VERTIGO : Symptoms, Cause, Treatment and Prevention

VERTIGO

What is Vertigo ?

Vertigo  is a sensation of feeling off balance. you might feel like you are spinning or that the world around you is spinning.

Vertigo is the sense of the world spinning, rotating, or rocking that is experienced even when a person is holding perfectly still.

Some patients use term vertigo interchangeably with dizziness  to describe a variety of symptoms, ranging from balance disorders and difficulty with walking to motion  sickness  or lightheadness . However, most health care professionals consider vertigo to be a specific complaint that involves the balance centers of the inner ear and the brain.

To understand vertigo, it's helpful to understand the ANATOMY OF EAR.

Sound waves travel through the outer ear canal until they reach the eardrum. 
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From there, sound turns into vibrations, which transmits in the middle ear via three small bones -- the incus, the malleus, and the stapes -- to the cochlea 
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and finally to the vestibular nerve, which carries the signal to our brain that interprets those nerve impulses as sound.

The inner ear is not involved with hearing.

This system provides instantaneous feedback to the brain, along with vision and proprioception receptors in the body, regarding our position in space.

Symptoms of Vertigo

Vertigo is often triggered by a change in the position of your head.

People with vertigo typically describe it as feeling like they are:

• Spinning
• Tilting
• Swaying
• Unbalanced
• Pulled to one direction

Other symptoms that may accompany vertigo include:

• Feeling nauseated
• Vomiting
• Abnormal or jerking eye movements (nystagmus)
• Headache
• Sweating 
• Ringing in the ears or hearing loss.

Symptoms can last a few minutes to a few hours or more and may come and go.

It is important for the medical professional to determine whether inner ear problems or the cerebellum (the balance centers of the brain) is the cause of the vertigo. 

The patient may be asked to perform coordination tasks to make certain that the brain performs normally. Some tests might include reaching out to touch the examiner's index fingertip, sliding a heel up and down the opposite shin, or walking (to look for balance problems).

What causes vertigo?

There are a number of different causes of vertigo. Vertigo can be defined based upon whether the cause is Peripheral or central. Central causes of vertigo arise in the brain or spinal cord, while peripheral vertigo is due to a problem within the inner ear.

Peripheral causes:

•  BPPV. These initials stand for Benign Paroxysmal Positional Vertigo.   BPPV occurs when tiny Calcium  particles (canaliths) clump up in canals of the   inner ear. The inner ear sends signals to the brain about head and body   movements relative to gravity. It helps you keep your balance.
• Infection of the vestibular nerve can cause dizziness, or vertigo. This is called vestibular neuritis, or labyrinthitis.
• Fluid buildup within the inner ear or the endolymphatic system causes Menierie  disease, vertigo that also includes hearing loss and tinnitus  (ringing in the ear) . The cause of this fluid accumulation is unknown.
• Acoustic neuromas, tumors of the vestibular nerve, may also present with these three symptoms.

Central causes:

• Concussion  or traumatic brain injury may be associated with vertigo.
• Strokes may cause vertigo and loss of coordination.
• Multiple sclerosis. 
• Tumors of the brain and spinal cord
• Some patients with a type of migraine headache  called vestibular migraine  may develop vertigo as a symptom

How medical proffesionls diagnose vertigo? 

During an evaluation for vertigo, the health care professional usually asks questions to take a history of the events and symptoms associated with vertigo. This includes medications taken , recent illnesses, and prior medical problems. Even seemingly unrelated problems may provide a clue as to the underlying cause of the vertigo.

After getting the person's medical history, a medical professional then performs a physical examination. This often involves a full neurologic exam to evaluate brain function and determine whether the vertigo is due to a central or peripheral cause. 

Some cases of vertigo may require MRI or CT Scan of the brain and inner ears to exclude a structural problem like stoke,  multiple sclerosis  or a non-malignamt tumor. 

