GLUTEAL STRAIN

A gluteal strain is a stretch or tear of a muscle in your buttocks called the gluteal muscle.

This type of injury is often called a pulled muscle.

WHAT IS THE CAUSE?

A gluteal strain most often happens when you are running or jumping. It’s a common injury for hurdlers and dancers.

WHAT ARE THE SYMPTOMS?

A gluteal strain causes pain in the buttocks. You may have pain when you walk up or down stairs and pain when you sit. You may have pain when you move your leg backward.

HOW IS IT DIAGNOSED?

Your healthcare provider will ask about your symptoms, activities, and medical history and examine you.

HOW IS IT TREATED?

You will need to change or stop doing the activities that cause pain until your muscle or tendon has healed. For example, you may need to swim instead of run.

Your healthcare provider may recommend stretching and strengthening exercises to help you heal.

A mild strain may heal within a few weeks. A more severe strain may take 6 weeks or longer to heal.

HOW CAN I TAKE CARE OF MYSELF?

To help relieve swelling and pain:

Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the sore area every 3 to 4 hours for up to 20 minutes at a time.
Do ice massage. To do this, freeze water in a Styrofoam cup, then peel the top of the cup away to expose the ice. Hold the bottom of the cup and rub the ice over the painful area for 5 to 10 minutes. Do this several times a day while you have pain.
Take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen or naproxen, may cause stomach bleeding and other problems. These risks increase with age. Unless recommended by your healthcare provider, do not take an NSAID for more than 10 days.
After you recover from your injury, moist heat may help relax your muscles and make it easier to use them. Put moist heat on the sore area for 10 to 15 minutes before you do warm-up and stretching exercises. Moist heat includes heat patches or moist heating pads that you can buy at most drugstores, a wet washcloth or towel that has been heated in a microwave or the dryer, or a hot shower. Don’t use heat if you have swelling.

Follow your healthcare provider's instructions, including any exercises recommended by your provider. Ask your provider:

How long it will take to recover
What activities you should avoid and when you can return to your normal activities
How to take care of yourself at home
What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup.

HOW CAN I HELP PREVENT A GLUTEAL STRAIN?

Warm-up exercises and stretching before activities can help prevent injuries.

EXERCISES

You may do the first 3 exercises right away.

Single knee to chest stretch: Lie on your back with your legs straight out in front of you. Bring one knee up to your chest and grasp the back of your thigh. Pull your knee toward your chest, stretching your buttock muscle. Hold this position for 15 to 30 seconds and then return to the starting position. Repeat 3 times on each side.
Gluteal stretch: Lie on your back with both knees bent. Rest the ankle on your injured side over the knee of your other leg. Grasp the thigh of the leg on the uninjured side and pull toward your chest. You will feel a stretch along the buttocks on the injured side and possibly along the outside of your hip. Hold the stretch for 15 to 30 seconds. Repeat 3 times.
Gluteal Sets: Lie on your stomach with your legs straight out behind you. Squeeze your buttock muscles together and hold for 5 seconds. Relax. Do 2 sets of 15.
You can do the rest of the exercises to strengthen your gluteal muscles when the sharp pain goes away and you have just a dull ache when you do the gluteal sets.

Prone hip extension with bent leg: Lie on your stomach with a pillow under your hips. Bend the knee on your injured side. Draw your belly button in towards your spine and tighten your abdominal muscles. Lift your bent leg off the floor about 6 inches (15 centimeters). Keep your other leg straight. Hold for 5 seconds. Then lower your leg and relax. Do 2 sets of 15.
Resisted hip extension: Stand facing a door with elastic tubing tied around the ankle of your injured side. Knot the other end of the tubing and shut the knot in the door near the floor. Draw your abdomen in towards your spine and tighten your abdominal muscles. Pull the leg with the tubing straight back, keeping your leg straight. Make sure you do not lean forward. Return to the starting position. Do 2 sets of 15.
Resisted hip abduction: Stand sideways near a door with your injured side further from the door. Tie elastic tubing around the ankle on your injured side. Knot the other end of the tubing and close the knot in the door near the floor. Pull the tubing out to the side, keeping your leg straight. Return to the starting position. Do 2 sets of 15. For more resistance, move farther away from the door.
After these exercises get easy, strengthen your buttock muscles by doing lunges.

