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 Tags >> Causes Of De Quervain's Tenosynovitis,  symptoms of De Quervain's Tenosynovitis,pain management in delhi, Pain Specialist In Delhi

What is De Quervain’s Tenosynovitis?

Tendons are like ropes which connect muscles to bones and are enclosed within a sheath (covering) that allows smooth movement. De Quervain’s Tenosynovitis is caused by painful irritation of the sheath of two tendons as they travel from the wrist towards the thumb. These tendons travel in close proximity to each other and are involved in thumb movements (such as bringing the thumb away from the hand as it lies flat in the plane of the palm). When their sheath becomes thickened or irritated, the tendons have less space for movement resulting in pain and other symptoms. Some experts attribute the degeneration of tendon and deposition of fibrous tissue as the cause for the condition.

What are the symptoms of De Quervain’s Tenosynovitis?

De Quervain’s tenosynovitis presents with

• Pain and swelling at the base of thumb, wrist
• Pain during thumb movements such as griping or pinching
• Sometimes a snapping/ sticking sensation may be felt  with thumb movement 

Image 1: Area of pain in De Quervain’s Tenosynovitis

What causes De Quervain’s Tenosynovitis?

This condition occurs most often between the ages of 30 -50 years. Quite often the cause is unknown although tendon sprain and overuse during repetitive movements can predispose to the development of this condition. Some of the risk factors include:

• Women, especially mothers with young infants are more likely to be affected due to a combination of overuse, hormonal changes and fluid retention. Improper lifting technique can specially predispose to the development of this condition and it is also addressed as Mothers Thumb.
• Professions or hobbies involving repetitive wrist or hand motions such as with musicians, dental hygienists, golfers, mountain bikers, typists, video game players. Other commonly used names used for the same condition include texting thumb, gamers’ thumb, washerwoman’s sprain and designer’s thumb.

How is De Quervain’s Tenosynovitis diagnosed?

A simple test used for diagnosis involves making a fist around the thumb placed in the palm on the affected side (Image 2). The patient is then asked to bend the wrist towards the little finger as shown in the image 3. If this makes your pain worse, then the test is considered positive

Image 2

Image 3

An ultrasound scan may help identify thickening of the tendons, increased fluid surrounding the tendons, increased blood flow, narrowing of the canal/ passage for tendons, anomalies in tendon slips and thus help confirm the diagnosis. MRI is useful for detecting mild disease where ultrasound in inconclusive. An x-ray of the wrist is sometimes requested to rule out other conditions with similar presentation.

How is De Quervain’s Tenosynovitis managed

The treatment option will vary depending on multiple factors such as the duration of symptoms, severity & impact on your daily activities, previous treatments and their results. It can be self-limited and may resolve without intervention. For most individuals non surgical treatment options suffice with very few requiring surgery. Treatment options include-

Rest. This includes avoidance of provoking activities and heavy work with the affected hand for several weeks. Rest provides an opportunity for the symptoms to settle. In mothers with young infants, changing the lifting technique and breast feeding position can make a difference.

Icing – Ice can help in reducing the pain and swelling.  Avoid applying the ice directly to the skin. Ice can be wrapped in a towel and used for a few minutes (as tolerated), a few times in a day.

Splinting – The splint may be required to be worn for a few weeks. It works by restricting the movement of thumb thereby providing an opportunity for healing to occur. The combined use of splints and steroid injections has been found to be more effective than splinting alone.

Medications – Pain killers can provide temporary relief and may include anti-inflammatory medications. It is important to use these medications as directed by your doctor.

Physiotherapy– This involves a combination of stretching and strengthening exercises to improve the hand function. Exercises are best learned under supervision of an experienced therapist. Once you have learned the correct technique, you can continue with these at home. Exercises have been shown to improve the duration of pain relief when used in combination with steroid injection and splinting.

Steroid injections In case the pain does not settle, then your doctor may consider injections. Steroids are effective anti-inflammatory medicines and are commonly used treatment modality with near complete relief with one or two injections.

Sometimes septae (partitions) may be present in the intended injection compartment. Using ultrasound can help not only in verifying the diagnosis but also in visualizing these septae and accurately guiding the injection into the tendon compartments. There are studies highlighting the role of ultrasound in increasing injection accuracy and citing success rates of 91% after up to two injections.

Surgery– if the problem persists despite the above treatments then surgery can be considered.