Treatment for Vertigo And Role of Physiotherapy in Vertigo

Treatment for vertigo depends on what's causing it. In many cases, vertigo goes away without any treatment. This is because your brain is able to adapt, at least in part, to the inner ear changes, relying on other mechanisms to maintain balance.

For some, treatment is needed and may include:

Vestibular Rehabilitation.

This is a type of PHYSIOTHERAPY aimed at helping strengthen the vestibular system. The function of the vestibular system is to send signals to the brain about head and body movements relative to gravity.

Canalith repositioning maneuvers

Guidelines from the American Academy of Neurology recommend a series of specific head and body movements for BPPV. The movements are done to move the calcium deposits out of the canal into an inner ear chamber so they can be absorbed by the body. You will likely have vertigo symptoms during the procedure as the canaliths move.

A doctor or PHYSICAL THERAPIST  can guide you through the movements. The movements are safe and often effective.

Medicine - In some cases, medication may be given to relieve symptoms such as nausea or motion sickness associated with vertigo.

If vertigo is caused by an infection or inflammation, antibiotics  or steroids may reduce swelling and cure infection.

Surgery -  In a few cases, surgery may be needed for vertigo.

Is it possible to prevent vertigo?

Most cases of vertigo occur spontaneously, and it is difficult to predict who is at risk. Prevention  may not be possible. However, maintaining a healthy lifestyle will decrease the risks of experiencing this condition.

Vertigo vs. Dizziness

Dizziness can describe lightheadedness and vertigo. Dizziness is the sensation of feeling lightheaded as if you are weak and will pass out. Lightheadedness is often caused by a decrease in blood supply to the brain.

Vertigo is a feeling that you are dizzily turning around or that your surroundings are dizzily turning about you. Vertigo is medically distinct from dizziness, lightheadedness, and unsteadiness in that vertigo involves the sensation of movement. Vertigo may be caused by disturbances of the inner ear and the balance centers of the brain.

STAYING SAFE WHEN YOU HAVE VERTIGO

• Stay hydrated  - Dehydration can decrease vertigo symptoms.
• Sit down immediately  -  As soon as vertigo hits, find a safe place to sit.
• Sit up slowly from bed -  Always sit up slowly if you have been lying on you back.
• Use a cane or Walker - To avoid falls.
• Warn others around you - So they are prepared.
• Hold on tight - Find a steady support or ask for help.

WORK FROM HOME WITH ACTIVE MIND ,NEED GOOD POSTURE TO DO IT RIGHT

WORK FROM HOME WITH ACTIVE MIND, NEED GOOD POSTURE TO DO IT RIGHT

If you are reading this hunched in front of your laptop to the extent you are not realizing it, here is a gentle reminder to straighten your posture. Owing to the COVID-19 outbreak, a lot of people had to make an abrupt shift from the corporate setting to working from their bedrooms. While some are lucky enough to have an ergonomic work from home space, others try and make use of the less-than-ideal set up consisting of beds, coffee tables, couches and dining tables.

Even though the initial news of this transition may have sounded go at first, it is certainly proving to be a literal pain in the neck and the back as we stay slouched over our laptops for an extended period of time.

The sad part is there is no clarity when the situation might go back to normal. Hence, this less-than-ideal situation may prove to wreak more havoc on workers with pre-existing neck and back problems.

The problem is when you sit on a sofa, a couch or even your bed, you don’t maintain a correct posture. You end up rounding your shoulders, putting your head forward and slouching. As a result, you put too much strain on the tissues of your body which may result in chronic pain in your neck and back.

So here is what you should do about it👇

❎No more slouching -

As slouching puts a tremendous amount of stress on your spine and neck. You can use a pillow or even roll up towel horizontally to preserve the hollow arch in the lower back. This will provide lumbar support and prevent pain.
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☑️Change your Posture throughout the day-

Good Posture and Healthy Brain,
Work Mode on and You are Active again.

