Jul 22
If you are a gay man or lesbian who is already in a partnership at the time of your injury, reestablishing a sexual relationship with your partner involves the same issues as those for heterosexual couples. If you are single, finding a new sexual partner depends on your self-esteem, social skills, communication skills, opportunities to [...] [...more]
Posted: under Healthy bones Osteoporosis Rheumatic.
If you are a gay man or lesbian who is already in a partnership at the time of your injury, reestablishing a sexual relationship with your partner involves the same issues as those for heterosexual couples. If you are single, finding a new sexual partner depends on your self-esteem, social skills, communication skills, opportunities to meet people, and ability to cope with stigma. To the best of our knowledge, virtually no research has been done on sexuality issues specific to gays and lesbians with spinal cord injury. We can speculate that sexual adjustment might be somewhat easier because gays and lesbians are more comfortable with sexual acts other than genital intercourse.If you live in an area with an organized gay community, you may be able to get informal support and information on these issues. If you feel a need for psychological or relationship counseling, many mental health referral services can recommend professionals who work with gay and lesbian issues.
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May 05
Ligaments are strong bands of connective tissue that connect bones to bones and provide strength and stability. Ligaments give the knee the necessary flexibility to move in different directions without throwing the leg off balance. If a ligament is injured—if it is stretched out or torn—it will allow for excessive movement, which may make the [...] [...more]
Posted: under Healthy bones Osteoporosis Rheumatic.
Ligaments are strong bands of connective tissue that connect bones to bones and provide strength and stability. Ligaments give the knee the necessary flexibility to move in different directions without throwing the leg off balance. If a ligament is injured—if it is stretched out or torn—it will allow for excessive movement, which may make the leg feel wobbly. There are several tests for stability that may help your physician determine which, if any, ligaments may be injured. In each of these tests, your physician will move each leg in such a way that stresses a particular ligament and will compare one leg in relation to the other. She will straighten, bend, flex, and rotate the leg. If the leg has too much slack—for example, if it “gives” too much in either direction—or if the patient feels pain, it suggests that that particular ligament is injured.
Ligament injuries are called sprains and are classified according to degree of severity ranging from grade 1, the most benign, to grade 3, the most serious. In a grade 1 sprain, the knee does not move excessively, which means the ligament is still intact; however, the patient may be in pain. In a grade 2 sprain, the knee will open up less than 5 millimeters. In a grade 3 sprain, the ligament will open all the way to 1 centimeter, and the knee is wobbly.
There are several tests that are commonly used to diagnose specific ligament problems.
Medial Collateral Ligament (MCL)
The MCL prevents the leg from turning to the outside. To test the stability of this ligament, your physician will apply a force to the outside of the leg and gently tug. If the MCL is intact, the knee will not move. However, if it’s torn or damaged, the knee will feel painful, or it will swing out too far.
Lateral Collateral Ligament (LCL)
The LCL prevents the leg from turning inside toward the other leg. To test the stability of this ligament, your doctor will apply force on the inside of your leg and pull it toward the other leg. If you feel pain or the leg rotates too much toward the other leg, it is a sign that the LCL may be injured.
Anterior Cruciate Ligament (ACL)
The ACL limits rotation and forward motion of the tibia. The Lachman test is often used to test the ACL. In this test, your doctor will put your leg in 10 to 15 degrees of flexion and then pull forward on the tibia, almost as if she’s trying to pull the tibia away. If the knee moves 3 to 5 millimeters or more from the other knee, it could signify a torn ACL.
Posterior Cruciate Ligament (PCL)
The PCL limits the backward motion of the knee. The posterior draw test is used to test the PCL. In this test, your doctor will bend your knee 90 degrees and push the tibia back. If it moves more than 5 millimeters, it’s a sign of a torn PCL.
In the right hands, stability tests can be very accurate. However, they must be done by an experienced practitioner who is able to discern subtle movements in the leg—so minute they can be measured in millimeters—and equally subtle differences between legs that may be clinically significant.
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Feb 09
Rheumatoid arthritis varies from being an acute disease with fever and sudden disability of many joints to a condition that develops gradually in which the patient may at first notice only stiffness or pain in one joint. Some may have deformity of a joint without ever having felt any pain. Sometimes the first signs of [...] [...more]
Posted: under Healthy bones Osteoporosis Rheumatic.
Rheumatoid arthritis varies from being an acute disease with fever and sudden disability of many joints to a condition that develops gradually in which the patient may at first notice only stiffness or pain in one joint. Some may have deformity of a joint without ever having felt any pain. Sometimes the first signs of rheumatoid arthritis are fatigue, loss of appetite and loss of weight. Patients complain of numbness and loss of feeling in hands and arms, feet or legs. On getting up in the morning and at the end of the day, the joints feel stiff. When swellings of the joints are noticed the condition is usually well advanced. The knees and the finger joints may be the first to give pain. Practically all the joints may be involved, however, including those of the spine.
Other signs and symptoms of rheumatoid arthritis are known and noticed by many people. The palms and soles are cold and clammy. Sometimes the lymph glands near the joint become swollen. The finger joints nearest to the wrist swell and the fingers pull to the sides in a distortion that gives the hand a “flipper-like” appearance. Because of failure to move and use the muscles around the swollen joint, the tissue breaks down and the area looks thin and wasted.
