Duputyrens Contracture

Why Can’t I Straighten My Finger ?

Duputyrens Contracture is often called the Viking disease as its very much related to North European heritage. Perhaps the incessant rowing over the hazardous North Sea and then clutching those heavy swords which they used with such effectiveness to diplomatically show the early residents of York and the North what the Vikings could do for them.

What Happens to my Finger in Duputyrens?

Amongst the many gifts from the Vikings was this contracture which happens particularly to people with a bit of Viking in them..it happens over time especially in those aged 50 or over – What doesn’t? . The first symptoms may be the inability of putting your hand in a pocket as the outermost fingers start to contract. This is followed by usually the outermost fingers starting to flex over, putting on gloves proves tricky and handshaking can prove awkward (but in these days of corona virus may be seen as an advantage.)

duputyren
Duputyrens Contracture

So What Happens in Duputyrens?

Overtime a sufferer may feel a thickening of the skin particularly over the palm near the last two fingers, the skin may pit a bit as the tendon pulls on skin and eventually a hard fibrous nodule is felt. When this becomes severe the ring or little finger may buckle over and lead to tears in the skin. Thankfully the thumb is never affected in this condition as this would lead to far more disablement. Indeed the history of these Isles would be different as the poor old Vikings’ swords would have dropped out of their hands and have had to return to Sweden as laughing stocks.

Causes of Duputyrens

Nobody knows. That’t the problem apart from the heritage. This condition certainly runs in families and there does seem to be a link to people who are diabetic. Of course the fun things in life like alcohol and tobacco seem to be heavily linked as well, and certainly if you have blond hair , wearing a helmet with horns, and finding the grip lessening when you hold a sword now would be the right time to give up the fags and alcohol.

Complications of Duputyrens

One thing for sure you’re not going to die of this condition which should be a relief to many. However the problem lies that it can cause varying degrees of disablement for example writing / holding a pen can become impossible. You can imagine life if you’re a keyboard warrior (the modern equivalent of working with your sword). Your hand would never be able to tackle such a modernity. Simple things like getting things from you pocket become problematic.

Treatment Possibilities for your contracted hand

Certainly in the initial stages stretching your fingers and Osteopathic Manipulation may well help symptomatically, by breaking down some of the hard chords however this may be a temporary event. Studies have shown that Acupuncture or needling around the tendon can certainly help alleviate pain and some studies suggest that it may provide benefit for a period. So if it has started it is certainly worth having some treatment to try and help alleviate this problem.

If your fingers are curled over and is now totally inflexible then there are two choices:

  1. The first is a drug called Xiaflex, (but recently having spoken to a hand consultant who told me this is very difficult to obtain on the NHS now due to cositng (surprise surprise!), however if this is obtainable by whatever means then this substance is injected around the fibrous part of the tendon and after a few days the fingers are manipulated and you may feel a painless “pop” as the finger straightens. Duputyrens can return of course and the advantage is this treatment can be repeated.
  2. Surgery: The final resort if nothing else helps, this can be curative , but after such surgery it takes a few weeks to regain full use and of course the main disadvantage of surgery is it is surgery.

Finally if you think you may have a problem with your fingers or this condition might be starting give me a call as its fairly easy to diagnose and some treatment can be initiated to help bring back some function.

Sitting Comfortably

In the last blog I went through the cons of sitting too long and on the whole it didn’t make comfortable reading.

So much so that in the last week I am sure many of you have resorted to become like horses in a state of perpetual standing and only when exhaustion takes over do you take or fall into a seat or even a recliner due to fear.

Sitting on throne
Sitting on throne

Certainly Medical Studies do suggest that all standing and sitting postures are often accompanied by pains. These pains can come from many anatomical structures including joint, connective tissues and muscles.

As in all good research its the detail that counts. Fear not your sitting days will come back and you will not have to suspend yourself in mid air for eternity.