Lunge: Stand and take a large step forward with your injured leg. Keep your trunk upright. Dip your other knee down toward the floor, bending your back leg. Then step back to the starting position. Do 2 sets of 15.
Developed by RelayHealth.
Published by RelayHealth.
Copyright ©2014 McKesson Corporation and/or one of its subsidiaries. All rights reserved.
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DYSPAREUNIA: PAIN HAVING SEX

Dyspareunia is a term used for pain felt in the genital area or pelvis during or after having sex (intercourse). Nobody really knows exactly how common it is, as many women never seek medical help. However, questionnaires asking women if they have symptoms suggest that somewhere between 1 and 4 out of 10 women experience it. Most commonly, this is early in their sexual lives or around the menopause.

There are many causes of dyspareunia, most of which are not serious or damaging in nature, but all can be detrimental to your sex life and ultimately may lead to relationship difficulties. It can be a vicious circle, with pain leading to nervousness about having sex, and nervousness leading to dryness and further pain.

It's also not uncommon for dyspareunia to remain after the cause has been treated, particularly if things have been left untreated for a while. For this reason, it is important to seek help early, so that treatable causes can be discovered and managed. This leaflet discusses the types and possible causes of dyspareunia.

What is dyspareunia?

Dyspareunia is pain felt in the genital area or  pelvis during or after having sex (intercourse). It may be thought of as either superficial dyspareunia or deep dyspareunia. They have different causes and treatments and, although it's possible to experience both at the same time, most women find that their dyspareunia is predominantly one or the other type.

Superficial dyspareunia

This is pain felt in the lips of the vagina (labia), at the vaginal entrance (introitus) and the lower part of the vagina. It typically begins with penetration or very early on after intercourse has begun. It is sore and instant. It is usually quickly relieved by stopping penetration, although you may be sore to the touch afterwards for a little while. The causes of superficial dyspareunia are usually local problems of the labial, vaginal and perineal skin (the perineum is the area of skin between the vaginal opening and the back passage).

Deep dyspareunia

This is the term for pain felt deeper in the pelvis during or after intercourse. It can also spread to involve the fronts of the thighs. It may be sharp or dull, may stop when penetration stops or can continue for minutes or even hours. The causes of this type of pain usually lie rather deeper in the pelvis.

Causes of superficial dyspareunia

Skin bridge

Formation of a little bridge of scar tissue at the very back of the vaginal entrance (introitus) is common after childbirth, particularly if you have had a cut between the vagina and back passage (anus) - a procedure called episiotomy. The scar tissue contains nerve endings and is very sensitive, and so it causes pain on penetration. The pain tends to become worse as having sex (intercourse) continues, as the skin bridge becomes rubbed by the continuing rubbing of penetration.

Intact hymen

The hymen is a membrane that lines the vaginal opening. Early in your sex life the hymen is broken down by the act of having sex. In many young women it will already have been stretched by use of tampons. The name 'intact hymen' is misleading, as the hymen does in fact have a small hole in it from birth. This hole becomes larger little by little as girls grow older. However, the hymen can be quite thick and the hole not quite large enough. This can mean that early in her sexual life a woman my feel pain from the hymen as it is forced open the first time she has intercourse. The pain is superficial, felt at the entrance to the vagina as soon as penetration is attempted and may prevent it from taking place.

Vaginismus

Vaginismus causes a powerful and often painful contraction of the muscles around the entrance to the vagina, which makes penetration painful or impossible. It may also prevent the use of tampons and any sort of gynaecological examination. The spasm of vaginismus is not something you can cause deliberately; it's completely outside your control. It may seem to begin for no reason but can also result from a painful or worrying experience of sex, when it becomes a kind of protective reflex. However, vaginismus is upsetting and dispiriting for both halves of a couple, as it can prevent the enjoyment of sex for many years and can prevent sex completely. Once it has begun, fear of failure and nervousness about not being able to have sex make it worse. It's important to seek help to break the cycle of anxiety and pain. Vaginismus is not difficult to treat but your doctor may need to refer you to a psychologist or specialist physiotherapist.

Bartholinitis

Bartholin's glands are a pair of glands on either side of the vagina, in the tissues of the wall. They can become inflamed and tender causing Bartholinitis and this will lead to pain during sex. Occasionally, the glands swell during sex, so that it starts off as painless but then becomes painful as it continues. See separate leaflet called Bartholin's Cyst and Abscess for more details.