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• Pain Management

Headaches are a common health issue that affects people of all ages world over

 

Headaches are a common problem that affects people of all ages worldwide. There can be many reasons why people can develop headaches and these poor neck position while working or sleeping, stress, overwork, medical conditions such as degenerative disease of the spine, trauma, sinus problems, strokes, infections etc. Headaches which keep recurring are called recurrent headaches and those that tend to persist for a long period of time are called chronic headaches.

Headaches can hinder day to day activities and severely affect the quality of life especially in individuals who experience frequent severe headaches or long lasting / constant headaches . Recurrent headaches can be quite difficult to handle since they tend to develop suddenly, not giving you an opportunity to prepare for it and plan your day. There a variety of measures that you can take in order to reduce the impact and frequency of these headaches. Some of these are quite simple, but most people doubt the effectiveness and hence are hesitant to implement. These can work synergistically with the other management options suggested by your pain specialist. These include

General lifestyle modifications

• Regulating your sleep cycle: Having a regular sleep cycle goes a long way in helping to reduce these headaches. Good sleep environment plays an important role and includes a darkened bedroom, a quiet place where you are comfortable and it helps to unwind. Some find a relaxing hot bath helpful in unwinding prior to heading off to bed. It is advised to avoid watching TV, using laptops or mobiles before you go to bed.
• Hydration: Keep yourself well hydrated, because dehydration is a known trigger of headaches, and can worsen pre-existing headaches.
• Regular meals: Have you meals on time. This another important factor that plays a role in the development of headaches. Low blood sugar/ hypoglycemia can trigger headaches. If you are in the habit of skipping meals or eating late and heavy meals, then you should consider changing this.
• Avoiding triggers: Other trigger/ precipitating factors may vary from individual to individual. From particular foods to the brightness of TV screens to loud noises, certain smells etc there are numerous factors. You are the best person to identify these and avoid them as much as possible.
• Tea and coffee: Minimize your intake of coffee and tea, because they are known to precipitate headaches. Avoid taking them late in the evenings and just before going to bed.
• Quit smoking
• Stress management and relaxation: Learn how to manage your stress in a productive manner and practice relaxation techniques.

These general measures, when used in combination with advice from your pain specialist can help you control your headaches better. Some of the common medical interventions used in management of headaches include:

Medications:

Medications for headache can be used to terminate the headache at the time you are experiencing it or can be taken as a preventive measure to reduce your chances of developing a headache. Preventive medications are usually taken when people experience frequent or continuous headaches, and they should be taken as prescribed by your doctor. Too much of any medication can also end up being the cause of your headache as well, and is given the name Medication Overuse Headache. The different medicines used for recurrent headaches are:

• Antidepressants: These medications, besides the pain relieving effects can also have other beneficial effects like reducing anxiety and sleep disturbances. The drug selected will depend on your individual situation.
• Beta blockers: Beta blockers, commonly used in management of high blood pressure and heart problems. They are helpful in the management of migraine related headaches
• Anti-seizure medicines: Several anti-seizure medicines help in the prevention different types of recurrent/ chronic headaches including migraine.
• NSAIDs: Nonsteroidal anti-inflammatory drugs are commonly used over the counter medications for mild to moderate pain, and they are effective in various different types of headaches. On frequent usage they can have harmful side effects such as gastritis and peptic ulcer disease; therefore they must be used with caution and under medical supervision.

Other interventional methods:

When simple measures such as lifestyle modifications and oral medications are not successful in resolving the headaches, then it may be worth considering other interventional methods. The intervention used will depend on the diagnosis. The common interventions include:

• Nerve blocks
• Injections of the cervical spine
• Radiofrequency treatment
• Botulinum toxin injections

Complementary & Alternative therapies

These include:

• Acupuncture – which involves the insertion of thin needles at definitive points in your body, with the intention of providing pain relief
• Massage therapy – this can help to reduce the stress and tension. It helps to relax the tightened muscles and thereby provides relief.
• Meditation and relaxation therapy
• Herbs and nutrients – Several organic herbs help in preventing migraine headaches and reduce the intensity of headaches. In deficiency states vitamin and mineral supplements can be taken to reduce headaches and prevent them from reoccurring.

It is best to seek medical advice before you starting with any of the above methods.

Tags >> chronic headache pain, Headache Specialist In Delhi, Headache treatment in Delhi, Migraine, Pain Specialist In Delhi

Carpal Tunnel Syndrome (CTS) Treatment In Gurgaon

 

What is carpal tunnel syndrome?

