"Medical Supply News"

One of the more common injuries in young athletes is rupture of the Achilles tendon. In almost all cases, the rupture is sudden and without warning. The injury is quite often seen in the 2nd-3rd decade of life and men are more affected than women. Most individuals have no prior premonition of any pain or swelling. In fact the majority have no prior history of any injury or trauma to the heel. The tendon usually ruptures during exercise, jogging or sprinting. The Achilles tendon usually ruptures not at the site of insertion into the heel but a few centimeters above the heel bone.

The Achilles tendon is a strong tendon and very durable. The tendon connects the muscles at the back of the leg (gastrocnemius and soleus muscles) to the heel bone (calcaneal tuberosity). These muscles are vital for jogging, walking, jumping, standing on the toes and climbing the stairs. Studies have shown that while running or climbing the stairs, the forces within the tendon are strong enough to withstand at least 10 times the body weight of the individual.Like most tendons, the Achilles tendon has a poor blood supply and this makes it prone to tears or rupture. If the tendon develops a tear or gets irritated it is prone to rupture. In many cases the Achilles tendon  injury occurs in athletes who fail to warm up or condition their body adequately.

Other causes of rupture include old age, over exertion during exercise and injury to the heel.The majority of individuals who rupture the tendon are young healthy males who have no prior medical problems. The injury occurs suddenly while standing on the toes or sprinting. The rupture is spontaneous and often associated with pain in the heel area.When the Achilles tendon ruptures, the individuals will at once have difficulty walking. The affected foot will drag and lifting it is difficult. Some individuals describe the rupture as a painful kick in the back of the heel or a sharp burning pain. In any individual who complains of sudden onset of pain just above the heel, Achilles tendon rupture should be the preliminary diagnosis.

The Achilles tendon is a strong fibrous cord that attaches it self from the muscle belly to the edge of the heel bone. The function of the Achilles tendon is to help you elevate the heel while you walk. It also helps one push up on the toes while standing. When the tendon is ruptured, one can have great difficulty walking.In some individuals the tendon does not completely rupture but one can have a small tear(s). These usually present with a constant aching pain sensation. When the diagnosis is missed, it can develop into a full blown rupture of the tendon. While the tendon rupture usually occurs just above the heel, it can also occur at any other point along the tendon.

Often the diagnosis of Achilles tendon tear is confused with tendinitis, plantar fasciitis or bursitis. In all these cases, the treatment is rest and supportive care. When Achilles tendon rupture occurs, the best treatment is surgery.The number of individuals who develop Achilles tendon rupture is not exactly known.

It is more common in men but recently with the increased female participation in sports, there are also reports of this condition in some females. By far Achilles tendon rupture is most common in athletes.

The initial treatment for Elbow arthritis is always non surgical. In the majority of cases conservative treatment can help decrease the swelling, pain and improve the range of movement.

The non surgical treatments include:

Pain control: The pain with elbow arthritis is variable and ranges from mild to moderate. In all individuals, the pain is easily controlled with non steroidal anti-inflammatory drugs. However, these medications do have certain side effects such as stomach upset and long term use can result in ulcers. Today, there are also a variety of topical pain medications available as creams/lotions. The cream is gently applied on the joint surface and works rather well.

Rehabilitation: Once the pain relief has been obtained, the next step is to enter a physical therapy program. Initially it is important to go for therapy as an outpatient and once the exercises have been learnt, one can do them at home. The aim of all physical therapy programs is to help build strength, relieve pain and swelling and help with the range of motion. Besides exercises, there are a number of ultrasound devices which can be used to restore joint mobility.

Splints: Elbow arthritis can be painful at times in the initial phase. The pain is usually worse at night or during cold weather. During such periods any movement of the joint can be painful. Thus, it is highly recommended that one wear splints. The splints not only protect the joint, but also help decrease the pain and swelling. The splints should not be worn all the time but only as needed. When the pain eases, gentle passive exercises should be done.

Strengthening: Because elbow joint pain can be moderate sometimes, many individuals lose strength in that arm. Physical therapy exercises can help restore joint mobility and increase strength. Exercises that stretch the muscles will help improve joint flexibility.

