform disorders often lead to general health anxiety; frequent or recurrent and excessive preoccupation with unexplained physical symptoms; inaccurate or exaggerated beliefs about somatic symptoms; difficult encounters with the health care system; disproportionate disability; displays of strong, often negative emotions toward the physician or office staff; unrealistic expectations; and, occasionally, resistance to or noncompliance with diagnostic or treatment efforts. These behaviors may result in more frequent office visits, unnecessary laboratory or imaging tests, or costly and potentially dangerous invasive procedures.5–7Little is known about the causes of the somatoform disorders. Limited epidemiologic data suggest familial aggregation for some of the disorders.1These data also indicate comorbidities with other mental health disorders, such as mood disorders, anxiety disorders, personality disorders, eating disorders, and psychotic disorders.1,3DiagnosisThe challenge in working with somatoform disorders in the primary care setting is to simultaneously exclude medical causes for physical symptoms while considering a mental health diagnosis. The diagnosis of a somatoform disorder should be considered early in the process of evaluating a patient with unexplained physical symptoms. Appropriate nonpsychiatric medical conditions should be considered, but over-evaluation and unnecessary testing should be avoided. There are no specific physical examination findings or laboratory data that are helpful in confirming these disorders; it often is the lack of any physical or laboratory findings to explain the patient's excessive preoccupation with somatic symptoms that initially prompts the physician to consider the diagnosis.Two related disorders, factitious disorder and malingering, must be excluded before diagnosing a somatoform disorder. In factitious disorder, patients adopt physical symptoms for unconscious internal gain (i.e., the patient desires to take on the role of being sick), whereas malingering involves the purposeful feigning of physical symptoms for external gain (e.g., financial or legal benefit, avoidance of undesirable situations). In somatoform disorders, there are no obvious gains or incentives for the patient, and the physical symptoms are not willfully adopted or feigned; rather, anxiety and fear facilitate the initiation, exacerbation, and maintenance of these disorders.Clinical diagnostic tools have been used to assist in the diagnosis of somatoform disorders.8One screening tool for psychiatric disorders that is used in primary care settings is the Patient Health Questionnaire (PHQ).9The somatoform screening questions on the PHQ include 13 physical symptoms(Figure 1).9If a patient reports being bothered “a lot” by at least three of the symptoms without an adequate medical explanation, the possibility of a somatoform disorder should be considered.View/Print FigurePatient Health Questionnaire: Screening for Somatoform DisordersFigure 1.Patient Health Questionnaire: screening for somatoform disorders.CharacteristicsThere are three required clinical criteria common to each of the somatoform disorders: The physical symptoms (1) cannot be fully explained by a general medical condition, another mental disorder, or the effects of a substance; (2) are not the result of factitious disorder or malingering; and (3) cause significant impairment in social, occupational, or other functioning. The additional characteristics of each disorder are discussed briefly in the following and are listed inTable 1.1View/Print TableTable 1Characteristics of Somatoform DisordersDISORDERESSENTIAL CHARACTERISTICSSomatization disorderUnexplained physical symptoms manifested before age 30Symptoms last for several yearsSymptoms include two gastrointestinal, four pain, one pseudoneurologic, and one sexualUndifferentiated somatoform disorder≥ Six months' historyOne or more unexplained physical symptomsConversion disorderSingle unexplained symptom involving voluntary or sensory functioningPain disorderPain symptom is predominant focusPsychological factors play the primary role in the perception, onset, severity, exacerbation, or maintenance of painHypochondriasisFixation on the fear of having a life-threatening medical conditionBody dysmorphic disorderPreoccupation with a real or imagined physical defectSomatoform disorder not otherwise specifiedMisinterpretation or exaggeration of unexplained physical symptomsPatient does not meet full criteria for any of the other somatoform disordersSOMATIZATION DISORDERPatients with somatization disorder (also known as Briquet's syndrome) present with unexplained physical symptoms beginning before 30 years of age, lasting several years, and including at least two gastrointestinal complaints, four pain symptoms, one pseudoneurologic problem, and one sexual symptom(Table 2).1For example, a patient might have chronic abdominal complaints (e.g., abdominal cramping, diarrhea) that have been thoroughly evaluated but have no identified cause, as well as a history of other unexplained somatic symptoms such as anorgasmia, ringing in the ears, and chronic pain in the shoulder, neck, low back, and legs. Patients with this disorder often have made frequent clinical visits, had multiple imaging and laboratory