Knee Pain

CHIDAMBARAM HOSPITAL
चिदंबरम अस्पताल,
ചിദംബരം ഹോസ്പിറ്റൽ
சிதம்பரம் மருத்துவமனை,
திசையன்விளை.627657

Knee pain facts

• Knee pain is a common problem with many causes, from acute injuries to complications of medical conditions.
• Knee pain can be localized to a specific area of the knee or be diffuse throughout the knee.
• Knee pain is often accompanied by physical restriction.
• A thorough physical examination will usually establish the diagnosis of knee pain.
• The treatment of knee pain depends on the underlying cause.
• The prognosis of knee pain is usually good although it might require surgery or other interventions.

What is knee pain?

Knee pain is a common problem that can originate in any of the bony structures compromising the knee joint (femur, tibia, fibula), the kneecap (patella), or the ligaments and cartilage (meniscus) of the knee. Knee pain can affect people of all ages, and home remedies can be helpful unless it becomes severe

What are knee pain symptoms and signs?

The location of the knee pain can vary depending on which structure is involved. With infection or an inflammatory process, the whole knee might be swollen and painful, while a torn meniscus or fracture of a bone gives symptoms only in one specific location.
The severity of the pain can vary, from a minor ache to a severe and disabling pain.
Some of the other findings that accompany knee pain are

• difficulty walking due to instability of the knee,
• limping due to discomfort,
• difficulty walking up or down steps due to ligament damage,
• locking of the knee (unable to bend the knee),
• redness and swelling,
• inability to extend the knee.

·         What causes knee pain

Knee pain can be divided into three major categories:

• Acute injury: such as a broken bone, torn ligament, or meniscal tear
• Medical conditions: arthritis, infections
• Chronic use/overuse conditions: osteoarthritis, patellar syndromes, tendinitis, and bursitis

Below is a list of some of the more frequent causes of knee pain. This is not an all-inclusive list but rather highlights a few causes of knee pain in each of the above categories,

Acute injuries

Fractures: Direct trauma to the bony structure can cause one of the bones in the knee to break. This is usually a very obvious and painful injury. Most knee fractures are not only painful but will also interfere with the proper functioning of the knee (such as kneecap fracture) or make it very painful to bear weight (such as tibial plateau fracture). All fractures need immediate medical attention.
Ligament injuries: The most common injury is the ACL (anterior cruciate ligament) injury. This is often a sports-related injury due to a sudden stop and change in directions.
Meniscus injuries: The menisci (medial and lateral) are made of cartilage and act as shock absorbers between bones in the knee. Twisting the knee can injure the meniscus.
Dislocation: The knee joint can be dislocated, which is a medical emergency that requires immediate attention. Knee dislocation can compromise blood flow to the leg and have other related problems. This injury often occurs during a motor-vehicle accident when the knee hits the dashboard.

What causes knee pain? (Continued)

Medical conditions

Rheumatoid arthritis is an autoimmune condition that can affect any joint in the body. It can cause severe pain and disability, as well as swelling.
Gout is a form of arthritis that is most commonly found in the big toe, though it can also affect the knee.
With septic arthritis (infectious arthritis), the knee joint can become infected; this leads to pain, swelling, and fever. This condition requires antibiotics and drainage treatments as soon as possible.
Patellar tendinitis is an inflammation of the tendons connecting the kneecap (patella) to the bone of the lower leg. Patellar tendinitis is a chronic condition often found in individuals repeating the same motion (such as runners and cyclists).
Osteoarthritis: A wearing down of cartilage of the joint due to use and age

Other causes

Children can develop inflammation of the point of bony insertion of the patellar tendon (Osgood-Schlatter disease).

What are risk factors for knee pain?