This is because it is now fairly well established that these symptoms only establish themselves if there is already an underlying weakness, and may also be the symptoms of chronic diseases attributed to rheumatic disorders.

What seems to occur is that when sitting or standing incorrectly leads to a rise in intra – discal meaning the pressure in the shock bearing discs can increase leading to both disc wear and degeneration and in some cases may increase the likelihood of disc prolapses which in turn can cause such painful conditions as back pain and Sciatica (pain running down the leg from pressure on the Sciatic nerve)

Sitting causes the pelvis to rotate backwards and the lumbar lordosis to reduce. 

So it now becomes straightforward to start recommending the type of seating that may benefit your sitting habits as it is shown beyond doubt via electromyogram studies (these studies show how much a muscle is contracting) that lumbar support and also armrests both have the function of reducing disc pressure

The Best Type of Seats

So the nuts and bolts are as follows:

The optimal seat would have an adjustable seat back inclining backward to 100 degrees from horizonal, an adjustable height, and also something to help you adjust the inclination of the bottom of the seat. To help the pelvis it is also important to be able to adjust the edge of the seat bottom. It is also important to be able to adjust the arm rest.

if you really want to go hight tech you could add some pulsation to the lumbar support as this additionally helps to reduce static load.

Finally the good news is that ultimately what constitutes a good seat is the one in which you feel comfortable. Certainly you can add specialities to it but this is obviated if you are not comfortable, and the additional price tag will add discomfort.

So go out and buy a reasonable chair make sure it has some lumbar support and arm rests as a minimum. Above all don’t forget to get out of your chair as this is by far the most important aspect!

The Office and How to Survive it from a Sitting Point of View

The office whether we like it or not is the place where most of us will while away a third of our lives whilst employed in an office.

Questions are often asked as to how sitting might help mitigate the worst excesses of sitting all day and whether buying highly expensive seating from bespoke shops advertising enhanced seating experiences may help reduce the potential problems that extended periods of seating may confer to the sitter.

In a series of a few articles I aim to take you on a seated journey to explore the anatomy of sitting and what it does to you, (not a pleasant journey).

Should you manage to sit comfortably at the end of the article(s), not only will you be healthier, and in less pain  but you may also have saved yourself a lot of hard earned money by buying a chair that is both comfortable and reasonably priced.

Sitting
My Back Hurts

Why Sitting too Much in an Office is Bad

So let’s start with the cheerful stuff first:

  1. Sitting too long hurts the heart in many studies including one done on bus conductors (when we had them) and drivers.  The drivers had twice the frequency of heart disease as those like the conductors who walked about.
  2. You are more prone to diabetes. It is not known exactly why, but the body whilst sitting seems to change its way it reacts to insulin the hormone that regulates your sugar level.
  3. You are more prone to DVT (Deep vein thrombosis), which in essence can kill you. The mechanism here is that your leg is flexed for prolonged periods and a clot can develop and travel towards your vital organs e.g. brain or heart.
  4. In a similar vein it can also cause varicose veins, again the prolonged sitting leads to increased pressure in the veins and if the valves which help contain the venous blood from flowing back stop working efficiently varicosities ensue.
  5. Osteoporosis is an added risk, from prolonged sitting bones aren’t getting forces through them which allow them to strengthen, which over time leads to a weakening of bone structure and makes people more prone to fractures.
  6. Sitting leads to increased disc pressure which increases the likelihood of disc problems such as herniations and prolapses. (More of this later)
  7. If I haven’t depressed you just yet, and as I get into the swing of warnings there is also the increase risk of cancer of the colon, endometrial and lung cancer.
  8. The final nail in the coffin is that sitting too long can shorten your life.

Now my mission is to very gently cheer you up.

Before this though let’s just debunk some of the more common perceptions of what the overall problem with “research” into correct seating is:

Firstly, when sitting people often have difficulty in telling which chair is the more comfortable whilst chairs have been graded into a hierarchy of ergonomic capabilities. Sitting in different chairs becomes indistinguishable because differences are difficult to perceive.