tests, and had numerous referrals made to work up their diverse symptoms.Somatization disorder appears to be more common in women than men, with a lifetime prevalence of 0.2 to 2 percent in women compared with less than 0.2 percent in men. Subthreshold somatization disorder may have a prevalence up to 100 times greater. Familial patterns exist, with a 10 to 20 percent incidence in first-degree female relatives.1No definitive cause has been identified for somatization disorder, although the familial patterns suggest genetic or environmental contributions.UNDIFFERENTIATED SOMATOFORM DISORDERThe diagnosis of undifferentiated somatoform disorder is a less-specific version of somatization disorder that requires only a six-month or longer history of one or more unexplained physical complaints in addition to the other requisite clinical criteria. Chronic fatigue that cannot be fully explained by a known medical condition is a typical symptom. The highest incidence of complaints occurs in young women of low socioeconomic status, but symptoms are not limited to any group.1CONVERSION DISORDERConversion disorder involves a single symptom related to voluntary motor or sensory functioning suggesting a neurologic condition and referred to as pseudoneurologic. Conversion symptoms typically do not conform to known anatomic pathways or physiologic mechanisms, but instead they more commonly fit a lay view of physiology (e.g., a hemiparesis that does not follow known corticospinal-tract pathways or without changes in reflexes or muscle tone), a clue to this disorder. Patients may present in a dramatic fashion or show a lack of concern for their symptom. Onset rarely occurs before age 10 or after 35 years of age. Conversion disorder is reported to be more common in rural populations, persons of lower socioeconomic status, and those with minimal medical or psychological knowledge.1PAIN DISORDERPain disorder is fairly common. Although the pain is associated with psychological factors at its onset (e.g., unexplained chronic headache that began after a significant stressful life event), its onset, severity, exacerbation, or maintenance may also be associated with a general medical condition. Pain is the focus of the disorder, but psychological factors are believed to play the primary role in the perception of pain. Patients with pain disorder use the health care system frequently, make substantial use of medication, and have relational problems in marriage, work, or family. Pain may lead to inactivity and social isolation, and it is often associated with comorbid depression, anxiety, or a substance-related disorder.HYPOCHONDRIASISPatients with hypochondriasis misinterpret physical symptoms and fixate on the fear of having a life-threatening medical condition. These patients must have a nondelusional preoccupation with their symptom or symptoms for at least six months before the diagnosis can be made. Prevalence is 2 to 7 percent in the primary care outpatient setting, and there do not appear to be consistent differences with respect to age, sex, or cultural factors.1The predominant characteristic is the fear patients exhibit when discussing their symptoms (e.g., an exaggerated fear of having acquired human immunodeficiency virus despite reassurance to the contrary). This fear is pathognomonic for hypochondriasis.BODY DYSMORPHIC DISORDERBody dysmorphic disorder involves a debilitating preoccupation with a physical defect, real or imagined. In the case of a real physical imperfection, the defect is usually slight but the patient's concern is excessive. For example, a woman with a small, flat keloid on the shoulder may be so self-conscious of it that she never wears clothing that would reveal it, avoids all social situations in which it may be seen by others, and feels others are judging her because of it. The disorder occurs equally in men and women.10SOMATOFORM DISORDER NOT OTHERWISE SPECIFIEDSomatoform disorder not otherwise specified is a psychiatric diagnosis used for conditions that do not meet the full criteria for the other somatoform disorders, but have physical symptoms that are misinterpreted or exaggerated with resultant impairment. A variety of conditions come under this diagnosis, including pseudocyesis, the mistaken belief of being pregnant based on actual signs of pregnancy (e.g., expanding abdomen without eversion of the umbilicus, oligomenorrhea, amenorrhea, feeling fetal movement, nausea, breast changes, labor pains).TreatmentPatients who experience unexplained physical symptoms often strongly maintain the belief that their symptoms have a physical cause despite evidence to the contrary. These beliefs are based on false interpretation of symptoms.11Additionally, patients may minimize the involvement of psychiatric factors in the initiation, maintenance, or exacerbation of their physical symptoms.DISCUSSING THE DIAGNOSISThe initial steps in treating somatoform disorders are to consider and discuss the possibility of the disorder with the patient early in the work-up and, after ruling out organic pathology as the primary etiology for the symptoms, to confirm the psychiatric diagnosis. A psychiatric diagnosis should be made only when all criteria are met.Discussing the diagnosis requires forethought and practice.12The