Biomechanics: The knee joint is complicated in its operation and is used frequently throughout the day. Any change in the movement of the joint (leg-length difference, change in walking style due to back problems) can cause subtle changes and cause pain and injuries.
Excess weight: The stress on the knee joint is increased with excess weight. Obesity also increases the risk of osteoarthritis as the cartilage breaks down more rapidly.
Overuse during repetitive motions as are found during certain exercises (jogging, skiing) or work conditions (long periods of kneeling) can cause breakdown of cartilage and lead to pain.

When should people with knee pain call a health-care professional?

Any pain that does not respond to rest or disappears within a few days should be evaluated by a doctor. In addition, the following are symptoms and signs in the knee that a doctor should evaluate:

• Swelling
• Inability to bend
• Deformity
• Unable to walk or discomfort while walking
• Significant pain

What are some of the complications of knee pain?

Frequently, knee pain will disappear without ever finding a specific cause. Depending on the underlying cause of the pain, the condition can progress and lead to more serious injuries or complications. Usually, these complications are long term and result in worsening pain or an increasing difficulty to walk.

How do physicians diagnose knee pain?

A health-care professional will begin by asking questions related to the person's general health and then specifically to the nature of the knee pain (how long, how severe, does anything make it feel better or worse, etc.).
Next, an examination of the knee will be performed. This will include bending the knee through the full range of motion, checking for stability of the ligaments, and evaluating for any tenderness and swelling. It is often helpful to compare the results of the examination of the painful knee with the other knee. Frequently, this is all that is required to make a diagnosis and start treatment. In several research studies, it has been found that an experienced examiner is as reliable as X-ray examination.
Sometimes the doctor might want to do further studies such as the following tests.

Radiologic tests

Plain X-ray can establish fractures and degenerative changes of the knee. MRI is used to evaluate the soft tissues of the knee for ligament tears or cartilage and muscle injuries.

Blood tests

If gout, arthritis, or other medical conditions are suspected, a health-care professional might order blood tests.

Removal of joint fluid (arthrocentesis)

Some conditions are best diagnosed by removal of a small amount of fluid from the knee joint. During arthrocentesis, a small needle is placed into your joint and fluid is withdrawn. This is done in a sterile method. The fluid is then sent to the laboratory for evaluation. This procedure is especially helpful if an infected knee joint is suspected or to distinguish gout and different forms of arthritis.

What kind of doctors treat knee pain?

Often knee pain can be evaluated and treated by your primary-care doctor. If the knee pain requires surgery or the cause of the pain needs further evaluation, an orthopedic surgeon will usually be consulted. With arthritis, gout, or inflammatory joint problems a rheumatologist may be consulted.

What is the treatment for knee pain?

Treatments for knee pain are as varied as the conditions that can cause the pain.

Medications

Medications might be prescribed to treat an underlying medical condition or for pain relief.

Physical therapy

Sometimes strengthening the muscles around the knee will make it more stable and help guarantee the best mechanical movements. This can help avoid injuries or further worsening of an injury.

Injections

Injecting medications directly into your knee might help in certain situations. The two most common injections are corticosteroids and lubricants. Corticosteroid injections can help arthritis and other inflammations of the knee. They usually need to be repeated every few months. Lubricants that are similar to the fluid already in your knee joint can help with movement and pain.

What is the treatment for knee pain? (Continued)

Surgery

Knee operations range from arthroscopic knee surgery to total knee replacement. Arthroscopic knee surgery is a very common surgical procedure that allows the physician look inside your knee through a few small holes and a fiberoptic camera. The surgeon can repair many of the injuries and remove small pieces of loose bones or cartilage. This is a common outpatient procedure.
Partial knee replacement: The surgeon replaces the damaged portions of the knee with plastic and metal parts. Because only part of the knee joint is replaced, this procedure has a shorter recovery then a total knee replacement.
Total knee replacement: In this procedure, the knee is replaced with an artificial joint.

Other therapies

Acupuncture has shown some relieve of knee pain, especially in patients with osteoarthritis. Glucosamine and chondroitin supplements have shown mixed results in research studies.