Vulvodynia

This is a very troublesome condition where the vulval area becomes painful and extremely sensitive to pressure and touch. It can be accompanied by severe pain on attempted penetration. It can also cause the vulval area to be painful touched and during activities of everyday living. It can lead to frustration and depression, as symptoms can be very long-standing. The causes are uncertain but may involve the nerves in the area becoming much more sensitive than normal and the way the brain communicates wtih these nerves changing in some way. Treatment includes the use of emollient soap substitutes, creams that numb the area, medicines that lessen pain, physiotherapy and cognitive behavioural therapy.

Lichen sclerosus

This is a scarring skin condition which may affect women of any age, including children. It can affect men too. It results in thinning of the skin of the genital area, together with formation of white patches. It may be caused by the immune system. It causes itching and pain, which can last for a very long time. It's often mistaken for thrush as it can be very itchy and sometimes slightly sore. Lichen sclerosus carries a small risk risk of cancer of the genital skin. For this reason it should be diagnosed and treated - treatment is usually with regular application of creams.

Female genital mutilation

Female genital mutilation (which used to be known as female circumcision), involves varying degrees of mutilating surgery to the genitals of a girl. In the more extreme forms, the vagina is stitched shut. Following genital mutilation there is usually permanent scarring, which may lead to damaged nerves and pain. Any of these issues can cause pain on penetration and may make sex impossible.

Vaginal abnormalities

Very rarely, abnormalities of the vagina itself make sex painful or even impossible. These include pieces of extra tissue inside the vagina which are present at birth (vaginal septa).

Causes of superficial and deep dyspareunia

Vaginal trauma

The vagina is pretty flexible and strong and usually recovers well from the stretch and (sometimes) small tears of childbirth. However, more significant injury to the vagina - for example, from difficult childbirth or mutilation - can lead to scarring and then to pain and difficulty during sex (intercourse).

Vaginal or genital infection

Infections of the vagina and the area around it cause inflammation of the tissues and so commonly cause pain on having sex. Infection may be with thrush (candida - a yeast that often lives in the bowel), with viruses such as herpes and with germs (bacteria). A wide range of bacterial infections can infect the vagina. Some (but by no means all) are sexually transmitted. The vagina is not always sore and itchy before sex but becomes so afterwards. There is often a coloured discharge and you may notice an offensive smell.

Vaginal dryness

Sometimes pain during sex is due to lack of lubrication, meaning that the vagina is too dry. Normally, the vagina produces secretions which keep it moist and these increase when you become sexually aroused. If there isn't enough foreplay, or you are not aroused enough, you may not produce enough secretions to make penetration comfortable.

However, it isn't always as simple as that. There may be reasons why you don't produce the secretions that you should. These can include psychological reasons such as nervousness because sex has previously been uncomfortable; anxiety around becoming pregnant; or anxiety around waking your sleeping children. Dryness can also be for physical reasons - the vagina tends to be drier after the menopause (see below). Some medicines can cause vaginal dryness, including some contraceptive methods. Vaginal dryness is also associated with a condition called Sjögren's syndrome, in which the body's secretions are generally rather reduced. Finally, pregnancy itself can make the vagina dry during intercourse (although it can also have the opposite effect).

Vaginal atrophy

After the menopause the levels of hormones in your body fall - particularly the level of oestrogen. Oestrogen is the hormone that keeps the vaginal wall strong and resistant. It increases the blood supply and the level of secretions and makes the wall softer and more stretchy. Therefore, when oestrogen levels fall after the menopause, the tissues become thinner, less stretchy and less well lubricated. Sometimes they can become as fragile and delicate as the vaginal tissues of young girls (who have not yet reached puberty and started their periods). There are lots of very effective treatments for this problem.

Causes of deep dyspareunia

Deep dyspareunia can be caused by the genital organs themselves but may also be caused by other structures in the tummy (abdomen) that can be easily knocked during sex (intercourse). There are therefore many possible causes of deep pain in the tummy during sex.

Cervical pain

The neck of the womb (cervix) should not normally be painful. However, if can become infected by many of the organisms which can infect the vagina - particularly herpes. If the cervix becomes inflamed then knocking it with the penis during sex may cause deep pain in the pelvis and sometimes across the fronts of the thighs. The cervix may also become tender and sensitive if you have an intrauterine contraceptive device, particularly if it is sitting a little too low or falling out. This can cause sudden sharp pains in the cervix during sex. (Fortunately cervical cancer is very rare and does not usually cause painful sex.)

Endometriosis

Endometriosis is a condition in which little bits of womb (uterine) lining become embedded in other parts of the body. Most usually this is in the ovaries, the Fallopian tubes that link the womb to the ovaries, and the cervix. These bits of tissue bleed whenever you have a period. This blood tends to cause scar tissue formation with sticking of organs to one another, and the whole pelvis can become painful.