Job change: there are times when the elbow pain is unremitting and the only solution is a job change. For some individuals who have repetitive work at the office, a job change may help relieve the constant ache and elbow stiffness. Job change should only be an alternative when physical therapy and pain control have been tried out. Individuals who have moderate to severe elbow pain will simply be unable to lift weights or carry out any type of heavy exercise.

Thermal Care heating pads: Today there are a variety of heating pads and thermal devices available to help ease the pain and relive the swelling. These wraps can be applied to the elbow and provide soothing warmth for up to 12 hours. These devices can be used 12 hours a day, for 7 days a week. 

Cortisone injections: In moderate cases of arthritis, cortisone injections can help. The injections can decrease the pain, and limit the swelling. Cortisone injections are not a cure for arthritis and the symptoms do come back in 3-9 months. Other novel therapies have included injections of hyaluronic acid into the joint, this molecule helps cushion the joint and also lubricate the joint  

When high blood pressure is untreated, complications are inevitable. Just imagine the constant high blood pressure pushing up against the very thin walled vessels in the brain, eyes and other parts of the body. Over time, almost every organ in the body sustains some type of damage. In general, the higher the pressure the more severe the complications. To make matters worse, complications of hypertension are not easily reversible.

Some of the complications of untreated hypertension include:

 -         Trauma to the blood vessels: the constant pounding of the fragile blood vessels due to high blood pressure leads to damage and severe trauma to the arteries. With time, these blood vessels will become thick and narrow down or may even rupture. Rupturing of small blood vessels is common in the brain 

-         Heart failure. Individuals who have high blood pressure usually have a very big heart. The heart has to constantly work against the higher resistance and over time starts to thicken. At some point in time, the heart can no longer sustain this magnitude of work and fails, resulting in either a heart attack or congestive heart failure.

 -         Brain hemorrhage: Small strokes do occur from untreated blood pressure. The high blood pressure leads to rupture of the small vessels in the mid brain – these strokes are known as lacunar infarcts. 

-         Kidney failure: One of the most common complication of untreated blood pressure is kidney failure. This results because of damage to the vessels. After diabetes, hypertension is the next most common cause of kidney failure.

 -         Eye: The retina of the eye has very fine and fragile blood vessels. Often these are damaged by high blood pressure. When the vessels rupture, it often leads to partial vision loss. 

-         Dementia:  The constant pounding of the high blood pressure into the small blood vessels of the brain is known to cause a type of dementia. Know as multi infarct dementia, the condition occurs after years of untreated blood pressure. 

-         Erectile dysfunction is often an end result in individuals who have untreated blood pressure. 

The only way to prevent the complications of hypertension is to get the blood pressure checked regularly. This silent disease has devastating complications when the treatment is delayed.         

Many people have high blood pressure but because the disorder has no symptoms or signs in the early stages, the diagnosis is often missed. Making a diagnosis of high blood pressure requires making several measurements at different times. The blood pressure must be consistently elevated at various times to make a diagnosis of hypertension. In many cases, the health care worker will make several blood pressure measurements over several weeks.

It is recommended that on any given visit to the physician, one obtain at least 2-3 readings 5 minutes apart. The blood pressure should be obtained in both the standing and supine position. During the initial visit the blood pressure should be measured from both arms to ensure there is no discrepancy. Sometimes the blood pressure in the left arm may be higher than the right arm because of a congenital heart disorder.It is also very important to use the right cuff size to measure blood pressure. For individuals who have an arm circumference of greater than 30 cm, the largest size of cuff should be used.

Before making a blood pressure measurement, the patient should be relaxed and calm. Sometimes, the blood pressure is measured from the legs. While this is not inaccurate, it is generally always slightly higher.

Laboratory exam:

The diagnosis of blood pressure is made clinically. In less than 10% of patients is any extensive testing or blood work required to make a diagnosis of blood pressure. Essential hypertension is one which is defined as having no known cause. And all the work u is normally negative. Essential hypertension affects 90% of the population. Only in the remaining 10% cases of hypertension are studies worthwhile. One can order basic blood work and check for high cholesterol, blood sugars and kidney function.In majority of secondary hypertensive cases, the kidney is the culprit. Sometimes, the renal artery may be narrow or blocked.Because high blood pressure has no symptoms or signs, it is important for all individuals over the age of 50 to get routine measurements of their blood pressue. Any individual with symptoms like visual problems, headaches, general malaise, and chest pain difficult walking far, should always see a physician to ensure that the blood pressure is with in normal limits.

