1. Infection

Infections occurring are rare nowadays due to the advanced technique and the usage of sterile needles. They are extremely unusual, occurring only less than 0.5%. However, patients suffering from diabetes are at a higher risk.

1. Bleeding

Bleeding is also unusual and patients who are suffering from bleeding disorders or taking blood thinning medications are not allowed to be given epidural steroid injections. Their spinal cord can be compressed and could lead to serious consequences, possibly even death.

1. Dural tears

It is a very common side effect which occurs in 1% to 2% of all reported cases. The dural is accidentally punctured with the needle and results in the patient suffering from headache. The needle punctured dural reduces the amount of cerebrospinal fluid pressure which in turns causes a spinal headache and is improved when the patient lies down. It will usually go away by itself in a couple of days.

1. Nerve damage

It is an extremely rare side effect but has been reported. The injection needle injures the spinal nerves which are compressed, resulting in either temporary or worse permanent damage.

1. Blood sugar

Blood sugar levels especially in patients suffering from diabetes have been reported.

1. Allergy reaction

Patients have reported to be allergic to the medication present in the injection and this is normally due to the preservative in the medication and not with the active ingredient itself.

1. Weakening of muscles

Steroid myopathy which is effectively the weakening of thigh muscles has been reported. Cases are rare.

1. Facial redness

Occasionally, patients have reported to suffer from facial redness after the injection. The effects usually subside in a couple of hours, at most a few days and are not serious.

1. Fevers

Patients have also reported having low grade fever after injection and this is due to the body’s natural defence mechanism reacting with the steroid. It is nothing serious and will go away on this own.

Long term side effects from epidural steroid injections are uncommon and the side effects are usually non critical, however do not be complacent and always seek the help of a qualified medical practitioner if any complication arises.

Hylan G-F 20 or more commonly known as Synvisc is a treatment specifically targeted towards the treatment of osteoarthritis and it is directly injected into the knee so as to both lubricate and cushion the knee joints. Synvisc contains hyaluronan which is a substance that is present in our joint fluid and they provide lubricating properties for our joints. Synvisc is administered as 3 separate injections direct into the knee spaced about a week from each other.

As with all treatments available, Synvisc causes side effects. However, different people experience different side effects depending on their body tolerance and most people tolerate it rather well without the need for external treatment.

Safety tests on the treatment of Synvisc therapy on patients with Osteoarthritis have been carried out through the usage of clinical trials. Results have concluded that Synvisc injection is nonantigenic, non toxic and noninflammatory and it has been given to millions of arthritis patients. There are no definite known side effects of synvisc treatment but as it is a localized treatment which involved injection into the knee, patients do thus experience discomfort and swelling and pain area the region. As with all kinds of available treatment in the market today, strenuous activities within the first 48 hours of treatments are strictly prohibited. Activities that will provide stress to the knee such as running, jumping, basketball or football are also forbidden.

1. General

During clinical trials conducted, the most common side effect of Synvisc observed was knee pain, swelling and warming of the area, which happened to 11% of patients who received the treatment. In most of the cases, this side effect was mild and treatment was not even necessary.

1. Locomotor system

Severe inflammation of the joint together with pain and effusion experienced 24 to 72 hours after injection also known as Pseudosepsis, has been experienced by patients. It is not common and nonsterodial anti-inflammatory drugs can be used to treat pseudosepsis.

1. Cardiovascular

Side effects such as abnormally rapid heartbeat accompanied by an irregular rhythm and swelling of a vein that is caused by blood clot has been observed.

1. Nervous system

Side effects such as anxiety, idleness, disequilibrium, headache, chills and muscular ache has been reported.

1. Hypersensitivity

Cases of fever accompanied with allergic reaction and effusion in the knee coupled with synovial eosinophilia was reported.

1. Local

Commonly acute painful joints experienced after injections were reported in most of the patients and the pain normally subsides a few hours later.

We introduce you Singapore Sports and Orthopaedics Clinic where professional help will be offered in the areas of diagnosis, treatment and rehabilitation for all knee pain and sports injuries.