Do not remain seated at one position for extended time.Keep switching between chairs and sitting surface.You can choose from a standing desk, kitchen table, coffee table to even your dining table. When you keep shifting your sitting position, it will not put a lot of pressure on one particular area and the strain will be migrated to different tissues.

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☑️Fluff up your seat -    

To make your sitting comfortable, you can add a hard pillow underneath your seat. You can also drape a fluffy and soft towel around the back of your chair to add more comfort to your ordinary chair. While it cannot completely replace an ideal office chair, it will certainly make working from home more convenient and comfortable.
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☑️Get up every 40 mins -

Just as you get up from your seats at work, for toilet and coffee breaks, it is important to look away from your laptop screens and not stay seated for an extended period of time at home as well. You can take a walk around the house, fill up your water bottle or do some quick stretches at your desk. Take a break of 5 minutes every 40 minutes to keep your body healthy and in good shape.
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☑️Get your workstation "work ready" -

This simply means that even without your work table and office chair, one needs to make certain minor changes to prevent work from home from becoming a pain in your butt.
Like your laptop screen should be just below your eye level, so elevate the height your screen by putting like some books  to avoid the strain your neck. Secondly, you may also try to increase the font size to avoid putting a strain on your eyes and even put a blue light filter on the screen.

Wrist joint Anatomy and Biomechanics

Wrist Joint Anatomy and Biomechanics

The human hand has a complex mechanism to perform functional capabities. its integrity is essential for daily functions. The Wrist Joint also, known as the Radiocarpal joint is a Synovial joint of Ellipsoid variety, in the upper limb, marking the area of transition between the forearm and the hand.

Structures of the Wrist Joint:

Articulating Surfaces 

The wrist joint is formed by:
• Distally – The proximal row of the carpal bones (except the pisiform).
• Proximally – The distal end of the radius, and the articular disk.

The ulna is not part of the wrist joint – it articulates with the radius, just proximal to the wrist joint, at the distal radioulnar joint.
It is prevented from articulating with the carpal bones by a fibrocartilaginous ligament, called the Articular disk, which lies over the superior surface of the ulna.
Together, the carpal bones form a convex surface, which articulates with the concave surface of the radius and articular disk.

Joint Capsule
Like any synovial joint, the capsule is dual layered. The fibrous outer layer attaches to the radius, ulna and the proximal row of the carpal bones. The internal layer is comprised of a synovial membrane, secreting synovial fluid which lubricates the joint.
Ligaments
There are four ligaments of note in the wrist joint, one for each side of the joint.

• Palmar radiocarpal – It is found on the palmar (anterior) side of the hand. It passes from the radius to both rows of carpal bones. Its function, apart from increasing stability, is to ensure that the hand follows the forearm during supination.

• Dorsal radiocarpal – It is found on the dorsum (posterior) side of the hand. It passes from the radius to both rows of carpal bones. It contributes to the stability of the wrist, but also ensures that the hand follows the forearm during pronation.

• Ulnar collateral – Runs from the ulnar styloid process to the triquetrum and pisiform. Works in union with the other collateral ligament to prevent excessive lateral joint displacement.

• Radial collateral – Runs from the radial styloid process to the scaphoid and trapezium. Works in union with the other collateral ligament to prevent excessive lateral joint displacement.

Neurovascular Supply

Innervation to the wrist is delivered by branches of three nerves:
• Median nerve – Anterior interosseous branch.
• Radial nerve – Posterior interosseous branch.
• Ulnar nerve – deep and dorsal branches.

Muscles of the wrist joint:

• EXTENSOR CARPI RADIALIS LONGUS.

• EXTENSOR CARPI RADIALIS BREVIS.
• EXTENSOR CARPI ULNARIS.
• FLEXOR CARPI RADIALIS.
• FLEXOR CARPI ULNARIS.
• PALMARIS LONGUS.