The latest blood pressure guidelines issued by the National Heart, Lung, and Blood Institute, classify blood pressure measurements into four general categories:

- Normal blood pressure. If your blood pressure is below 120/80, you are okay. Once the blood pressure goes above 140/80, there is a risk of developing heart disease.

- Prehypertension is defined as systolic pressure ranging from 120 to 139 or a diastolic pressure ranging from 80 to 89. This condition generally progresses with time. The majority of individuals who have Prehypertension will develop full blown hypertension within 4 years.- Stage 1 hypertension is a systolic pressure ranging from 140 to 159 or a diastolic pressure ranging from 90 to 99.

- Stage 2 hypertension is the most severe form of hypertension. In stage 2 hypertension the systolic pressure is usually greater than 160 or higher or the diastolic pressure is higher than 100 mmHg.

Both numbers in a blood pressure reading are important. After the age of 50-60, the systolic reading is significant and remains a common cause if hypertension in the elderly.

Surgery for elbow is usually never a first resort. It is always selected when all conservative methods have failed. Unlike the knee, surgery on the elbow is not common and a lot of thought should be given to this surgery. Even though there have been many advances in surgery, the potential for complications is always present. The surgical options of treating osteoarthritis of the elbow depend on the severity of the joint degeneration, your age, activity level and what the hand is being used for. For all individuals who seek elbow surgery, a thorough knowledge should be available beforehand.Arthroscopy: The easiest elbow surgery is arthroscopic debridement. A camera is placed in the joint and the articular cartilage is visualized. The joint is cleansed of all debris, spurs and bony fragments are removed. Sometimes a small part of the disease synovium is removed together with bony fragments. The procedure can help even out the cartilage and remove all loose bodies. The procedure is short and relatively painless. Most individuals recover rapidly from this surgery.More complex elbow surgery that involves attachment of tendons, elbow fusion or joint reconstruction, elbow joint replacement should only be performed by surgeons familiar with these techniques. These surgeries also have no guarantee that the arm function will return back to normal. And thus, if in doubt, a second opinion should always be obtained

After elbow surgery, rehabilitation is highly recommended, No matter how small the surgery, rehabilitation is vital to bring back function of the elbow joint. Initially after the surgery, the arm is always bandaged and placed in a splint. Once the pain is less and the wounds have healed, physical and occupational therapy sessions are undertaken. The duration of these sessions vary but on average most individuals require 1-3 months of therapy. The initial therapy sessions are limited to dealing with pain and limiting swelling. The therapy is begun with passive exercises, followed by active therapy. Exercise will be done to help regain function, strength and improve the range of motion of the elbow joint.

You will also be taught how to perform some of these exercises at home without placing too much stress on the elbow joint.

Arthritis can affect any joint in the body. The most common joint to be affected by osteoarthritis is the knee. The elbow joint can sometimes be affected by osteoarthritis. The elbow is one of the least affected joints because of its well matched joint surfaces and it has strong stabilizing ligaments. Osteoarthritis is simple degeneration of the cartilage in the joint. The degeneration occurs from the normal wear and tear of a joint. The cartilage functions to maintain a stress free joint motion and when it is destroyed, the joints move under a lot of friction. Whenever the cartilage of a joint is damaged, it does not heal well. The injury alters the proper function of the joint and leads to more wear and tear of joint surface. Over time, the joint degenerates, causes pain and interferes with normal daily activities. Osteoarthritis is also known as degenerative arthritis, or posttraumatic arthritis.

Elbow osteoarthritis can be caused by:

 - gout

- joint fracture

 - sprain/dislocation

- trauma

 Elbow osteoarthritis typically occurs in patients 50 years of age or older, but some patients can have symptoms earlier. Pain is a common and initial feature of osteoarthritis of the elbow. Initially the pain only comes on after elbow activity but as the disease progresses, the pain can become constant. The pain may come on at night and the joint may become stiff with time. Also noticeable with time will be joint swelling and decreased strength. If no treatment is undertaken and the condition is allowed to progress, one may hear clicks when the elbow is moved; these creaking sensations are known as crepitus. Frequently, you may feel that the elbow is locking during movements. The “locking” is caused by loose pieces of cartilage or bone in the joint. The loose bodies may have been dislodged from the joint and become trapped between the moving joint surfaces. Unlike other joints, the elbow is sensitive to injury and one quickly develops stiffness and inability to move the joint. At this stage it may be difficult to open the arm completely and later if mat be impossible to bend the arm.