Endometriosis is typically found in young women, and may only become apparent when they come off the contraceptive pill if they have been taking it for a while. This is because 'the pill' suppresses it and is, in fact, a treatment for endometriosis. Endometriosis causes pain on sex, typically pain that comes on with deep penetration and continues for some time after penetration is over. It also causes painful periods, and women with endometriosis can find it difficult to get pregnant.

Ovarian cysts

The presence of cysts on the ovaries can cause pain during sex (intercourse). This is because the ovaries can be knocked by the penis during intercourse and this can cause the cysts to leak fluid. It's not unusual to have cysts on the ovaries, as cyst formation is a normal part of the period (menstrual) cycle. However, these 'physiological cysts' are typically very small. Larger cysts are more likely to leak and cause pain, and can be a sign of endometriosis, especially in younger women. In women who have passed their menopause, ovarian cysts are worrying, as they can be a sign of ovarian cancer.

Another, harmless form of pain from the ovary is called 'Mittelschmerz.' This is pain when an egg is released from the ovary. Pain from Mittelschmerz may not be related to sex at all, and typically lasts for two or three days in the middle of the month - but sex may make it worse when it's there.

Fibroids and growths in the womb

Fibroids are non-cancerous (benign) growths in the muscle of the womb, which can cause the womb itself to become quite bulky. This is not always painful but it can lead to discomfort during sex.

Causes related to womb position

In some women the womb tilts backwards, rather than forwards; the ovaries then tend to fall backwards too. This can lead to them being knocked in positions involving deep penetration. This can result in deep pain in the pelvis that is more noticeable with deep penetration and which settles slowly when penetration stops or when you change your position.

Bowel pain

During intercourse the bowel is also knocked and moved. If the bowel is sensitive or tender then this can be the origin of pain during sex. This is particularly likely in women who have Crohn's disease, ulcerative colitis or irritable bowel syndrome, all of which are conditions that cause the bowel to be painful.

Pelvic inflammatory disease

This is a condition of the Fallopian tubes, the womb and, sometimes, the ovaries. It is caused by infection and makes these organs inflamed. As they tend to move during sex, this is painful. The pain is typically felt deep in the pelvis, is worse with deep penetration and settles slowly when penetration stops. Pelvic inflammatory disease also tends to make you feel unwell, and may cause a temperature and a vaginal discharge.

Bladder pain

The bladder sits on top of your womb, just behind and above your pubic bone. Like the womb, the bladder moves and gets pressed on during intercourse. So, if the bladder is inflamed, this may hurt. Typical causes include urine infections and interstitial cystitis. This is a condition in which the bladder becomes sensitive and painful. It behaves like a urine infection but no infection is present.

Summary

Symptoms of dyspareunia (pain felt in the pelvis during or after sex) are distressing and depressing. They can affect your sex life, your fertility and even your relationship. Many of the causes have a very simple solution and it is important to seek help if you are experiencing problems.

PEYRONIE'S DISEASE

This is a condition in which patches of scar tissue (fibrous plaques) develop along the shaft of the penis. This can result in changes in the shape (bending or deformity) of the penis, painful erections and difficulties with having sex (intercourse). The disease was named after the French surgeon François Gigot de la Peyronie who described it in 1743. The options for treatment include medicines taken by mouth, applied to the surface of the penis or injected into the scar tissue. Stretching, electrical treatment, lasers and surgery are other options. In rare cases, the condition may clear up completely but most men find that it either stays the same or becomes worse over time.

What is Peyronie's disease?

Peyronie's disease is a condition in which scar tissue (fibrous plaques) develop along the shaft of the penis. These plaques cause the penis to curve or to adopt an hourglass shape. The change in shape is usually only obvious when the penis is erect.

What causes Peyronie's disease?

The cause is not known but it has been suggested that one-off or repeated damage to blood vessels causes leakage into areas of the penis which do not usually come into contact with blood. This triggers an attack by the body's immune system, resulting in scarring. Other suggestions are that there is a defect in the person's genetic make-up or associated with low levels of the male hormone testosterone. 'Genetic' means that the condition is passed on through families through special codes inside cells called genes. There is also a form in which a baby is born with the condition (congenital) but this is not recognised until sexual maturity develops.

Who develops Peyronie's disease?