Movements of the Wrist Joint

The wrist is an ellipsoidal (condyloid) type synovial joint, allowing for movement along two axes. This means that flexion, extension, adduction and abduction can all occur at the wrist joint.
All the movements of the wrist are performed by the muscles of the forearm.

Flexion –  Produced mainly by the flexor carpi ulnaris, flexor carpi radialis, with assistance from the flexor digitorum superficialis.

Extension – Produced mainly by the extensor carpi radialis longus and brevis, and extensor carpi ulnaris, with assistance from the extensor digitorum.

Adduction – Produced by the extensor carpi ulnaris and flexor carpi ulnaris

Abduction – Produced by the abductor pollicis longus, flexor carpi radialis, extensor carpi radialis longus and brevis

Osteokinematics and Arthrokinematics

Osteokinematics

flexion /Extension :

• Axis – Coronal axis
• Plane – sagittal  plane
• ROM for flexion – 65 -85 degree
• Rom for extension – 55-80 degree

Ulnar / radial deviation –

• Axis – Anteroopostrior axis
• Plane -coronal plane
• ROM – 0-30 ulnar radiation , 15-20 degree radial deviation

ARTHROKINEMATICS

 Wrist Flexion / Extension:

• It follows CONVEX - CONCAVE rule.
• Roll and Slide will be in opposite direction.
• Dorsal Roll - during extension.

Ventral Slide - lunate moves on styloid process of radius.

* Extension at RadioCarpal joint :
• The convex surface of lunate rolls dorsally on radius and slides ventrally.

*Flexion at RadioCarpal joint :
•The convex surface of lunate rolls centrally and slides dorsally.

Clinical

COLLES FRACTURE :

Colles fracture most common fracture involving the wrist , caused by falling onto outstretched hand. The radius fractures, with the distal fragment being displaced postiorly. In this radius bone breaks.

The ulnar styloid process can also be damaged in majority of cases.
This condition is called Dinner fork deformity

Scaphoid fracture :

 The Scaphoid  bone of the hand is most commonly fractured bone – typically fall on an outstretched hand ( FOOSH).
Clinical features is pain and tenderness  in the anatomical Snuff box .
Patient with missed Scaphoid fracture are likely to develop osteoarthritis of the wrist in later life.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

The carpal tunnel is a narrow passageway found on the anterior portion of the wrist.
It serves as the entrance to the palm for several tendons and median nerve.

Clinical : Carpal Tunnel Syndrome

Compression of Median nerve within the carpal tunnel can cause Carpal tunnel syndrome.
It can be caused by thickened ligament and tendon sheaths.
If left untreated, CTS  can cause weakness and atrophy of the Thenar muscles.

 Symptoms - include tingling, burning, or itching and numbness in the palm of the hand and the fingers, especially the thumb and index finger.Symptoms are often being worse in the morning.

The National Institute of Neurological Disorders and Stroke (NINDS), describe carpal tunnel syndrome (CTS) as the “most common and widely known of the entrapment neuropathies in which the body’s peripheral nerves are compressed or traumatized.”

Causes - The most common causes are thought to be:

• repetitive maneuvers
• repeated use of vibrating hand tools
• work stress
• pregnancy, for example, because of edema .
• inflammatory, degenerative, and rheumatoid arthritis

Spending too much time working on a computer keyboard and
 with a mouse can cause hand pain and numbness

• hypothyroidism, or a thyroid
• diabetes
• trauma, such as dislocation or fracture of the wrist
• structural problems in the wrist joint
• lesions in the wrist
• a cyst or tumor in the carpal tunnel
• an overactive pituitary gland
• any kind of swelling or inflammation around the tendons

Diagnosis

Self-tests for CTS include  tapping the wrist lightly to see if this produces a tingling sensation or numbness in the fingers.

Another test is to flex the wrist or hold it above the head for a minute. If there is pain, numbness, or tingling, it may mean that CTS is present.

However, these tests are not conclusive.