All spinal joints are attached by tendons and ligaments and via a complex of nerves via what is called a proprioceptive feedback (Cells in and around your joints convey back to the brain exactly where you are and at what angles which in turn relaxes and tenses different muscles to make you stable and not topple over.).

Joints are relatively insensitive to small angular changes as a result the spine does not recognize so easily small changes in posture.

As humans though we do perceive comfort. When were not comfortable most of us are not happy.  We therefore will always move the body into a position of maximum comfort.

In the end we it is comfort more than anything else which must drive our decision.

On this cliff-hanger I will add on this article next week to conclude the various options and what can be done both to extend your lives and help you sit more comfortably.

If you can’t wait for the next episode you can contact me anytime and although I won’t be able to give the plot away completely, I will ensure a peaceful week of sitting.

Shoulder Instability

Shoulder Instability

When Shoulder Instability was first Recognised:

Shoulder instability has not been new , and has been recognised over 3000 years ago on Papyrus in Egypt. Hippocrates used the old fashioned technique of placing a heel in the axilla of the unfortunate injured person and applied traction and with various degrees of success helped to “put the shoulder back in the right place. 

Dynamic Anatomy of Shoulder Instability

There are a group of Static stabilisers including:

The Dynamic Stablisers include:

  1. Bony
  2. Labrum
  3. Glenohumeral Ligaments
  4. Coracohumeral Ligaments
  5. Capsule
  6. Negative pressure (which helps “suck in arm to shoulder”.
  1. The rotator cuff
  2. Biceps
  3. Scapula stabilisers.
  4. Proprioreceptors

Anatomy of Instability

Instability happens when one of the above structures goes wrong eg the labrum a soft tissue lining that cloaks the joint may weaken, as it also is the anchor for ligaments.

There is good news as when we age this shoulder bone stiffens and becomes stronger reducing the propensity to disclocation.

The ligaments above the joint (the superior glenohumeral ligaments act as a restraint fo inferior/ posterior translation

The middle gleno humeral ligaments act as a restraint for inferior translation and also limits external rotation.

Testing the Shoulder

For any shoulder issue a general range of motion is done to see how far the shoulder will move, along with seeing how strong all the particular strengths and range of movements are: (external rotation, internal rotation, flexion and extension).

A very simple test is to just see how far down you can pull the shoulder instablility shows if the joint can be pulled down and show a dimple in the shoulder. This is called the sulcus sign.

The patients overall laxity must also be assessed. Generally as an overall test for laxity the mobility  of fingers, thumbs, elbows, knees and palms to ground is assessed.  A score of above 6 indicates hyper-mobility. This is often found in conditions such as Marfans and Ehler’s – Danlos syndromes.

The other tests that are done are X Ray , MRI arthrogram, and CT arthrogram.

Types of Instability

 Shoulder instability leading to anterior dislocation is at 90% the most common, which affect 2% of the population, around 90% of these occur under the age of 20, 14% recur after the age of 40.

Posterior dislocation comprise only 2 -5% of shoulder dislocations in such cases patients are unable to externally rotate their arm.

 Surgery For Recurrent Dislocations

 If a shoulder dislocates too often or recurs then surgery should be considered. This is particularly the case when there is structural pathology and when this occurs ligaments can be  tightened , and any looseness of the joint capsule repaired.

What Can Be Done Before Dislocation?

If a shoulder shows signs of instabilty there are plenty of shoulder strengthening exercises that can be done to address this issue.

Osteopathy and Acupuncture

Are very useful tools that can help both help ensure better stability, and is helpful in the post surgical rehabilitation where there might be residual stiffness and awkwardness in movement.

The SacroIliac Joint. What can help?

The SacroIliac Joint. What can help?