The diagnosis of elbow osteoarthritis is made after a complete medical history and a physical examination. Besides the elbow, the other joints will be examined to ensure that there are not multiple joint involvements. X rays are always ordered to look at the joint and determine what the problem is. X rays can help determine the progress of the arthritis and determine therapy. Additional radiological imaging tests like CT (computed tomography) or MRI (magnetic resonance imaging) are typically not needed to diagnose osteoarthritis of the elbow.

Tennis elbow is also known as lateral epicondylitis. This is a common injury that occurs from overuse of the elbow joint. The majority of individuals who develop tennis elbow are into racquet spots like badminton, tennis, squash or table tennis. The injury is also commonly seen outside the racquet sports and includes individuals who are electricians, golf pros, gardeners, carpenters and baseball pitchers.

Tennis elbow generally presents with an odd ache over the elbow joint. With time the pain will radiate along the outside of the forearm and on to the wrist. Initially the pain may come on with some arm activity but later the joint is continuously sore. When the condition is severe, any movement of the elbow joint is painful.

Tennis elbow can occur at any age but generally affects individuals in the 3-5^th decade of life. It affects men more than women.

The classic symptoms of tennis elbow include:

-         pain which radiates on the outside of the elbow along the forearm

-         pain when the outside of the elbow joint is compressed

-         moderate to severe pain when the elbow is forcefully manipulated

-         forearm pain which radiates to the wrist

-         diminished strength and a weakened grip in the arm

-         pain which occurs while holding a racquet or any other equipment.

The prognosis of tennis elbow is good. However, one does need to treat the condition. Without treatment, the pain gets worse and the range of motion of the arm is limited. Once the condition has been allowed to progress, the elbow pain may occur at rest and more so at night

Conditions that are known to cause tennis elbow include:

-         playing tennis with poor technique

-         continuous use of machinery like drills, screw drivers (carpenters)

-         constant hammering (carpenters, electricians, gardeners)

-         weaving, knitting (tailors)

-         any condition that cause repeated twisting or turning of the foreman

-         playing musical instruments

Causes of tennis elbow

Tennis elbow is generally due to overuse of the joint. It occurs from repeated use of the forearm muscles that one uses to straighten the hand and extend the wrist. The repeated motion causes stress to the muscles and induces irritation or tiny tears in the tendons that attach the forearm muscles to the outside of your elbow. 

There are many individuals who have gait problems and the majority of them are the elderly. The cause of the gait problem is varied and includes diabetes, stroke, falls, post surgery, and so on. For the majority of these individuals there are no other medical options if they want to remain ambulatory. Therefore, the use of a walker, cane or crutch is required. Today there are many types of ambulatory devices sold on the market. The best type of ambulatory device for each individual depends on a variety of factors. Evaluation for the need of an ambulatory device is best done by a physical therapist.

Once the need is determined, ambulatory devices can readily be purchased without a prescription from any health store. Individuals who need walkers also need to have some mental capacity, decent vision, upper body strength, intact cognition and a generally flat living environment. Walkers improve balance by increasing the patient’s base of support, enhancing lateral stability, and supporting the patient’s weight. Despite the enhanced support and utility for weight bearing, walkers also have some disadvantages. These include difficulty maneuvering the device through doorways and narrow passages, reduction in normal arm swing, and poor posture with abnormal flexion of the back while walking. In general, walkers should not be used to go up or down steps.  

Today, there are a variety of walkers available. At Medexsupply, we have a variety of walkers which come in different colors, styles and function. Our ergonomically designed walkersare easy to operate from either a sitting or standing position. All our walkers have been thoroughly tested for stability and durability. The latest Walker on the market is the Uprise Onyx Folding Walker. This device is quite popular because of several factors. It can fold, is light weight and best of all can be used as a rising aid. This multifunction walker not only provides great stability when standing but also allows the individual to get up from a seated position. The Uprise is operated using a single push button and can carry a weight load of 400 lbs. the surface of the walker has handle bars with grips and the legs have anti glide features. The Uprise Onyx is uniquely designed for greater clearance.  Each side operates independently to allow easy movement through narrow spaces and greater stability while standing. The device is made from anodized aluminum and provides optimum stability and is very stable on the ground.