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Knee Pain

 

Quick GuideOsteoarthritis Pictures Slideshow: Exercises for OA of the Knee

Are there any home remedies for relief of knee pain?

Over-the-counter pain medications can frequently alleviate the pain. If someone is taking these medications on a regular basis, he or she should see a health-care professional to evaluate the knee pain for proper diagnosis and to avoid the potential side effects of chronic medication use.
The RICE mnemonic is often helpful, especially for minor injuries:
Rest: Rest the joint, and take a break from your usually activities involving the knee joint.
Ice: Applying ice can help with pain and inflammation.
Compress: A compression bandage can help prevent swelling and help knee alignment. It should not be tight and should be removed at night.
Elevate: Elevation can help with swelling and resting of the knee.

Is it possible to prevent knee pain?

There can be many reasons for knee pain. Therefore, there are different strategies to prevent the pain depending on the underlying cause. Running on soft surfaces or decreasing the amount of running can help if the pain is due to overuse. Avoiding any direct injuries to the knee including wearing a seatbelt can prevent traumatic injuries. Weight loss can be helpful for many different forms of knee pain.

What is the prognosis of knee pain?

Frequently, knee pain will occur for a short period of time and then resolve. Sometimes it can return a few weeks or months later. If your knee pain becomes chronic, it is important to get it evaluated to avoid further damage to cartilage, bones, or ligaments. Prognosis depends on the underlying causes of the pain.

With modern surgical techniques, it's possible to relieve many of the knee pain syndromes and return to an active lifestyle.

 

CHIDAMBARAM HOSPITAL
चिदंबरम अस्पताल,
ചിദംബരം ഹോസ്പിറ്റൽ
சிதம்பரம் மருத்துவமனை,
திசையன்விளை.627657

- தீவிர சிகிச்சை மருத்தவம்
- பொது மருத்துவரம்
- பொது அறுவை சிகிச்சை
- குழந்தை அறுவை சிகிச்சை
- குழந்தை லேப்ராஸ்கோப்பி அறுவை சிகிச்சை
- Cesarean section
- Dilation and Curettage
- Vulvectomy
- Tubal Ligation
- Trachelectomy
- Selective Salpingography
- Myomectomy
- Hysterosalpingography
-Endometrial or Uterine Biopsy
- Colporrhaphy
-Vaginal hystectomy
- Appendicitis
- Lymphangioma
- Cleft lip and palate
- Esophageal atresia and tracheoesophageal fistula
- Hypertrophic pyloric stenosis
- Intestinal atresia
- Necrotizing enterocolitis
- Imperforate anus
- Undescended testes
- Omphalocele
- Gastroschisis
- Hernias
- Teratomas
- Amputation
- Appendectomy
- Cholecystectomy
- Colectomy
- Cystoscopy
- Hemorrhoidectomy
- Hysterectomy
- Hysteroscopy
- Inguinal Hernia
- Laparoscopy
- Mastectomy
- Thyroidectomy
- Tracheostomy
- Tonsillectomy and Adenoidectomy
- Umbilical Hernia
- லேப்ராஸ்கோப்பி அறுவை சிகிச்சை
- மகப்பேறு மருத்துவம்
- தாய்மை மருத்துவம்
- மகளிர் நோய் இயல்
- சர்க்கரை வியாதி மருத்தவம்
- X - ரே (X-Ray)
- ஈசிஜி (ECG)
- இரத்த ஆய்வு (Blood Investigation LAB)
- அல்ட்ராசவுண்ட் ஸ்கேன்
(ULTRASOUNDSCAN)
- பிசியோதெரபி பயிற்சி (PHYSIOTHERAPY)
- முக வாதம் தூண்டுதல் பயிற்சி (BELLS PALSY STIMULATION)
- துரக்கம்-முதுகு வலி நிவாரணத் பயிற்சி(TRACTION)
- மெழுகு ஓத்தLம் (WAX BATH)
- அகச்சிவப்பு கதிர் வலி நிவாரணத் ஓத்தLம்(INFRA RED Hot Fermentation)