The exact number of men who develop Peyronie's disease is not known, as some may be too embarrassed to see their doctor about the condition. However, it is thought that it affects between 3-9 men out of a 100. It usually appears in men in their fifties. The congenital form is rare. A small number of teenagers also develop the disease.

Are any other conditions seen in people who develop Peyronie's disease?

Peyronie's disease is seen more frequently in people who have diabetes, high blood pressure (hypertension), hyperlipidaemia, conditions affecting the heart muscle and Dupuytren's contracture (a thickened band of fibrous tissue develops across the palm). It is seen more commonly in people who smoke or drink a lot.

What are the symptoms of Peyronie's disease?

If you develop Peyronie's disease, the first problem you may notice is painful erections and areas of thickening along the shaft of the penis. You may notice that the penis starts to become curved, angled or distorted. This is most obvious when the penis is erect but can occasionally be seen even when it is soft (flaccid). This period of pain with erection usually lasts 18-24 months and is known as the inflammatory phase. This is followed by a fibrotic stage in which the pain settles but scarring continues to develop and the distortion of the penis continues. About half the men who develop Peyronie's disease also develop depression.

How is Peyronie's disease diagnosed?

The typical symptoms of painful erections and curvature, angulation or deformity of the shaft are usually enough for a doctor to suspect that you have the disease. The doctor will usually want to measure the bend or distortion of the penis whilst it is erect. This can be assessed by either of two methods:

Photographs you have taken at home.
More accurately, by use of a vacuum pump or injection into the shaft, in the surgery, to stimulate an erection.
Your doctor may ask you to complete a short questionnaire to assess how much the condition is impacting on your life.

Do I need any tests for Peyronie's disease?

In most cases it is not necessary to do any other tests but, occasionally, you may be asked to undergo a type of scan called a duplex ultrasound which shows up the blood circulation of the penis.

What are the treatment options for Peyronie's disease?

You may decide that you do not want any treatment if:

You have a mild version of the disease which does not cause much pain.
You are not sexually active.
You have few or no difficulties with sexual intercourse.
There are many non-surgical treatments available for Peyronie's disease but research has so far failed to prove that they are guaranteed to work in all people.

Stretching: the technical name for this is external penile traction. It involves wearing a device which stretches the penis. It has shown some effect in improving the length of the penis and lessening deformity.

Vacuum devices: these work in a similar way to traction devices by creating a vacuum around the penis, which stretches the shaft.

Medicines taken by mouth: medicines tried in the past for this condition include para-aminobenzoate, colchicine, propoleum, pentoxifylline, vitamin E, tamoxifen and acetyl-L carnitine. Only para-aminobenzoate has the backing of European guidelines and a UK licence to be used for this condition.

Medicines applied to the surface of the penis: topical verapamil has been used with some success in reducing the amount of curvature and thickening of the fibrous tissue. However, it needs to be used for about nine months to have any significant effect.

Medicines injected into the scar tissue (fibrous plaques): various medicines have been tried, including verapamil, interferon and a substance called clostridial collagenase (recently approved by the FDA in the USA). Research studies have reported some improvement in pain, the size of the plaques and the amount of bend of the penis after these injections.

Electrical currents: the technical term for this treatment is iontophoresis. A medicine is applied to the surface of the penis and a mild electrical current is applied. The idea behind this is to help the medicine penetrate into the deeper tissues of the penis, where they will have the greatest effect. Some research studies report that this method has some benefits whilst others say it has little effect.

Surgery

Surgery is the only treatment guaranteed to have a beneficial effect on Peyronie's disease. However, it would only be offered to you once the changes caused by the condition had settled down. This normally takes 12-18 months. Surgery is not without risks and can include shortening of the penis and a chance that the distortion will return. If your foreskin is already tight, you may need a circumcision to prevent it becoming even tighter after the operation. Some people can feel knots or stitches under the skin. You should consider all these issues carefully before consenting to surgery.

There are various options available:

Extracorporeal shock-wave therapy. This uses vibrations from sound waves to break down the tough fibrous plaques. The sound waves are delivered by a device outside the body. You may be offered sedation during the procedure. The technique is safe but its effects are uncertain.
'Cold steel' surgery This means surgery involving conventional surgical instruments. Several operations are available including:
The Nesbit tuck procedure - this involves removing some tissue from the side of the penis opposite the plaque. This has the effect of straightening but shortening the penis.
Plication - this involves folding the normal tissue on itself rather than removing it completely.
Cutting out the plaque - this sometimes is combined with the insertion of a plastic rod (prosthesis) to counteract any shortening.
Laser surgery - a carbon dioxide laser is used to thin the plaque.