Exercise 1

Often people who suffer from plantar fasciitis experiences intense heel pain in the morning when they wake up, and taking the first steps of the day is a painful process to undergo. This is due to the tightening of the plantar fascia during sleep. Stretching the plantar fascia before standing up can have significant results and often reduces the heel pain.

Stretch the foot by flexing it up and down 20 times before standing. Use a towel and pull the heel towards you, stretching the bottom of the foot.

Exercise 2

Stand 6 to 8 meters away from a wall and lean towards it while keeping the knees straight and heel firmly flat on the ground at all times. There will be a slight strain on the calf muscles and you can feel your Achilles tendon starting to tighten up. Holding this position for 15 seconds, repeat it 10 times each set, doing it throughout the day. Thru this exercise, the Achilles tendon and calf muscles can be stronger and much more flexible.

Exercise 3

Place marbles and a cup on the floor. Using only the toes, lift the marbles up one by one and place them into the cup. Repeat the exercise for 10 times, 3 sets each time. This not only stretches the muscles, it also improves the coordination skills of you.

Exercise 4

Place your left leg infront of you and keep it flexed. As you bend your right knee, lean back slightly. You should notice your pelvis tilted forward. Keep the upper body straight and hold the position for 15 seconds, then switch sides. You should be able to feel a strain all the way up the back of the extended leg.

Exercise 5

Standing on the floor barefooted, raise your heels up slowly while using the balls of your feet and toes. Hold the position for 5 seconds and slowly go down again. Repeat this exercise 10 times, 5 sets each.

Exercise 6

Either with or without shoes, move your foot around your ankle drawing a big circle with your big toe in the air. Do it both clockwise and anticlockwise and repeat as many times as you like.

The nature of symptoms for psoriatic arthritis depends on the type, but they are more or less similar to each other. Generally, patients will suffer pain, stiffness and tenderness at their joint areas in more than one place. Their range of motion is also significantly decreased and the pain amplifies when there are attempt to move the joints. The pain is significantly higher in the morning but subsides throughout the day.

There are 5 different types of psoriatic arthritis with each having their own unique symptoms:

Distal Interphalangeal Predominant

Patients will tend to feel tenderness and pain only in the last joints of their fingers and toes as only the distal interphalangeal joints are affected.

Asymmetrical Arthritis

Only 2 or 3 joints are affected and they are individual and not in pairs. Any joints in the body can feel pain and are often red and warm to touch.

Symmetrical Polyarthritis

Joint swelling in pairs is observed on both sides of the body, such as both elbows for example.

Spondylitis, or Psoriatic Spondyloarthritis

Joints in the spine will be inflamed and is a serious condition that will cause deformity and changes in the posture as well. Inflammation, tenderness and stiffness of the joints in both the back and neck will occur and the ligaments might be affected.

Arthritis Mutilans

The bones and cartilage in the joints will be destroyed and deformed and flares in the skin will be observed. It will affect the small joints in the fingers and toes nearest to the nail and lower back and neck pain can be observed.

The symptoms vary according but the common signs and symptoms are:

• Uncomfortableness, inflexibility, tenderness and swelling in one or more joints.
• Range of motions in joints are greatly reduced.Re
• Stiffness in the morning.
• Lower back experiencing stiffness and inflammation.
• Swelling in the smaller joints of the toes and fingers that are closest to the nail.
• Pitting of nails.
• Fingernails or toenails are detaching.
• Tenderness, pain, or swelling where tendons and ligaments attach to the bone
• Eye inflammation

What kinds of surgical techniques are used to stabilize an ankle with chronic sprains?

Answer

There are many surgical techniques, but they basically fall into two groups. One is anatomic reconstruction. With this technique, surgeons use the original ankle ligaments to repair the ankle. The other technique is called tenodesis. In this procedure, surgeons reconstruct the ankle ligament using tendon from elsewhere in the body, such as the lower leg. Surgeons attach the transplanted tissue to bones in the ankle joint.