Dr.M.I. கிறிஸ்டோபர் சாமுவேல் MBBS,MS.,FIAGES.,லேப்ராஸ்கோப்பி அறுவை சிகிச்சை நிபுணர்.,
DR.அலெக்ஸ் J கிறிஸ்டோபர் MBBS,MS,MCH.,(PAEDIATRIC SURGEON),லேப்ராஸ்கோப்பி அறுவை சிகிச்சை நிபுணர்.,
DR.அருண் G கிறிஸ்டோபர் MBBS,MD(Anaesthesia)மயக்க மருந்து நிபுணர்,Pain Management., Dip.Diab., சர்க்கரை வியாதி மருத்துவர்.,
PT.அந்தோணி றீகன் B.P.T
(பிசியோதெரபி நிபுணர்)MCSE,COPA,D.Pharm., 

Migraine-Headache

 

CHIDAMBARAM HOSPITAL
चिदंबरम अस्पताल,
ചിദംബരം ഹോസ്പിറ്റൽ
சிதம்பரம் மருத்துவமனை,
திசையன்விளை.627657

 

Migraine

Definition

A migraine headache can cause intense throbbing or a pulsing sensation in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound.
Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down.
Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots, or tingling in your arm or leg.
Medications can help reduce the frequency and severity of migraines. If treatment hasn't worked for you in the past, talk to your doctor about trying a different migraine headache medication. The right medicines, combined with self-help remedies and lifestyle changes, may make a big difference.

Symptoms

Migraine headaches often begin in childhood, adolescence or early adulthood. Migraines may progress through four stages, including prodrome, aura, headache and postdrome, though you may not experience all the stages.

Prodrome

One or two days before a migraine, you may notice subtle changes that signify an oncoming migraine, including:

• Constipation
• Depression
• Food cravings
• Hyperactivity
• Irritability
• Neck stiffness
• Uncontrollable yawning

Aura

Aura may occur before or during migraine headaches. Auras are nervous system symptoms that are usually visual disturbances, such as flashes of light. Sometimes auras can also be touching sensations (sensory), movement (motor) or speech (verbal) disturbances. Most people experience migraine headaches without aura. Each of these symptoms usually begins gradually, builds up over several minutes, and then commonly lasts for 20 to 60 minutes. Examples of aura include:

• Visual phenomena, such as seeing various shapes, bright spots or flashes of light
• Vision loss
• Pins and needles sensations in an arm or leg
• Speech or language problems (aphasia)

Less commonly, an aura may be associated with limb weakness (hemiplegic migraine).

Attack

When untreated, a migraine usually lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or much less often. During a migraine, you may experience the following symptoms:

• Pain on one side or both sides of your head
• Pain that has a pulsating, throbbing quality
• Sensitivity to light, sounds and sometimes smells
• Nausea and vomiting
• Blurred vision
• Lightheadedness, sometimes followed by fainting

Postdrome

The final phase, known as postdrome, occurs after a migraine attack. During this time you may feel drained and washed out, though some people report feeling mildly euphoric.

When to see a doctor

Migraine headaches are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.
Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.
See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems:

• An abrupt, severe headache like a thunderclap
• Headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
• Headache after a head injury, especially if the headache gets worse
• A chronic headache that is worse after coughing, exertion, straining or a sudden movement
• New headache pain if you're older than 50
  

Causes

Although much about the cause of migraines isn't understood, genetics and environmental factors appear to play a role.
Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway.
Imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system — also may be involved. Researchers continue to study the role of serotonin in migraines.
Serotonin levels drop during migraine attacks. This may cause your trigeminal system to release substances called neuropeptides, which travel to your brain's outer covering (meninges). The result is headache pain.

Migraine headache triggers

Whatever the exact mechanism of the headaches, a number of things may trigger them. Common migraine triggers include:

• Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen.
  