The Uprise Onyx also comes with accessories which include baskets, crutch pockets and replacement parts.  The surface of walkers has nylon paddles to lessen crack or damage to the frame.  At Medexsupply, we usually ship within 24-48 hours.   

Plantar fasciitis or heel pain is a common ailment in millions of individuals. The pain of plantar fasciitis is worse in the morning and burning in nature. As the individual starts to move around in the day time, the pain decreases but may return after long periods of standing or getting up from a resting or seating position. Most individuals who develop plantar fasciitis are active in sports, middle aged, slightly overweight or pregnant.

The classic symptoms of plantar fasciitis are pain which comes on gradually. It is a burning pain and often sharp. It often feels worse the first thing in the morning. In a few individuals it may be associated with swelling around the heel.The causes of plantar fasciitis are many. Normally the plantar fascia acts like a shock absorber but if it is exposed to too much tension, the fascia develops small tears.

The most common causes include:

Intense Physical activity: Plantar fasciitis is common in athletes such as joggers or long distance runners. Even standing all day or lifting weights can cause stress on the heel.

Arthritis: in some individuals it is believed that arthritis along the tendon may lead to plantar fasciitis.

Diabetes: For some unknown reason plantar fasciitis is quite common in diabetics.

Anatomy: Some individuals with flat foot or a high arch are also prone to developing plantar fasciitis.

Poor shoe wear: Shoes that are thin soled or lack arch support increase the chance of developing plantar fasciitis.

The diagnosis of plantar fasciitis involves a physical exam and a radiological test to ensure that one does not have a one spur.

In the majority of cases, conservative treatment is adequate to cure the condition. Non surgical treatments include night splints, crutches, specially designed arch supports and physical therapy. Most individuals do require some type of pain medication. If this fails, injection of corticosteroids may help. Recently Extracorporeal shock wave therapy has also been found to be helpful in some individuals.

Surgery is extremely rare and never the first choice. The best way to avoid plantar fasciitis is to maintain a healthy weight, wear decent shoes and warm up slowly prior to starting a new exercise program  

Bunions are an abnormal bony protrusion that develop on the joint base of the big toe. The toe joint becomes enlarged, distorted and crowds the other toes. The outward pressure of the joint gradually increases, leading to pain and an abnormal profile of the foot. Bunions can occur for many reasons but the most common is wearing of tight fitting shoes- especially at the toes

Other causes of bunions may be congenital, trauma or stress on the toes from another medical disorder.

The symptoms of bunions include:

-         An unattractive  bulge at the side of the big toe

-         swelling, redness or pain

-         corns or calluses at the base/side of the big toe

-         limited movement of the big toe

-         difficulty wearing shoes

Most individuals with bunion have one complain- pain. The pain can be variable but is usually constant and can be severe. Because the bunion pushes the other toes, crowding and ingrown toes nails are also common. Bunions once acquired can be worsened in individuals who wear high heels or ill fitting shoes. Individual with flat feet and arthritis also have a tendency to develop bunions.

The diagnosis of a bunion is usually straightforward and may include an x ray of the foot.  Bunions are a big problem in our society and various treatments have been developed. The earlier one seeks treatment, the less the chance of developing joint deformity. In all cases, the initial treatment is conservative and includes the following:

-         change in shoe wear with plenty  of toe space

-         padding of the shoes around the toes to relieve pain and eliminate stress

-         most people require some type of pain relief. Over the counter NSAIDs suffice in most cases. Sometimes cortisone injections may help if the pain is severe

-         Physical therapy including wearing splints, ultrasound or whirlpool baths can help sooth the pain and assist in ambulation

-         Often shoe inserts can help control abnormal movement of the foot. Shoe inserts can be acquired with or without a prescription

When all the above non surgical treatments fail, surgery may be the only other alternative. Surgery involves removal of the swollen tissues and realigning the toe. Recovery after surgery can take a few weeks and recurrences are common. To prevent recurrences one should wear proper shoes and avoid high heels.