Carpal tunnel syndrome or ‘median nerve compression’ is a painful condition that develops as a result of excess pressure on a nerve (median nerve) as it travels into the wrist through the narrow passageway.

Median nerve of arm carries sensation from thumb, index finger, middle finger and a part of the ring finger to the brain and controls the movement of some important hand muscle.  This nerve arises from the brachial plexus which is formed by the joining of many nerve roots exiting the spine in the neck region.  Median nerve runs down the forearm and passes through a narrow tunnel like passageway (carpal tunnel) on the palm side of the wrist. Your pain specialist can further explain the anatomical details to help you understand the condition better.

What causes carpal tunnel syndrome?

CTS may affect one or both hands. Those, who are involved in jobs requiring repetitive movement of the wrist such as construction workers, manufacturers etc. are more likely to be diagnosed with CTS. Women are three times more likely to have CTS and the prevalence, severity increases with age. Some studies have observed a peak incidence between the age of 45 and 59 years and a second peak between 75 and 84 years. In most cases it is difficult to pinpoint the cause as to why this condition develops although many predisposing factors have been identified and these include:

• Fluid retention from pregnancy especially in 3rd trimester
• Diabetes
• Thyroid dysfunction
• Obesity
• Autoimmune disorders such as rheumatoid arthritis
• Fractures or trauma to the wrist
• Repeated over extension of the wrist or movement such as typing, working on computers for more than 20 hours/ week
• Hereditary factors and conditions such as polyneuropathy (where multiple nerves are affected)

What are the symptoms of carpal tunnel syndrome?

In the early stage the symptoms may be intermittent and only at night.  As the condition advances these may become constant with development of wasting and weakness of hand muscles. The common symptoms include

• Numbness, burning, tingling, shock like sensation, pain in the ring, middle, index fingers and the thumb.
• Affected individuals often have disturbed sleep with urge to shake out their hand to obtain relief from symptoms.
• Provocation of symptoms by sustained hand or arm positions especially those involving arm elevation and wrist flexion as while holding a phone.  Provocation may also be more noticeable after repetitive actions of the hand or wrist.
• Clumsiness and weakness of hand with difficulty performing simple tasks like buttoning clothes & opening jars.
• Losing grip over things/ difficulty to hold objects firmly in hand due to weakness.
• Burning sensation/ pain may involve forearm, upper arm.

How is carpal tunnel syndrome diagnosed?

Your doctor will take a careful history and perform examination of your hand, arm, shoulders and neck. The sensation and movements of the hand may also be evaluated. The doctor may also hold, bend your wrist in a flexed position to check if this increases/ brings on your symptoms as this position further narrows the space for the nerve temporarily.

He/she may request for investigations such as electrodiagnostic studies (nerve conduction studies and electromyography) and ultrasound. Electrodiagnostic studies can help determine severity and prognosis. Plain X-ray may be useful if bone or joint disease/ structural abnormalities are suspected. Magnetic Resonance Imaging is useful in picking up rare pathological causes of CTS such as ganglion or bony deformity and these can have bearing on the surgical plan.

How is carpal tunnel syndrome treated?

Management of CTS depends on the severity of symptoms. In mild to moderate cases your doctor may recommend the conservative approach which should result in improvement in a few weeks time. This includes

Non-surgical methods

Splinting or bracing – Wearing a splint or brace will keep you from moving or bending the wrist while you rest. One study has shown that using a neutral wrist splint is twice as likely to give symptom relief compared to a splint in extension position. This modality, in combination with other treatment modalities, can be especially useful in pregnancy. However not everyone is able to get accustomed to the splint.

Physical therapy – There is some evidence that physical therapy techniques are effective CTS treatments. Multiple sessions from specialist physiotherapists and treatment modalities include carpal bone mobilization, therapeutic ultrasound and nerve glide exercises.

Oral medications – Oral steroids have shown to improve symptoms for limited time but are less effective than local injections with more side effects. Anti-inflammatory medications (NSAIDS) and diuretics have questionable benefits. Similarly  research studies show that vitamin B-6 supplementation has a negligible therapeutic effect.

Ultrasound-guided local injections

This involves injecting local anaesthetics and a small dose of steroid close to the problem site under ultrasound guidance. Ultrasound helps to ensure accuracy and minimises the risk of complications. One study has estimated the risk of serious complication with these injections as less than 0.1%.  There is evidence suggesting that the local injection is effective for more than one month in patients with mild to moderate carpal tunnel syndrome and delays the need for surgery at one year. Some studies have demonstrated improvement lasting 10 weeks to more than one year. This option can help manage the symptoms, avoiding the need for surgery. Certain cases may require a repeat injection for more effective symptom control. Wrist injections may help to relieve inflammation of the affected nerves and the fibrous sheath and fasten the healing process.