Rheumatoid arthritis is a condition that comes and goes. Doctors have noticed particularly that it disappears during pregnancy and during jaundice. These facts helped to reveal the specific effects of ACTH and Cortisone upon the disease.
Nodules appear under the skin in about one fifth of the cases of rheumatoid arthritis. These nodules may persist for months or years. Inflammations of the eye and red spots on the skin are also seen often in chronic rheumatoid arthritis.
Since arthritis is now recognized as affecting the body as a whole and not just the joints, the treatment is changed considerably. Nevertheless, the methods that helped when most of the attention was focused on the joints were not lost and are still valuable in a direct approach to the control of the pain and disability which are features of the disease.
The sooner good treatment can be applied to rheumatoid arthritis the better are the results secured in stopping the progress and the damage done by the disease. While the disease is active, rest and freedom from motion are helpful. If there is fever and severe pain certainly confinement to bed is desirable. Then as these troubles subside motion is permitted, but never to the point of fatigue. During the severe stages the patients are anxious and disturbed, often by solicitous people, and the doctor must protect the patient against emotional upsets.
No special diet cures arthritis. Nevertheless the patient with rheumatoid arthritis needs to be sustained with sufficient proteins, vitamins and minerals and enough carbohydrates and fats to provide needed energy and to avoid damage to tissues. Good animal proteins, calcium and iron must be adequate in the diet.
Europeans with arthritis go regularly to spring and mineral-water resorts, but there is no evidence that these are helpful beyond getting the patient away from his usual surroundings and under a well-regulated routine of rest, diet, baths, and physical therapy. Drugs are prescribed to relieve pain and permit rest. Bee stings, snake poison, and similar methods are not proved to have any real curative value beyond their psychological effect.
For many years a mainstay in treating arthritis has been the application of heat. Heat may be applied by hot bricks wrapped in towels, hot water botties, electric heat pads, infra-red heat lamps, heat cradles containing incandescent bulbs, and other methods. If many joints are involved relief frequently comes from a hot tub bath once or twice a day, but prolonged hot baths are weakening.
Doctors help the patient with painful joints by several devices which require medical knowledge and application. The orthopedic surgeons control movements by splints, braces, and casts. These have to be released several times daily to permit help by rubbing and slight controlled motion. A local anesthetic like procaine may be injected around a joint and relieve pain from the pulling of muscles and ligaments. New drugs are known of the curare type which prevent spasm of muscles and thus relieve pain. While preventing pain, the doctor must be sure there is sufficient motion to prevent wasting of the tissues. After long-continued arthritis deformity of joints may be so severe that surgical orthopedic procedures may be necessary to relieve crippling.
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Jan 26
The knee joint consists of many different components which must work in sync to provide maximum stability and mobility. In this chapter, I describe the different parts of the knee, what they do, and how they work together. The Fascia Fascia is a strong, fibrous structure that encases the leg, providing protection and support. A [...] [...more]
Posted: under Healthy bones Osteoporosis Rheumatic.
The knee joint consists of many different components which must work in sync to provide maximum stability and mobility. In this chapter, I describe the different parts of the knee, what they do, and how they work together.
The Fascia
Fascia is a strong, fibrous structure that encases the leg, providing protection and support. A taut layer of fascia can hold fat deposits under the skin in place, helping the knee to maintain a sleek appearance. As we age, however, fascia can lose some of its tone, which result in bulges of fatty tissue that can be mistaken for swelling. Due to the fact that women tend to be thinner than men, the bulging may be more noticeable in women.
Muscle
There are two groups of muscles that control the knee joint; the quadriceps and the hamstrings. Strong muscles are essential to protect and cushion bones and soft tissue (such as ligaments and tendons) by absorbing the enormous forces that run through the knee.
The quadriceps are a collection of four muscles on the front of the thigh. Along with the quadriceps tendon, the patella (kneecap), and the patellar ligament, the quadriceps are responsible for the extensor mechanism of the leg, that is, the ability to straighten the knee or bring the bent knee to a straight position.
The hamstring muscles, on the back of the thigh, come down from the hip and the pelvis and insert below the knee. They control the knee by allowing it to go from an extended or straight position to a bent position.
The Capsule
The capsule is also a thick, fibrous type structure that wraps around the knee joint. Inside the capsule is soft tissue called synovium. If the knee is injured, the synovium can become inflamed and will secrete excess synovial fluid as a protective mechanism. Inflammatory arthritis, such as rheumatoid arthritis, affects the synovium, which hypertrophies (thickens), secretes fluid, and can potentially destroy the articular cartilage and bone.
Tendons
There are two major tendons about the knee: the quadriceps tendon and the patellar tendon.
By definition, a tendon connects muscle to bone. However, the patellar tendon connects the patella (kneecap) to the tibia (shinbone), which means that the patellar tendon is really a ligament. Through the years, this ligament has become known colloquially as a tendon, and to prevent confusion, I will call it the patellar tendon throughout this book.
The quadriceps tendon connects the quadriceps muscle to the patella and thus provides power for leg extension.
Overuse of any tendon can result in tendinitis, which may cause local pain and tenderness.
Plicae
Plicae are embryological remnants of synovial folds—basically a dividing line along the joint in the embryo. As the embryo matures, the dividing lines are no longer needed, and they often rupture spontaneously. However, these long, elastic plicae (similar to rubber bands) remain in about 70 percent of all people. Plicae rarely cause problems; however, in some cases, the bands or folds can get caught between the femur and kneecap and can cause pain.
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