  Others have an increased tendency to develop migraines during pregnancy or menopause.
  
  Hormonal medications, such as oral contraceptives and hormone replacement therapy, also may worsen migraines. Some women, however, may find their migraines occur less often when taking these medications.
• Foods. Aged cheeses, salty foods and processed foods may trigger migraines. Skipping meals or fasting also can trigger attacks.
• Food additives. The sweetener aspartame and the preservative monosodium glutamate, found in many foods, may trigger migraines.
• Drinks. Alcohol, especially wine, and highly caffeinated beverages may trigger migraines.
• Stress. Stress at work or home can cause migraines.
• Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Unusual smells — including perfume, paint thinner, secondhand smoke and others — can trigger migraines in some people.
• Changes in wake-sleep pattern. Missing sleep or getting too much sleep may trigger migraines in some people, as can jet lag.
• Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
• Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
• Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.

 

Risk factors

Several factors make you more prone to having migraines.

• Family history. Up to 90 percent of people with migraines have a family history of migraine attacks. If one or both of your parents have migraines, then you have a good chance of having migraines too.
• Age. Migraines can begin at any age, though most people experience their first migraine during adolescence. By age 40, most people who have migraines have had their first attack.
• Sex. Women are three times more likely to have migraines. Headaches tend to affect boys more than girls during childhood, but by the time of puberty and beyond, more girls are affected.
• Hormonal changes. If you're a woman who has migraines, you may find that your headaches begin just before or shortly after onset of menstruation.
  
  They may also change during pregnancy or menopause. Generally migraines improve after menopause.
  
  Some women report that migraine attacks begin during pregnancy, or the attacks may get worse. However, for many, the attacks improved or didn't occur during later stages in the pregnancy.

 

Complications

Sometimes your efforts to control your pain cause problems.

• Abdominal problems. Certain pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others), may cause abdominal pain, bleeding, ulcers and other complications, especially if taken in large doses or for a long period of time.
• Medication-overuse headaches. If you take over-the-counter or prescription headache medications more than 10 days a month for three months, or in high doses, you may be setting yourself up for a serious complication known as medication-overuse headaches.
  
  Medication-overuse headaches occur when medications not only stop relieving pain but also cause headaches. You then use more pain medication, which continues the cycle.
• Serotonin syndrome. Serotonin syndrome is a rare, potentially life-threatening condition that occurs when your body has too much serotonin, which is a chemical found in your nervous system. It may occur if you take migraine medications called triptans and antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs).
  
  These medications naturally raise serotonin levels. When combined, they cause increased serotonin levels in your system, more than if you were taking one of these medications.
  
  Triptans include medications such as sumatriptan (Imitrex) or zolmitriptan (Zomig). Some common SSRIs include sertraline (Zoloft), fluoxetine (Sarafem, Prozac) and paroxetine (Paxil). SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor XR).

Also, some people experience complications from migraines such as:

• Chronic migraine. If your migraine lasted for 15 or more days a month for more than three months, you had a chronic migraine.
• Status migrainosus. People with this complication have migraine attacks that last for more than three days.
• Persistent aura without infarction. Usually an aura goes away after the migraine attack. However, some people have an aura that lasts for more than one week after a migraine attack has finished. A prolonged aura may have similar symptoms to bleeding in the brain (stroke). In this condition, though, you have a prolonged aura without signs of bleeding in the brain or other problems.
• Migrainous infarction. Some people who have a migraine with aura may have aura symptoms that last longer than one hour. This can be a sign of bleeding in the brain (stroke). If you have a migraine with aura, and your aura symptoms last longer than one hour, you should have it evaluated. Doctors can conduct neuroimaging tests to determine if you have bleeding in the brain

 

Lifestyle and home remedies

Self-care measures can help ease the pain of a migraine headache.

• Try muscle relaxation exercises. Relaxation may help ease the pain of a migraine headache.
  