Surgical management

This option is suitable for patients with severe carpal tunnel syndrome or when symptoms have not improved after four to six months of conservative therapy. It is an effective option and can provide a lasting relief in 70 to 90 % of cases. The procedure involves release of pressure by placing a cut on the fibrous sheath, which will provide more space for the median nerve to pass through.

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Neck Pain Management In Gurgaon

Tags >> neck and shoulder pain treatment specialists in Gurgaon, Neck Pain, Neck Pain Management In Gurgaon , Pain Management in Gurgaon

Majority of us would experience neck pain at some point in our life. Neck Pain can disrupt daily routine activities. Muscle spasm, pain can make it difficult to turn head and activities such as driving become difficult. It is not uncommon for the neck pain to radiate to shoulders or lead to persistent headaches. Neck pain is more commonly observed in middle ages and may have a mechanical or postural basis. Most uncomplicated neck pain is associated with poor posture, anxiety and depression, neck strain, injuries. Fortunately majority of cases are not due to serious causes. If you are experiencing unresolving or severe pain, you should seek medical opinion from neck and shoulder pain treatment specialists in Delhi so that timely diagnosis can be done and corrective action can be taken.

Some common causes include –

• Muscle sprain, spasm/ increased tension
• Poor posture and work ergonomics
• Incorrect positioning of the neck while sleeping
• Aging: Degenerative disc disease and spinal osteoarthritis become more common as we age
• Injuries/ Whiplash: Whiplash neck involves sudden jolting of neck forwards and backwards and is commonly observed in vehicular accidents. This can cause excessive stretching of neck muscles, ligaments or other injuries which can be associated with neck pain.

Neck pain can be a part of more widespread medical issues such as in fibromyalgia, arthritis, ankylosing spondylitis, infections, cancer etc. You can approach Pain Management Specialists in Delhi for diagnosing your problem and suggesting suitable solutions

It is advisable to seek early medical attention if you experience any of the following

• Persisting symptoms or severe pain not responding to usual care or medications
• Pain starting after fall, injury
• New onset numbness, weakness or tingling in arms
• Gait or balance problems
• Loss or urine or stool control
• Signs of infection/ meningitis
• Pain worse at night time/interfering with your sleep

Some of the pain management techniques for neck pain include:

Lifestyle changes: Incorrect/ ignored posture while working on laptops mobiles etc can put excessive cervical spine strain leading to pain. Certain professions can be more prone to develop neck pain. Simple posture awareness and improvement, taking regular breaks can go a long way in reducing symptoms.

Medications: Anti-inflammatory drugs such as ibuprofen or naproxen and pain relievers like acetaminophen may initially be prescribed by your doctor. Sometimes medications like muscle relaxants or stronger painkillers may also be suggested by your doctor.

Physical Therapy: Regular exercise, good posture, stretching can help to reduce/ prevent to prevent unwanted stress and tension to your neck muscles. Heat or cold application may be used during the initial phases of injury to facilitate your recovery and physical exercise. Depending on the severity, time since injury and your recovery the specialist may recommend limiting normal physical activity or slow range-of-motion exercises or strengthening exercises.

There is research evidence supporting the use of specific strengthening exercises as part of a routine practice for chronic neck pain, cervicogenic headache and radiculopathy.

Ergonomics & Posture
Simple posture changes and better workplace ergonomics can help in preventing/reducing neck pain. Measures include adjustment of furniture height and computer position such that

• Eyes point directly at the top third of the screen
• Forearm is parallel to floor
• Feet should be flat on the floor with thighs parallel with the floor

While sitting in office chair it’s a good practice to have back aligned against the back of the office chair and avoid slouching. Avoid sitting in one place for too long. Taking regular breaks to walk around and stretch is a good practice.

Relaxation techniques: relationship between stress and increase pain is well known and easily appreciated by most patients. Measures to deal with stress and anxiety help in more effective pain management.

Massage Therapy: The evidence supporting the use of massage therapy is limited although some people do find it useful in the short term. Massage can help in relaxing, loosening of muscles but it is important to remember that wrongly done massage can lead to harm.

Acupuncture: Certain people find Acupuncture helpful in neck pain management. When performed correctly it is a low risk procedure. The traditional acupuncture is based on the theory of restoring the energy balance in body and removing any blockages to the flow of energy.