A primary care physician can usually diagnose CTS after asking about symptoms and examining the hand and wrist for signs of weakness in the muscles around the thumb. They will also assess how well the person can use the hand and wrist.

SPLINT

Treatment – 

• Involve the use of a SPLINT.
• Holding the wrist in dorsiflexion overnight to relieve symptoms.
• Corticosteroids injection into the carpal tunnel  can be used. 
• In severe case – surgical decompression of carpal tunnel may be required.

Self-help tips

The following may help reduce discomfort:

• Resting the hand and wrist: The more rest the hand and wrist get, the greater the chance of relieving the symptoms.
• Cold compress: Placing an ice pack on the wrist may help when the problem flares up, but ice should not be applied ice directly onto the skin
• person should take breaks so the hand and wrist have time to rest and recover.
• Occupational therapy: A therapist can teach a person how to repetitive tasks differently.
• Wrist splints: These keep the wrist in the same position and prevent it from bending. They can be worn during sleep, but also during the day if they do not interfere with daily activities. Wrist splints are available over the counter at pharmacies. A doctor or pharmacist can advise about the best one to choose.

Exercise

Here are two exercise that may help relieve the discomfort of CTS:

1. Make a fist, with the back of the hand facing down. Slide the fingers up until they are pointing straight up toward the ceiling. Repeat five to 10 times.

2. Make a fist. Open your hand and spread out the fingers, stretching them as far as possible. Repeat five to 10 times.
 As Exercises really have any benefit.

PAIN : Causes, Types and Management (10-5-2020)

Pain : Causes, Types and Management

All of us have been to the doctor at least once because of pain.
So What is Pain?

Why do we feel it ?

Is it good or bad?

What are the Causes and Types of pain?

Treatment and Management.

Let see all the questions one by one: 

PAIN 

Pain is an uncomfortable feeling that tells you something may be wrong. It can be steady, throbbing, stabbing, aching, pinching, or described in many other ways. Sometimes, it’s just a nuisance, like a mild headache. Other times it can be debilitating.

Pain can bring about other physical symptoms, like nausea, dizziness, weakness or drowsiness. It can cause emotional effects like anger, depression, mood swings or irritability. Perhaps most significantly, it can change your lifestyle and impact your job, relationships and independence.

Why do we feel pain? 

People feel the pain when specific nerve called nociceptors detect tissues damage and transmit information about the damage along the spinal cord to the brain. 

For ex- For example, touching a hot surface will send a message through a reflex arc in the spinal cord and cause an immediate contraction of the muscles. This contraction will pull the hand away from the hot surface, limiting further damage. 

The brain may also release feel -good chemicals such as Dopamine, to try to counter the unpleasant effect of pain. 

Is it good or bad?

-Pain is a strange beast. It is far better to feel pain then it is to not feel pain. 
Pain happen for one simple reason : to protect you.
If your brain register pain, you typically stop doing what caused it.  So yes it is good for some extent. But it can

Types: 

Pain can either be Acute or Chronic. 

Acute :

This type of pain is generally intense and short-lived. It is how the body alerts a person to an injury or localized tissue damage. 

There are different types of acute pain:

• Somatic pain: A person feels this superficial pain on the skin or the soft tissues just below the skin.
• Visceral pain: This pain originates in the internal organs and the linings of cavities in the body.
• Referred pain: A person feels referred pain at a location other than the source of tissue damage. For example, people often experience shoulder pain during a heart attack. 

Chronic pain:

Long lasting than acute pain.Chronic pain can be mild or severe. It can also be either continuous, such as in arthritis,  or intermittent, as with migraine..

Describing pain

There are other more specialized ways of describing pain. 

Includes:

Neuropathic pain: This pain occurs following injury to the peripheral nerves that connect the brain and spinal cord to the rest of the body. It can feel like electric shocks or cause tenderness, numbness, tingling, or discomfort.

• Phantom pain: Phantom pain occurs after the amputation of a limb and refers to painful sensations that feel as though they are coming from the missing limb.