  Relaxation techniques may include progressive muscle relaxation, meditation or yoga.
• Get enough sleep, but don't oversleep. Get an adequate amount of sleep each night. It's best to go to bed and wake up at regular times, as well.
• Rest and relax. If possible, rest in a dark, quiet room when you feel a headache coming on. Place an ice pack wrapped in a cloth on the back of your neck and apply gentle pressure to painful areas on your scalp.
• Keep a headache diary. Continue keeping your headache diary even after you see your doctor. It will help you learn more about what triggers your migraines and what treatment is most effective.

 

 

CHIDAMBARAM HOSPITAL
चिदंबरम अस्पताल,
ചിദംബരം ഹോസ്പിറ്റൽ
சிதம்பரம் மருத்துவமனை,
திசையன்விளை.627657

- தீவிர சிகிச்சை மருத்தவம்
- பொது மருத்துவரம்
- பொது அறுவை சிகிச்சை
- குழந்தை அறுவை சிகிச்சை
- குழந்தை லேப்ராஸ்கோப்பி அறுவை சிகிச்சை
- Cesarean section
- Dilation and Curettage
- Vulvectomy
- Tubal Ligation
- Trachelectomy
- Selective Salpingography
- Myomectomy
- Hysterosalpingography
-Endometrial or Uterine Biopsy
- Colporrhaphy
-Vaginal hystectomy
- Appendicitis
- Lymphangioma
- Cleft lip and palate
- Esophageal atresia and tracheoesophageal fistula
- Hypertrophic pyloric stenosis
- Intestinal atresia
- Necrotizing enterocolitis
- Imperforate anus
- Undescended testes
- Omphalocele
- Gastroschisis
- Hernias
- Teratomas
- Amputation
- Appendectomy
- Cholecystectomy
- Colectomy
- Cystoscopy
- Hemorrhoidectomy
- Hysterectomy
- Hysteroscopy
- Inguinal Hernia
- Laparoscopy
- Mastectomy
- Thyroidectomy
- Tracheostomy
- Tonsillectomy and Adenoidectomy
- Umbilical Hernia
- லேப்ராஸ்கோப்பி அறுவை சிகிச்சை
- மகப்பேறு மருத்துவம்
- தாய்மை மருத்துவம்
- மகளிர் நோய் இயல்
- சர்க்கரை வியாதி மருத்தவம்
- X - ரே (X-Ray)
- ஈசிஜி (ECG)
- இரத்த ஆய்வு (Blood Investigation LAB)
- அல்ட்ராசவுண்ட் ஸ்கேன்
(ULTRASOUNDSCAN)
- பிசியோதெரபி பயிற்சி (PHYSIOTHERAPY)
- முக வாதம் தூண்டுதல் பயிற்சி (BELLS PALSY STIMULATION)
- துரக்கம்-முதுகு வலி நிவாரணத் பயிற்சி(TRACTION)
- மெழுகு ஓத்தLம் (WAX BATH)
- அகச்சிவப்பு கதிர் வலி நிவாரணத் ஓத்தLம்(INFRA RED Hot Fermentation)


Dr.M.I. கிறிஸ்டோபர் சாமுவேல் MBBS,MS.,FIAGES.,லேப்ராஸ்கோப்பி அறுவை சிகிச்சை நிபுணர்.,
DR.அலெக்ஸ் J கிறிஸ்டோபர் MBBS,MS,MCH.,(PAEDIATRIC SURGEON),லேப்ராஸ்கோப்பி அறுவை சிகிச்சை நிபுணர்.,
DR.அருண் G கிறிஸ்டோபர் MBBS,MD(Anaesthesia)மயக்க மருந்து நிபுணர்,Pain Management., Dip.Diab., சர்க்கரை வியாதி மருத்துவர்.,
PT.அந்தோணி றீகன் B.P.T
(பிசியோதெரபி நிபுணர்)MCSE,COPA,D.Pharm.,