Injections/ other interventions such as Radiofrequency ablation: These would depend on the cause of neck pain and actual pathology. They have been explained in more detail in the neck & arm pain section under treatments, on my website- removemypain.com

Ignoring persisting symptoms can aggravate the situation leading to chronic pain with reduced functionality. So, if your pain persists and does not respond to usual lifestyle changes and painkillers then seek medical opinion on time.

Cancer Pain Treatment In Gurgaon

 Tag: Cancer Pain Treatment In gurgaon, Pain Clinic in Gurgaon, Pain Specialist in Gurgaon, Pain Management in Gurgaon

Pain in cancer may arise due to many reasons and is often the presenting complaint leading to the diagnosis of cancer. It may be

• Related to cancer itself or its spread to other body parts
• A late presentation due to side effect of treatments such as chemotherapy, radiotherapy, and surgery
• A result of extra stress placed on other body parts for example shoulder pain due to using of a stick for walking
• A totally unrelated coincidental problem such as arthritis

Pain can be differentiated into background pain (which is always present in the background and is managed with regular medications) and breakthrough pain (pain which breaks through your regular pain relief). Breakthrough pain may occur unprovoked or may be triggered by external or internal factors. In cancer patients, different types of pain may coexist. It is not just limited to pain arising from inflammation and tissue damage for example cancer of pancreas spreading to neighboring organs and nerves leading to visceral and neuropathic pain respectively and a distant spread to bones producing bone pain. Different types of pain present differently for example

• Neuropathic/ Nerve pain is generally described as burning, shooting, electric shock-like or stabbing pain with associated tingling or numbness. It may be a consequence of cancer itself or a result of treatments such as chemotherapy (chemotherapy-induced peripheral neuropathy- CIPN).
• Visceral Pain originates from viscera (organs in the body cavity) and is generally described as deep aching, squeezing and cramping sensation
• Bone pain presents as an aching, throbbing sensation. Some cancers have a preference to spread to bones

Pain Management

Pain relief needs to be tailored to the cause, severity, and duration of pain. In most cases, reasonable control can be achieved by using a combination of methods. Multimodal, Multidisciplinary approach provides the opportunity to maximize pain relief and provide support not only for the physical needs but also for the emotional, spiritual and social needs.  

Some of the management options available via a pain clinic are

Medications management

This involves using different classes of medications to optimize pain control. Using a combination of drugs helps to minimize side effects and maximize the benefits. Whilst considering the drug therapy many factors need to be considered like the type of pain, cause and severity of pain, other medical problems and medications being used, medications tried previously, pre-existing nausea/vomiting, constipation, ability to take and absorb medications, liver and kidney function, etc. Apart from the standard medications mentioned in other sections some other medications are used more often in cancer pain such as steroids, bisphosphonates (for bone pain).

Nerve blocks, Radiofrequency & Neurolytic procedures

Nerves are commonly targeted in pain-relieving interventions, for example, pudendal nerve for perineal or rectal pain, suprascapular nerve for shoulder pain, intercostal nerves for chest wall pain, etc. The pain impulses being transmitted via the nerves can be temporarily blocked using local anesthetics. The transmission of impulses can be reduced for longer duration using Neurolytic procedures, which involve the injection of alcohol or phenol instead of local anesthetic. Examples of neurolytic procedures include

• Coeliac plexus, splanchnic nerves neurolysis
• Hypogastric plexus neurolysis
• Lumbar sympathetic neurolysis

Radiofrequency procedures e.g.

suprascapular nerve pulsed radiofrequency for shoulder pain involves exposure to high-frequency electrical current in the RF range (≈ 500 kHz). This exposure can be continuously generating high temperatures or pulsed where the temperature is kept below 42 °C. Pulsed RF can be used to target most nerves including those with motor components. The resulting neural modification effect’s the transmission of pain impulses producing pain relief.

Spinal procedures e.g. epidural, intrathecal pumps

Certain procedures such as pumps to deliver medicines directly in the spine (intrathecal pumps) are performed more often for cancer pain.

Drug infusions

Psychology

Cancer is often accompanied by anxiety, depression, and fear of the worst. A psychologist can help in analyzing these thoughts rationally and developing a positive approach. They can help by teaching relaxation techniques, coping strategies and by reducing the effect of mood on pain.

Physiotherapy

Complementary and alternative therapies including Acupuncture, TENS, meditation, Ayurveda and wellness. For more information on how these can be helpful please follow the respective links