What is the outlook (prognosis) for Peyronie's disease?

One research study found that only 13 out of a 100 men got better completely without treatment. Of the rest, half had mild but continuing symptoms and the other half had increasing amounts of pain and/or curvature of the penis. With treatment, the situation can often be improved. However, more research is needed to investigate the effect of the various available treatments on prognosis.

STERNOCLAVICULAR JOINT SEPARATION

The sternoclavicular joint is located where the collarbone (clavicle) attaches to the breastbone (sternum). These bones are held together by a piece of connective tissue called a ligament. A sternoclavicular separation occurs when the ligament tears.

WHAT IS THE CAUSE?

A sternoclavicular joint separation most commonly occurs when there is a direct blow to the sternum or a fall onto the shoulder or outstretched hands that causes a force along the length of the collarbone. It may occur in a contact sport when a player's shoulder hits the ground and another player lands on top of the other shoulder.

WHAT ARE THE SYMPTOMS?

There is pain, swelling, and tenderness over the sternoclavicular joint. There may be movement between the breastbone and the collarbone. Your collarbone may be in front of or behind your breastbone.

HOW IS IT DIAGNOSED?

Your healthcare provider will review your symptoms and examine you. You may also have an X-ray, CT scan, or MRI.

HOW IS IT TREATED?

To treat this condition:

Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the injured area every 3 to 4 hours for up to 20 minutes at a time until the pain goes away.
Take an anti-inflammatory medicine, such as ibuprofen, or other pain medicine as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.
Wear a sling.
Rest your shoulder and arm on the side of the separation until the pain goes away.
If the collarbone is forced behind the breastbone, there may be a risk of damage to the heart or the blood vessels in the chest. You may need surgery.

In some cases, the joint heals but may be unstable or shift when you move your arm or shoulder. If this instability causes pain, you may need surgery.

Follow your healthcare provider's instructions. Ask your provider:

How and when you will hear your test results
How long it will take to recover
What activities you should avoid and when you can return to your normal activities
How to take care of yourself at home
What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup.

HOW CAN I HELP PREVENT A STERNOCLAVICULAR JOINT SEPARATION?

A sternoclavicular joint separation is usually caused by an accident that cannot be prevented.

Exercises
Chest stretch: Grasp your hands behind your back and lift your arms away from your body. Hold 15 to 30 seconds. Repeat 3 times.
Shoulder flexion: Stand with your arms hanging down at your sides. Keep your arms straight and lift them in front of you and up over your head as far as you can reach. Hold this position for 5 seconds and then bring your arms back down in front of you and to your sides. Do 2 sets of 15.
Scaption: Stand with your arms at your sides and with your elbows straight. Slowly raise your arms to eye level. As you raise your arms, spread them apart so that they are only slightly in front of your body (at about a 30-degree angle to the front of your body). Point your thumbs toward the ceiling. Hold for 2 seconds and lower your arms slowly. Do 2 sets of 15. Progress to holding a soup can or light weight when you are doing the exercise and increase the weight as the exercise gets easier.
Single-arm shoulder abduction: Stand with your arms at your sides, your palms resting against your sides. Lift the arm on your injured side out to the side and toward the ceiling. Keep your arm straight. Hold the position for 5 seconds and then bring your arm back to your side. Repeat 10 times. Add a weight to your hand as the exercise gets easier.
Horizontal shoulder abduction, single arm: Standing with your arm out in front of you, elbow straight and at shoulder level, move your arm in a horizontal direction out to the side. Return to the starting position. Repeat 10 times.
Scapular squeeze: While sitting or standing with your arms by your sides, squeeze your shoulder blades together and hold for 5 seconds. Do 2 sets of 15.
Supine shoulder flexion: Lie on your back, hold your arm out straight, and move your arm up until your hand is toward the ceiling. Return your arm to the starting position. Do 2 sets of 15. As you get stronger, hold a weight in your hand as you do the exercise.
Prone shoulder extension: Lie on your stomach on a table or the edge of a bed with the arm on your injured side hanging down over the edge. Slowly lift your arm straight back and toward the ceiling. Do not bend your elbow. Return to the starting position. Do 2 sets of 15. As this becomes easier, hold a weight in your hand.
Horizontal abduction: Lie on your stomach on a table or the edge of a bed with the arm on your injured side hanging down over the edge. Raise your arm out to the side, with your thumb pointed toward the ceiling, until your arm is parallel to the floor. Hold for 2 seconds and then lower it slowly. Start this exercise with no weight. As you get stronger, add a light weight or hold a soup can. Do 2 sets of 15.
Supine chest fly: Hold a small dumbbell in each hand and lie on your back with your knees bent, arms out to your sides and elbows slightly bent. Slowly bring both arms across your chest until the dumbbells touch. Lower slowly back to the starting position. Do 2 sets of 15. As you get stronger, gradually increase the weight you are holding.
Developed by RelayHealth.
Published by RelayHealth.
Copyright ©2014 McKesson Corporation and/or one of its subsidiaries. All rights reserved.
Copyight google images.
For a general review of joint mobilization techniques and priciples check http://www.slideshare.net/mobile/caseychristyatc/joint-mobs-review