delivery of the diagnosis may be the most important treatment step. The physician must first build a therapeutic alliance with the patient. This can be partially achieved by acknowledging the patient's discomfort with his or her unexplained physical symptoms and maintaining a high degree of empathy toward the patient during all encounters.The physician should review with the patient the diagnostic criteria for the suspected somatoform disorder, explaining the disorder as for any medical condition, with information regarding etiology, epidemiology, and treatment. It should also be explained that the goal of treatment for somatoform disorders is management rather than cure.THERAPYOnce the diagnosis is made and the patient accepts the diagnosis and treatment goals, the physician may treat any psychiatric comorbidities. Psychiatric disorders rarely exist in isolation, and somatoform disorders are no exception. Clinically significant depressive disorder, anxiety disorder, personality disorder, and substance abuse disorder often coexist with somatoform disorders and should be treated concurrently using appropriate modalities.13Studies supporting the effectiveness of pharmacologic interventions targeting specific somatoform disorders are limited. Antidepressants are commonly used to treat depressive or anxiety disorders and may be part of the approach to treating the comorbidities of somatoform disorders. Antidepressants such as fluvoxamine (Luvox, brand not available) for treating body dysmorphic disorder, and St. John's wort for treating somatization and undifferentiated somatoform disorders have been proposed.14,15Cognitive behavior therapy has been found to be an effective treatment of somatoform disorders.16–21It focuses on cognitive distortions, unrealistic beliefs, worry, and behaviors that promulgate health anxiety and somatic symptoms. Benefits of cognitive behavior therapy include reduced frequency and intensity of symptoms and cost of care, and improved patient functioning.22REFERRALCollaboration with a mental health professional can be helpful in making the initial diagnosis of a somatoform disorder, confirming a comorbid diagnosis, and providing treatment.23The family physician is in the best position to make the initial diagnosis of somatoform disorder, being most knowledgeable of the specific presentation of general medical conditions; however, collaboration with a psychiatrist or other mental health professional may help with the subtleties between these disorders and their psychiatric comorbidities, the severity of disorders, and the time demands in caring for these patients. Results of a recent, small randomized controlled trial conducted in the Netherlands, which combined cognitive behavior therapy provided by general practitioners with psychiatric consultation, suggest improvements in symptom severity, social functioning, and health care use when multiple interventions are employed.24
The Tensor Fasciae Latae is a muscle, which helps in flexing and abducting the thigh. It becomes very vital for a runner due to this function. If the TFL is consciously kept flexible, it will help in keeping the body injury free as well as being fit. Activities like walking, bending and moving around can get affected if the muscles of the thighs and hip are injured. They will also affect exercise pattern. Tensor fasciae latae pain can be caused due to a tear or strain in the muscle. With proper directed exercise, the muscle can be healed and strengthened.What Are the Symptoms?The symptoms include:Pain in the outer hipReferred pain down the outer thighPain when lying on the affected hipWhen weight bearing on the affected side, the pain worsensThe trigger points for TFL myofascial can get misdiagnosed as trochanteric bursitis because they have very similar symptoms. In the beginning the treatment for either case should be to get the surrounding muscles in good condition and make corrections in existing imbalance in the muscles. If the case persists, it should be investigated for bursa involvement.What Causes Tensor Fasciae Latae Pain?Tensor fasciae latae and Iliotibial band muscle pain can be caused due to the following activities:Running, climbing, cycling, dancing, excessive walking when not in shape and playing court sports like basketball, volleyball and tennis.How to Relieve Tensor Fasciae Latae PainTherapiesWarm and Cold Therapy Gel:A pain relieving gel, which provides therapeutic warmth with burning, can be used. Or else a cooling gel, which reduces inflammation by cooling the area. The gel should be applied on the outside of thighs and knees. It will help in reducing the tensor fasciae latae pain as well as tightness.Hot and Cold Compress/Wrap:This kind of wraps can be used on thighs, knee, hip and back. It can be cooled in the freezer or heated in the microwave. It helps in reducing the pain and swelling in the injured muscle by cold therapy and chronic pain and swelling by warm therapy.Tensor Fasciae Latae Brace and Support:This brace is useful in providing compression and support to the TLF muscle. This type of support can be used in high thigh and groin injuries as well. The brace is held in place by wrapping around thigh and abdomen.Compression Leggings:Compression leggings are usually used for