Researchers evaluated the results of both kinds of surgery in a group of athletes. For these patients, anatomic reconstruction resulted in better ankle movement and stability. It also led to fewer degenerative changes in the joint. Compared to tenodesis, anatomic reconstruction more often gave a good or excellent result. For athletes and other active patients, researchers think anatomic reconstruction is the method of choice.

Osteitis pubis is an overtax injury whereby there are both tissue damage and inflammation at the pelvis. The causes are unknown but are commonly due to repeated stress or stress fractures at the pelvic bones.

Symptoms of Osteitis Pubis

In patients suffering from early Osteitis Pubis normally experience slight groin pain that starts slowly and develops overtime insidiously depending on the activities involved on either one or both sides of the groin to severe pain. The pain can be felt in the adductor muscles and are usually provoked while doing warm up, but reduces during the activity and only to return after the end of the activity. Short periods of rest reduce the pain but it is intensified when the patients attempt to return. They might at times experience pain in either or both lower abdominals and hips. Swelling at the front of the pelvis may also be observed and it might extend to the groin, inner thigh and lower belly. Pain is amplified when there is a sudden change of direction when running, doing activities such as kicking a soccer ball, sprinting, and climbing stairs, jumping or standing on one leg. He may also experience a loss of speed while sprinting and loss of flexibility is his groin region to manage all the stresses acting on it. The patient will thus often walk or run with a limp due to the pain and not wanting to exert weight on the painful side of the body. He will also experience weakness when bending the hip or kicking. A fever which will subside on its own might also be experienced.

All symptoms are not to be neglected and is extremely important to seek the advice of a qualified health practitioner who is able to carry out a full assessment and make a diagnosis and prevent it from becoming potentially more serious. Through the usage of x-rays, the doctor is able to see any signs of widening or erosions at the public symphysis, which is indicative of Osteitis Pubis. MRI scans are able to depict bone stress reactions and any inflammation in the tendons that are attached to the pelvis.

The most common symptoms of possible Osteitis Pubis are:

• Weakness in the lower region of the body
• Limping tendency and pain
• Pain during sporting activities
• Sudden change of technique or directions through inhibition of muscles
• Pain in the groin
• Pain in the lower abdomen

Elbow pain is something that is very common nowadays and can happen to many people especially those who participates in activities that requires the repetitive usage of the elbow, which in turn places extreme pressure on the structures of the elbow joint.

If the bursitis is due to infection, the bursa can be drained away with the usage of a needle and the fluid removal relieves pain. Antibiotics may also be prescribed to fight the infection. However if the bursitis is not due to infection, it can be treated with either surgical or non surgical methods.

Elbow pads

Usage of an elbow pad cushions the elbow and acts as a support for the elbow. While it is only temporary, it provides protection for the elbow and allows short term relief.

R.I.C.E

Rest the elbow as much as possible when you can as it will help to decrease the swelling and prevents the bursitis from worsening. When the pain subsidies, proceed to do simple but slow movements.

Ice allows the blood vessels to become smaller which will in turn decrease inflammation. Place crushed ice into a wet towel and place on the elbow for 15 minutes, four times a day. Or you can use a bag of frozen peas for convenience.

Compression prevents or reduces swelling. Wrap the injured elbow with an elastic bandage and make sure it is tight not to the extent blood flow is hindered. Take it off every 4 hours.

Elevating the elbow to below the heart level reduces swelling. Elevate the elbow when you are resting, especially during your sleep time. Place the injured elbow on several pillows.

Steroids

Doctors may opt to inject steroids which will help to decrease swelling and pain, providing relief. You may feel that you have fully recovered as you cannot feel pain and the swelling have subsided. However, do not exert stress n the elbow as it may worsen things.

Physiotherapy

Through the usage of ultrasound, increased blood flow to the area can be obtained. Slow and repeated exercises can increase the strength of the elbow and increase the range of motion, but only start it after the bursitis has healed.