POSTERIOR TIBIAL TENDON INJURY

A posterior tibial tendon injury is a problem with the tendons and muscles that extend from the back of your lower leg to your inner ankle and foot. Tendons are strong bands of tissue that attach muscle to bone. You use the posterior tibial tendon when you point your foot down and in, stand on your toes, and when you walk or run.

Tendons can be injured suddenly or they may be slowly damaged over time. You can have tiny or partial tears in your tendon. If you have a complete tear of your tendon, it’s called a rupture. Other tendon injuries may be called a strain, tendinosis, or tendonitis.

WHAT IS THE CAUSE?

A posterior tibial tendon injury can be caused by:

Overuse of the tendon, such as from lots of running, intense exercise, or sports training or from doing a lot of work that causes you to bend at the knees and ankles.
A sudden activity that twists or tears your tendon, such as jumping, starting to sprint, or a fall.
You are more likely to have a posterior tendon problem if you have a problem called over-pronation, which happens when your feet roll inward and your arch flattens out more than normal when you walk or run.

WHAT ARE THE SYMPTOMS?

Symptoms may include:

Pain or tenderness on the inner side of the shin, ankle, or foot
Pain with lifting your foot
Pain when you walk or run

HOW IS IT DIAGNOSED?

Your healthcare provider will examine you and ask about your symptoms, activities, and medical history. You may have X-rays or other scans.

HOW IS IT TREATED?

You will need to change or stop doing the activities that cause pain until the tendon has healed. For example, you may need to swim instead of run.

Your healthcare provider may recommend stretching and strengthening exercises to help you heal. Special shoes or shoe inserts may help.

If you have a severe injury, your healthcare provider may put your leg in a splint or cast for several weeks to keep it from moving while it heals.

You may need to use crutches until you can walk without pain.

The pain often gets better within a few weeks with self-care, but some injuries may take several months or longer to heal. It’s important to follow all of your healthcare provider’s instructions.

HOW CAN I TAKE CARE OF MYSELF?

To help relieve swelling and pain:

Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth, on the area every 3 to 4 hours.Do ice massage. To do this, first freeze water in a Styrofoam cup, then peel the top of the cup away to expose the ice. Hold the bottom of the cup and rub the ice over your tendon for 5 to 10 minutes. Do this several times a day while you have pain.
Keep your lower leg and foot up on a pillow when you sit or lie down.
Take pain medicine, such as acetaminophen, ibuprofen, or other medicine as directed by your provider.
If the pain is longer than 2 weeks then use  Moist heat may help relax your muscles and make it easier to move your leg. Put moist heat on the injured area for 10 to 15 minutes at a time before you do warm-up and stretching exercises. Moist heat includes heat patches or moist heating pads that you can purchase at most drugstores, a wet washcloth or towel that has been heated in the dryer, or a hot shower. Don’t use heat if you have swelling.

Follow your healthcare provider's instructions, including any exercises recommended by your provider.

HOW CAN I HELP PREVENT A POSTERIOR TIBIAL TENDON INJURY?

Warm-up exercises and stretching before activities can help prevent injuries. If your shin, ankle, or foot hurts after exercise, putting ice on it may help keep it from getting injured.

Follow safety rules and use any protective equipment recommended for your work or sport. For example, wear the right type of shoes for your activities. Taping your foot can give extra support to your arch.