The SacroIliac joint is the joint that attaches the spine via the Sacrum to the pelvis. It is a joint with cartilage much in the same way as the hip or knee.

The Sacroiliac joint also demonstrates movement in all directions, and the Sacroiliac joint and its surrounding areas has a lot of nerves, which help transmit pain.

Function of the Sacroiliac Joint

Its main function is to provide stability, motion and to also provide protection of internal organs and structures.

It is a rather immovable joint. In women its mobility increases during pregnancy to allow the passage of a baby, which helps open up the pelvis during childbirth.

Prevalence

There is a 13-30% incidence of SacroIliac pain in patients with low back pain. The SacroIliac joint can also become diseased in a inflammatory condition called sacroiliitis. This can be the start of an inflammatory disease called Ankylosing Spondylitis where the ligaments around the spine calcify and eventually fuse.

The other interesting thing to note is that 43% of pain in the SacroIliac joint comes about after spinal fusion. So the Sacroiliac joint is a significant source of pain after lumbar fusion.

This is thought to come about because sometimes the diagnosis of Sacroiliac joint is missed! Furthermore after a fusion more strain is put opon the Sacroiliac Joint which then becomes symptomatic.

In terms of health burden SacroIliac pain is roughly equivalent to hip Osteoarthritis, Spinal Stenosis, Knee Osteoarthrits and Chronic depression 

Referral Patterns

SacroIliac pain can frequently refer into the groin, but also to the side of the leg, and occasionally down the back of the leg. 

This sometimes makes diagnosing Sacroiliac patterns difficult as low back pain and leg pain often overlap.

However with a good Osteopathic examination it is relatively straightforward to diagnose whether pain is coming from this joint. 

Treatment

Once a diagnosis of Sacroiliac dysfunction is made, then treatment can be initiated.

Osteopathy is the number one choice where stretches are made to the joint, which helps return it to normal function which in turns helps reduce any inflammatory changes.

The joint is large and is usually quite stiff and sometimes difficult on which to use manipulative treatment.

In such a case Acupuncture is used as this has the advantage of not having to use any form of manipulative treatment, helps stimulate blood flow and is effective at reducing pain in the area.

Osteopathy For a Painful Foot?

Painful foot

This short article will describe how osteopathy for a painful foot is helpful. I will concentrate on the forefoot as this is the area more commonly afflicted with painful conditions that bring patients for osteopathic treatment.

The painful foot is the basis on which all movement relies. If the foot goes wrong we are then unable to walk properly and in many cases because our walking is affected via limping and altered gait, it then throws pressure on other parts of our body eg knees, hip , and spine and these can become painful.

There are many conditions but here will talk about the most common conditions affecting the foot particularly the front.

Bunion (Hallux Valgus)

In this painful foot condition the main symptoms are:

  1. Painful swelling on the side of the first toe
  2. Limited movement as in push off when walking
  3. Pain in rest and in walking, unable to run.
  4. May have pain up the body eg knee , hip or buttock from uneven walking.

This has been talked about before on a previous blog foot problems. As an add on it should also be noted that there is often rigidity and pain on flexing the toe. This is due to osteoarthritis and though Osteopathy may help sometimes it is necessary or desirable to seek further help.

The further problem of a bunion is that a person cannot walk properly due to the pain and transfers weight to the other part of the foot for example the second toe and pain is experienced here.

In some people the pain can spread to the rest of the forefoot which is called metatarsalgia and comes about when the forefoot takes on all the weight due to the bunion.

it is for this reason that a bunion needs to be taken seriously as it can cause a lot of pain and problems elsewhere. Painful

Osteopathy For A Painful Foot

Acupuncture is helpful in reducing the pain, and inflammation as osteopathic manipulation of the toe and fore foot, helps increase mobility.

if pain though ensues or there is too much rigidity then surgery may be necessary.

Here a small amount of bone is taken away to give a more even look and takes of some of the strain on the joint thereby reducing pain

References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528062/

Case of Knee Pain caused by Hip problem.