• Central pain: This type of pain often occurs due to infarction, abscesses, tumors, degeneration, or bleeding in the brain and spinal cord. Central pain is ongoing, and it can range from mild to extremely painful. People with central pain report burning, aching, and pressing sensations

Diagnose:

An individual’s subjective description of the pain will help the doctor make a diagnosis. There is no objective scale for identifying the type of pain, so the doctor will take a pain history.

They will ask the individual to describe:

• the character of all pains, such as burning, stinging, or stabbing
• the site, quality, and radiation of pain, meaning where a person feels the pain, what it feels like, and how far it seems to have spread.
• which factors aggravate and relieve the pain
• the times at which pain occurs throughout the day
• its effect on the person’s daily function and mood
• the person’s understanding of their pain.

Treatment and Management

Doctors will treat different types of pain in different ways. A treatment that is effective against one type of pain may not relieve another.

Acute pain treatment

Treating acute pain often involves taking medication.

1. Nonsteroidal anti-inflammatories (NSAIDs)

These are a type of analgesic, or pain reliever, that can reduce pain ,suitable for acute pain like headache etc.. 

It cang help to reduce localized inflammation(anti inflammatory drug). 

2.Opioids

Doctors prescribe these drugs for the most extreme acute pains, such as those that result from surgery, burns, cancer and bone fracture . But Opioids are highly addictive, cause withdrawal symptoms, and lose effectiveness over time. They require a prescription.

Chronic pain treatment

A range of non drug therapies can help relieve pain. These alternatives to medication may be more suitable for people experiencing chronic pain.

These therapies include:

• Acupuncture: Inserting very fine needles at specific pressure points may reduce pain.

• Transcutaneous electrical nerve stimulation (TENS):TENS is the one of the Electrotherapy Modality use in PHYSIOTHERAPY. It's aims to stimulate the brain’s opioid and pain gate systems and thus provide relief.

• Surgery: Various surgeries on the nerves, brain, and spine are possible for treating chronic pain. These include decompression, and electrical deep brain and spinal cord stimulation procedures.
• Biofeedback: Through this mind-body technique, a person can learn to control their organs and automatic processes, such as their heart rate, with their thoughts more effectively. Virtual reality may now play a role in the use of biofeedback in pain management, according to 2019 research.
• Relaxation therapies: These include relaxation therapy and exercise  mostly in the realm of alternative and complementary medicine. A person can try yoga, meditation, massage therapy, distraction techniques.

• Physical manipulation: A Physiotherapist or chiropractor can help to relieve pain by manipulating the tension .
• Heat and cold: Using hot and cold packs can help. People can alternate these or select them according to the type of injury or pain. Some topical medications have a warming effect when a person applies them to the affected area.

• Rest: If pain occurs due to an injury or overworking a part of the body, rest may be the best option.

With adequate pain management, it is possible to maintain daily activities, social engagement, and an active quality of life.

Smile - it's free Therapy ! (9-5-2020)

Smile – It’s free Therapy!

What can brighten your day as well as make those around you happy, doesn’t cost anything and is readily accessible and available anytime? It’s your smile!

"I have never seen a smiling face that was not beautiful.

Studies suggest that smiling, forced or not, can have a positive effect on your mood, decrease stress levels, and even make everyone around you feel better.

There is science behind this! The physical action of using the facial muscles involved in a smile sets off a neurochemical reaction that improves mood.

Smiling has been used successfully as part of a program to treat depression, requiring participants to smile at themselves in the mirror several times a day.

Whenever you’re in a stressful situation or are feeling down, slap a grin on your face so you can take advantage of the many benefits smiling has to offer.

Too stressed to smile? Here’s why grinning is winning for all aspects of your life, and how you can cultivate this happy habit.

Hopefully, you are smiling now as you read this. Practice stretching your skin and muscles less in life and see yourself grow old attractively!