Surgery

If the bursa is infected and antibiotics and drainage has no effect on it, surgery might be the only possible option left. The infected will be removed under general anesthesia, and this is often done together with the usage of oral antibiotics. After a few months, the bursa will grow back as an uninfected, perfectly normal bursa.

How to determine if an ankle is broken or just sprained?

Answer

The foot and ankle are complex parts of the body. Sometimes it is impossible to tell what the injury is without an X-ray or other tests, such as a bone scan or MRI (magnetic resonance image). Computed tomography (CT scan) is also helpful for seeing if there is serious damage to a bone. If there is pain, swelling, tenderness to touch, redness, decreased motion, and inability to put weight on the foot, then a visit to the doctor is necessary.

When in doubt, you can use the RICE advice. These four letters stand for Rest, Ice, Compression, and Elevation.

• Rest the sore ankle so it can begin healing.
• Ice the ankle for 20 minutes every three to four hours.
• Compress the joint with an elastic wrap or splint.
• Elevate the sore and swollen limb for 24 hours.

If after 24 hours the symptoms are much improved and it is possible to put full weight on the ankle, a fracture is unlikely. If there is little or no change in how the ankle looks and feels, see your doctor.

It is extremely important to attend to tendonitis as soon as you can to minimize long term pain. Plenty of rest and care will lessen the stress on the shoulder joints and allow it to heal.

1. R.I.C.E

Rest: Stop whatever activity that is causing that pain in the shoulder immediately. The shoulders will need to be rested for a minimum of 3 weeks and failure to comply with it would risk irregular repair of the injured tendon and that could possibly lead to more serious complications and possibly long term pain. Stop aggravating the injury!

Ice:  Apply ice immediately on the injured site as ice itself is anti-inflammatory. Ice is able to reduce the inflammation in the tendons. Apply ice regularly every 4 to 6 hours for 15 to 20 minutes and it will help to bring down the swelling.

Compression: Compression through the usage of a simple bandage reduces swelling caused by the inflamed tendon. Wrap the bandage firm and tight but there must be sufficient room for blood flow and expansion of muscles when they contract.

Elevation: Keep the injured tendon above the heart level so as to reduce blood flow and reduce pain and swelling. It reduces edema and also helps to rid waste from the area, allowing a faster healing rate.

1. Anti-inflammatory drugs:

Over the counter anti-inflammatory drugs such as Advil, ibuprofen or naproxen is used to reduce pain and inflammation of the tendon. These are basic treatments and can only provide a temporary relief.

1. Injection:

Localised injection has a high success rate of 70% and usually contains 2 medications, one to numb the shoulder and the other an anti-inflammation drug. The combination works quickly to reduce inflammation and pain. After the injection, it is required to rest for at least 48 hours.

1. Posterior stretching:

Often people with rotator cuff injuries have tight ligaments. This tightness can contribute to further movement abnormalities and pain in the shoulder.

Reach for the injured arm across the body at chest level, pull the arm closer to the body and hold for 30 seconds. Repeat this throughout the entire day, doing once every 15 minutes.

Lying on the back, extend both arms forward and towards the ceiling. Bend the elbows and hold the wrist of the injured shoulder with the left hand. Pushing the right arm down, you should be able to feel a strain on the shoulder. Hold for 30 seconds and repeat 8 to 12 repetitions.

I twisted and sprained my knee badly back in high school. I read once that having a bad knee injury can cause knee arthritis later in life. If so, I’m wondering if there is anything I can do now so I don’t end up with knee arthritis.

Answer

People who have had a significant injury of the knee joint may have a greater risk for knee arthritis in later years. Prevention includes safe exercises that focus on improving and maintaining joint movement and muscle strength.

Stay active in a low-impact conditioning program, such as walking. To help reduce shock with day-to-day activities, wear supportive shoes, and consider the addition of an insole to help absorb shock. Walk on soft surfaces when possible, and avoid standing and walking for long periods on hard surfaces, such as cement. You might also consider choosing sport and recreational activities that don’t require cutting, jumping, and quick starts and stops. The time and effort you invest now to improve the health of your knee and avoid future problems are worth it.