Case of Knee Pain caused by Hip problem.

In this blog I am highlighting an interesting case history of knee pain, caused by a hip problem.

I have written on cartilage tears for knee pain before. I want to write about some interesting cases whose outcome may come as some surprise.

Knee Pain

I want to write about an interesting case of knee pain caused by a hip problem. What you initially suspect is not always what it seems.

This case of knee pain concerns a 56 years old man who complained of right sided knee pain, over an eighteen month period. He had previously seen his GP, Physiotherapists, and another Osteopath.

Eventually he saw an Orthopaedic surgeon who found a tear in his cartilage.

No arthritis was found and the tear was deemed to be the cause of his pain. He was advised to undergo arthroscopic surgery. The outcome was that he still had exactly the same amount of knee pain after this surgery.

Treatment had not relieved any of his symptoms of pain and restriction, and he had difficulty walking any distance, and he walked with a walking stick.

Knee Examination

On recommendation he consulted me and the remarkable things was that his knee had a normal amount of movement and could flex and extend his knee normally.

I then examined his hip joint which was painful and restricted on rotation. This immediately suggested the possible start of hip Osteoarthritis.

I then proceeded to treat his hip with Osteopathic manipulative treatment to try and increase the movement, and lessen the pain in this area suspecting that this area might indeed be the cause of his pain.

within a few weeks all his symptoms had gone, and was able to walk without pain.

Case of knee pain caused by hip problem

This was a more unusual case in which his hip joint was actually referring pain into his hip.

This can happen as inflammation around the hip can be a cause of knee pain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336883/

This is a good example of why it is important for an Osteopath o look around the body for tissue that may refer pain to other parts of the body.

It is always wise to have your body checked to make sure there are no patterns emerging that may lead to your body not working as it should.

If you have any niggles that just aren’t going away give a call on

020 76921818 to get your body working efficiently again!

Paracetamol for Back Pain?

Does Paracetamol Help Back Pain 1
Does Paracetamol Help Back Pain

Does Paracetamol Help Back Pain?

As recently as 2014 with regard to paracetamol for back pain there was a paper in the lancet which suggested paracetamol for back pain was of almost no effect in the treatment of back pain. (The Lancet 2014; 384(9954): 1586-1596). https://www.sciencedirect.com/journal/the-lancet/vol/384/issue/9954

Sifting through the evidence though it seems paracetamol may still have a place, which helps answer the quandy of paracetamol and back pain?”.

Paracetamol for low back pain

Has been an over the counter medication that has been used over years to help reduce low back pain.  Studies have suggested that paracetamol for back pain is of little or no benefit to low back. These studies have not had many subjects in them to reach any definitive conclusion.

Recently studies have been done which was much larger where low back pain subjects were given ad hoc paracetamol for acute flare ups and some were given regular paracetamol.

The results showed that neither regular nor as required paracetamol improved recovery time as compared to a placebo.  There was additionally no effect on function, disability or pain and as a result there was no symptom change in sleeping or quality of life. There was also no increase in recovery time.

However, looking more carefully at the results although paracetamol does not alter the recovery from back pain it is still “mildly useful” in helping pain on a short term basis including on an “as needed basis”.

I advise patients in pain to try and see if it helps as the great thing with paracetamol is that unlike anti-inflammatories, it does not cause heartburn or aggravate the stomach.

The more noteworthy aspect is that manipulation and or Acupuncture are both superior to just paracetamol and in many cases not only reduces pain quicker but also curtails a low back event enabling a patient to get back to normal activities quicker, and as a result not having to take any medication!

If you do suffer back pain give a call and help will be there to get you off your Paracetamol.

Paracetamol and back pain
paracetamol

Sciatica Can it be helped?