preventing injuries, however, they are excellent when used as support for injured muscle. They help in reducing swelling as well. Good compression leggings cover the thighs and end below the knee. Tight compression at lower end of limb and decreased compression at top is essential for reducing inflammation and circulation.Massage Tools for Self Treatment:A roller is an excellent massage tool, which can be used on upper and lower leg muscles. It is easy to use and helps in relieving tension and pain. It just needs to be rolled up and down the muscle and usually does not strain the hands and wrists.Stretching and Strengthening Exercise for Tensor Fasciae Latae PainSome exercises are described below which help in strengthening the muscles and dealing with the tensor fasciae latae pain.Outer Hip StretchStart by lying down on the back, and bend your right knee. Cross the bent leg over the left knee and pull with your left hand. Hold this position for 10 to 30 seconds. This exercise stretches the gluteus medius, gluteus minimus and tensor fascia latae muscles.Standing Outer Hip StretchStart by placing the leg to be stretched behind the other leg. Lean your body on the side, which is not going to be stretched. The hip to be stretched should be pushed out to the other side. Hold for 10 – 30 seconds. The muscles stretched in the exercise are TFL, Iliotibial band and Sartorius.Hip Abduction with BandThis exercise is done to strengthen the hip abductors present on the outside of the joint. To start wrap a resistance band around the ankle and other end to a doorway or chair leg. Stretch the leg outside, as far as possible and slowly come back to position. Muscles stretched in this exercise are TFL, Gluteus medius and gluteus minimus.TFL Trigger PointingA trained person should help you in this exercise. A massage ball is laid on the bad side, under the TFL and moved around. It helps in identifying the painful or sensitive spot. The pressure is maintained for 10 – 15 seconds till the tenderness decreases. It should be done twice in the beginning, and repeated every 2-3 hours.Squatting ExerciseSquats are helpful in strengthening the TFL muscle and also in increasing the hip rotation and flexion. To start stand with the feet at shoulder distance, keep the back straight and abdominal muscles pulled in. Bend your knees while pushing the butt out, till your thighs are parallel to the floor. Push upwards from the heels and stand straight. This can be done 5 to 10 times.Watch this video to learn how to stretch TFL (tensor fascia latae) the right way.
Pronator Teres SyndromePronator teres syndrome is an entrapment of the median nerve, where it passes between the two parts of the pronator teres muscle in the arm causing pain, numbness and tingling in the forearm and hand.Pronator teres syndrome symptomsSymptoms of pronator teres syndrome can be very similar tocarpal tunnel syndromeand include tingling or numbness in the palm, thumb and three fingers but not the little pinky finger.There will be an aching sensation in the forearm and tenderness when feeling or pressing in on the pronator teres muscle in the arm. Strength will be decreased in the thumb and first three fingers as well as when turning the foream in and bending the wrist.Pronator teres syndrome explainedSpecific tests a doctor or therapist would do to help diagnosis pronator teres syndrome would be to try and resist pronation of the forearm and flexion or bending of the wrist. If pain is reproduced then this may indicate pronator teres syndrome.It is important to distinguish between pronator teres syndrome and carpal tunnel syndrome. With carpal tunnel syndrome there will be no weakness or pain with turning the palm down (pronation) and the Pronator Teres muscle is not tender to touch. Cases of carpal tunnel syndrome also do not cause neural symptoms such as numbness or tingling in the palm of the hand. In CTS this is isolated to the actual thumb and fingers.Pronator syndrome usually occurs after prolonged or repetitive forearm pronation (turning the palm of the hand to face downwards), accompanied by forced flexion of the fingers. In simple terms, forceful grasping with the hand and twisting at the wrist. These kind of movements are common in manual occupations such as carpentry and mechanics. In sports, racket sports, rowing and weight lifting are the most common culprits. The reasons this causes compression is due to an increase in muscle bulk of the pronator teres muscle.Pronator Teres Syndrome may also occur as a result of a trauma to the forearm, bony abnormalities, tumors or restrictive bands of fibrous tissue and scar tissue. Interestingly, it is four times more common in females than males!Pronator teres syndrome treatmentRest from activities which may be contributing to the condition.Apply iceto ease pain and swelling. Cold therapy or ice can be applied for 10 to 15 minutes every hour initially reducing to 3 or 4 times a day as required.A doctor may prescribe pain killers or anti-inflammatory medications such asibuprofen. A sports injury specialist may use electrotherapy treatments such asultrasoundorlaser. Sports massage may be helpful to reduce muscular tension.Pronator muscle stretches may be helpful.Acupuncturemay be effective in releasing muscular tension. A nerve block orcorticosteroid injectionmay be used if symptoms do not improve. Surgery is very occasionally used to release tight or abnormal structures.