SIGNS OF SCIATICA

 It is not always a disc that can cause this disturbance as it can also be caused by restrictions in movement particularly in the foraminal space (which is the space between the vertebrae through which the nerve travels) where the nerve exits the spine which can cause tethering or adhesions along the tract of the nerve which leads to  sciatica like symptoms.

Soft Tissue Compression

Compression from soft tissues which may be tight or sitting in an awkward position eg on a wallet can compress on that nerve and cause sciatica like symptoms.

Within the catchment of low back is a subgroup of Sciatica whose lifetime prevalence is 4 -5%.  Sciatica though   is a syndrome rather than a diagnosis, Very often caused by a disc compressing on a nerve in the lumbar spine which gives changes in motor or sensory feeling down the leg.

There can also be a double compression syndrome. Where two points along where the nerve runs become constricted which causes sciatica like symptoms.

The nerve itself can become inflamed causing a neuritis which again can cause symptoms of Sciatica going up and down the leg.

Sciatica like symptoms usually involve pain in the spine which refer pain down through the buttock and into a leg often going all the way down into the leg and foot. Typically, it is usually just one side that is affected. It

If Pain affects both sides or radiates down into both legs then this has to be looked at more carefully as more serious conditions may cause these problems.

Pain can be mild in character can be severe or sharp, burning, lancing or electric shock type symptoms.  Pins and needles can accompany this, burning sensations, weakness often e.g. limping can accompany this condition.

Sciatica can be short lived but, in many cases, can go on for months and sometimes years.

Sciatica can generally be helped with Osteopathy and Acupuncture is a very good adjunct to help in the painful and debilitating condition.  As nerve is affected these conditions can take longer than normal to help, and if cases don’t respond fairly quickly scans are needed to rule out other pathologies that can cause Sciatica.

If you have Sciatica do contact me and I will be pleased to advise If treatment may be of benefit.

https://www.bmj.com/content/334/7607/1313?flh=

https://www.sciencedirect.com/science/article/abs/pii/S1521694209001417

SIGNS OF SCIATICA

 It is not always a disc that can cause this disturbance as it can also be caused by restrictions in movement particularly in the foraminal space (which is the space between the vertebrae through which the nerve travels) where the nerve exits the spine which can cause tethering or adhesions along the tract of the nerve which leads to  sciatica like symptoms.

Soft Tissue Compression

Compression from soft tissues which may be tight or sitting in an awkward position eg on a wallet can compress on that nerve and cause sciatica like symptoms.

Within the catchment of low back is a subgroup of Sciatica whose lifetime prevalence is 4 -5%.  Sciatica though   is a syndrome rather than a diagnosis, Very often caused by a disc compressing on a nerve in the lumbar spine which gives changes in motor or sensory feeling down the leg.

There can also be a double compression syndrome. Where two points along where the nerve runs become constricted which causes sciatica like symptoms.

The nerve itself can become inflamed causing a neuritis which again can cause symptoms of Sciatica going up and down the leg.

Sciatica like symptoms usually involve pain in the spine which refer pain down through the buttock and into a leg often going all the way down into the leg and foot. Typically, it is usually just one side that is affected. It

If Pain affects both sides or radiates down into both legs then this has to be looked at more carefully as more serious conditions may cause these problems.

Pain can be mild in character can be severe or sharp, burning, lancing or electric shock type symptoms.  Pins and needles can accompany this, burning sensations, weakness often e.g. limping can accompany this condition.

Sciatica can be short lived but, in many cases, can go on for months and sometimes years.

Sciatica can generally be helped with Osteopathy and Acupuncture is a very good adjunct to help in the painful and debilitating condition.  As nerve is affected these conditions can take longer than normal to help, and if cases don’t respond fairly quickly scans are needed to rule out other pathologies that can cause Sciatica.

If you have Sciatica do contact me and I will be pleased to advise If treatment may be of benefit.

https://www.bmj.com/content/334/7607/1313?flh=

https://www.sciencedirect.com/science/article/abs/pii/S1521694209001417