Buttock Groin & HipGroin Strain- A groin strain is a tear of one of the adductor muscles on the inner thigh. A sudden sharp pain in the groin will be felt and depending on how severe the injury is there may be rapid swelling with bruising developing over time.Groin Inflammation- Groin inflammation feels a lot like a groin strain but develops gradually with no sudden onset of pain. It is caused by repeated overuse. Symptoms include pain in the groin at the top of the adductor muscles that can radiate down the leg.Gilmore's Groin- Gilmore's groin is a condition where the groin muscles and lower abdominal muscles are damaged. It is common in football players and may cause a vague persistent pain in the groin made worse by exercise.Inguinal hernia- An inguinal hernia is found in the lower abdomen just above the groin. Symptoms of pain in the groin during exercise which increases when coughing. A bulge in the groin may be seen which disappears when lying down.Perthes' Disease- Perthe's disease is a condition causing hip pain in children. There is a disruption of the blood flow to the head of the femur (thigh bone) in the hip. Tiredness, joint stiffness, pain in the groin and sometimes in the knee are also symptoms.Hip Bursitis- Hip bursitis or Trochanteric bursitis symptoms are pain on the outside of the hip that is worse during activity. Hip pain will gradually get worse and the area on the outside of the hip is tender when pressing in.Hip Pointer- A hip injury caused by an impact to either the iliac crest at the front of the hip or the greater trochanter of the femur, on the side. Symptoms include pain in the hip with tenderness at the point of injury, swelling and bruising.Piriformis Syndrome- Piriformis syndrome causes buttock pain that radiates down the leg. Usually happens gradually as the piriformis muscle tightens although symptoms of shooting pain into the leg will occur suddenly.Snapping Hip- A hip pain cause often seen in dancers where a snapping noise is heard or felt on the outer hip. Pain is not always present but can be felt at the front of the hip or side of the hip depending on which type of snapping hip is involved.Synovitis of the Hip- Hip synovitis in sportsmen and women rarely occurs on its own but in conjunction with another hip problem. It is a cause of hip joint pain in children. Symptoms include pain in the hip joint during activity, at rest and at night.Iliopsoas Inflammation- The iliopsoas muscle is a strong muscle that lifts the knee up. The muscle or tendon can become inflamed causing pain in the groin. There may be a sensation of tightness and swelling in the groin, especially if the bursa is involved.Labral Tear of the Hip Joint- The labrum is a ring of cartilage which surrounds the socket of the hip joint. This can an acute sudden onset cause of hip pain, or occur gradually over time. Clicking or locking of the joint, restricted movement and stiffness are symptoms.Osteoarthritis in the Hip- Osteoarthritis is a degenerative condition caused by wear and tear in the hip joint. It develops gradually, causing an aching hip pain with stiffness and reduced range of motion. The condition gets progressively worse until hip joint pain is constant.Myofascial Pain in Buttock Muscles- Myofascial pain or trigger points in the Gluteus medius and Piriformis muscles can cause pain in the buttock area. A trigger point is a tiny localized knot in the muscle.Scrotal Contusion- Scrotal contusion is bruising in the scrotum or testicles following a direct impact to the area from a ball or opponent. There may be groin pain with swelling in the testicles along with bruising, nausea or feeling of sickness.Femoral Hernia- A femoral hernia is found in the lower abdomen just above the groin. A lump may be felt in the groin area. Groin pain when exercising can be felt although not so much when coughing and sneezing such as in a inguinal hernia.Spermatic Cord Torsion- Spermatic cord torsion is the twisting of the testicle resulting in a reduced blood flow through the tissues which connects it to the abdomen.Bruised Buttocks- Bruised buttocks or a contusion of the buttocks is bleeding in the muscles caused by a direct impact to the area. The muscle is crushed against the bone causing reduced range of motion, swelling and sometimes bruising.Pelvic Fracture- A pelvic fracture is a break of any part of the pelvis. Symptoms will vary greatly depending on the severity or type of fracture and can range from mild pain of an avulsion fracture to severe hip and groin pain with numbness from nerve injury.Pelvic Stress Fracture- This is a hairline fracture of the pelvis, usually resulting from overuse. Symptoms include tenderness over the bone at the bottom of the pelvis. Pain in the groin or hip is felt that increases with exercise but eases or gets better with rest.Hip Dislocation- A dislocated hip occurs when the ball shaped head of the femur (thigh bone) moves out of its socket on the pelvis. Usually from a traumatic force to the thigh bone resulting in a severe hip injury requiring immediate medical attention.Slipped Capital Femoral Epiphysis- This injury occurs when there is a fracture at the neck or top of the thigh bone. It is more common cause of hip joint pain in boys aged 11 to 16 years old and occurs gradually over a period of time though over use.Hip Tendonitis- Hip tendonitis is inflammation of any one of a number of tendons in the hip although degeneration of the tendon is probably a more accurate description. Pain develops gradually over time with tenderness at a specific point.Ilium Apophysitis- Ilium apopysitis is an overuse injury that occurs in children and adolescents causing a dull pain at the front of the hip. It usually gets worse with activity and there may be some mild swelling.Iliopsoas Bursitis- Iliopsoas bursitis symptoms include pain at the front of the hip that may radiate down to the knee or even into the buttocks. There will be tenderness at the front of the hips and possibly in the front of the quadriceps muscles.Hip Flexor Strain- A hip flexor strain is a tear of one of the two muscles at the front of the hip that lift the leg upwards. Sudden onset pain at the front of the hip or in the groin may be felt. Swelling and bruising may occur in more serious cases.Hip Sprain- A hip sprain is an injury to the ligaments surrounding the hip joint. It is a rare cause of hip pain as the joint is very stable. Symptoms include a sudden onset of pain following a sudden movement, usually located at the front of the hip.Pelvic Avulsion Fracture- A pelvis avulsion fracture is where the tendon comes away from the bone often taking a piece of bone with it. This most commonly occurs at the ischial tuberosity causing buttock pain, local swelling and tenderness at a specific point.Rectus Femoris Avulsion Fracture- The Rectus Femoris muscle attaches to the hip bone at the front. An avulsion fracture occurs when a strong contraction pulls the tendon and a section of boneIschiogluteal Bursitis- Ischiogluteal bursitis is inflammation of the bursa at the top of the hamstring muscles. Buttock pain may gradually come on following a sprinting training session, be tender to touch and is aggravated by sitting.Osteitis Pubis- Osteitis pubis, also known now as pubic bone Stress injury results in groin pain originating from the pubic bones at the front of the pelvis.
Shin pain symptoms can often be very similar for a number of different causes. Our quick guide below outlines in simple terms the more common symptoms:Is it medial tibial stress syndrome?Pain is felt along the inside and back of the shin bone but it can vary in intensity.Pain decreases when warmed up but is worse during impact such as jumping or running.Pain is often worse in the morning and after exercise.Athletes may have flat feet or over pronating feet.Tender when pressing in along the inside of the shin bone.Is it a stress fracture?Pain is acute or sharp and along the inside of the shin bone.Pain stays the same or gets worse with exercise.Tender when pressing in along the inside of the shin bone.Is it chronic compartment syndrome?No pain at rest.Aching type pain gradually gets worse with exercise.Pain comes on at a specific point into a run and is relieved with rest.Little or no tenderness at rest, unless it affects the large muscle on the outside of the shin.Is it popliteal artery entrapment?Pain mostly in the calf muscles at the back of the shin bone.Pain gets worse with exercise, especially going up on your toes or jumping.Pulse is diminished when plantar flexing the foot (pointing the foot downwards).Assessing shin painAssessment of any injury should include questions concerning the patients general health, previous injuries and current injury. The aim of these questions is to determine what may be causing the pain and what treatment is appropriate ifshin splintsis this diagnosis. The therapist will then physically assess the ankle and lower leg using a variety of methods, including:Observation- The therapist may look at the lower leg, paying particular attention to the position and movement of the foot. Having fallen arches,overpronatingoroversupinatingare common contributors to developing shin splints.Palpation- The therapist will palpate, or feel, the muscles of the shin. In cases of shin splints the muscle just to the inside of the shin bone (tibia) will be tender to touch. The therapist may also feel that this area feels quite lumpy.Ankle range of motion- The therapist will look at the range of motion at the ankle joint. They will usually get the patient to move the ankle through all of its movements by themselves before asking the patient to relax, allowing the therapist to move the ankle. In shin splints, there may be pain when the therapist pushes the foot down (stretching the shin muscles) and when the patient actively points the toes up. Dorsiflexion (pointing the toes to the ceiling) will often be limited, indicating tight calf muscles.The therapist should also look at the position of your feet, looking for overpronation or oversupination. They may do this in standing, walking or even running. There are numerous other tests and assessments that the therapist may choose to perform, these are the most commonly used in cases of suspected shin splints.Other conditions which must be ruled out when assessing suspected shin splints includestress fracturesand anterior and posteriorcompartment syndromes.