EXERCISE
Prone hip extension: Lie on your stomach with your legs straight out behind you. Fold your arms under your head and rest your head on your arms. Draw your belly button in towards your spine and tighten your abdominal muscles. Tighten the buttocks and thigh muscles of the leg on your injured side and lift the leg off the floor about 8 inches. Keep your leg straight. Hold for 5 seconds. Then lower your leg and relax. Do 2 sets of 15.
Side-lying leg lift: Lie on your uninjured side. Tighten the front thigh muscles on your injured leg and lift that leg 8 to 10 inches (20 to 25 centimeters) away from the other leg. Keep the leg straight and lower it slowly. Do 2 sets of 15.
Towel stretch: Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your leg straight. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times.
Standing calf stretch: Stand facing a wall with your hands on the wall at about eye level. Keep your injured leg back with your heel on the floor. Keep the other leg forward with the knee bent. Turn your back foot slightly inward (as if you were pigeon-toed). Slowly lean into the wall until you feel a stretch in the back of your calf. Hold the stretch for 15 to 30 seconds. Return to the starting position. Repeat 3 times. Do this exercise several times each day.
Heel raise: Stand behind a chair or counter with both feet flat on the floor. Using the chair or counter as a support, rise up onto your toes and hold for 5 seconds. Then slowly lower yourself down without holding onto the support. (It's OK to keep holding onto the support if you need to.) When this exercise becomes less painful, try doing this exercise while you are standing on the injured leg only. Repeat 15 times. Do 2 sets of 15. Rest 30 seconds between sets.
Step-up: Stand with the foot of your injured leg on a support 3 to 5 inches (8 to 13 centimeters) high --like a small step or block of wood. Keep your other foot flat on the floor. Shift your weight onto the injured leg on the support. Straighten your injured leg as the other leg comes off the floor. Return to the starting position by bending your injured leg and slowly lowering your uninjured leg back to the floor. Do 2 sets of 15.
Balance and reach exercises: Stand next to a chair with your injured leg farther from the chair. The chair will provide support if you need it. Stand on the foot of your injured leg and bend your knee slightly. Try to raise the arch of this foot while keeping your big toe on the floor. Keep your foot in this position.
With the hand that is farther away from the chair, reach forward in front of you by bending at the waist. Avoid bending your knee any more as you do this. Repeat this 15 times. To make the exercise more challenging, reach farther in front of you. Do 2 sets of 15.
While keeping your arch raised, reach the hand that is farther away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 15.
If you have access to a wobble board, do the following exercises:

Wobble board exercises
Stand on a wobble board with your feet shoulder-width apart.

Rock the board forwards and backwards 30 times, then side to side 30 times. Hold on to a chair if you need support.
Rotate the wobble board around so that the edge of the board is in contact with the floor at all times. Do this 30 times in a clockwise and then a counterclockwise direction.
Balance on the wobble board for as long as you can without letting the edges touch the floor. Try to do this for 2 minutes without touching the floor.
Rotate the wobble board in clockwise and counterclockwise circles, but do not let the edge of the board touch the floor.
When you have mastered the wobble exercises standing on both legs, try repeating them while standing on just your injured leg. After you are able to do these exercises on one leg, try to do them with your eyes closed. Make sure you have something nearby to support you in case you lose your balance.

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Published by RelayHealth.
Copyright ©2014 McKesson Corporation and/or one of its subsidiaries. All rights reserved.

ACHALASIA - OVERVIEW

Achalasia is a disorder that makes it hard to eat and drink normally. The disorder affects your esophagus, which is the swallowing tube that connects the back of your throat to your stomach. If you have achalasia, your esophagus does not sufficiently push food or liquid into your stomach. In addition, the ring of muscle that circles the lower portion of your esophagus does not relax enough to let food and liquid pass through easily. In fact, achalasia means "failure to relax."

Achalasia usually develops slowly, making it harder for you to swallow food and beverages. It's caused by loss of the nerve cells that control the swallowing muscles in the esophagus. Why these nerve cells degenerate, however, isn’t known. Although achalasia has no cure, treatments are available. Achalasia affects about 2,000 people in the U.S. every year.

Symptoms

Symptoms of achalasia develop gradually. Over time, as the esophagus becomes wider and weaker, you may have these symptoms:

Difficulty swallowing food, a condition called dysphagia

Food or liquid flowing back up into your throat, or regurgitation

Waking up at night from coughing or choking because of regurgitation

Heartburn

Chest pain or pressure

Weight loss

Who's at risk

Achalasia can develop at any age, but it occurs most often between ages 30 and 60. Men and women are equally at risk. Scientists don’t know exactly why this loss of muscle control in the lower esophagus happens, but risk factors may include:

Genes you are born with

A disordered immune system that attacks the nerve cells in your esophagus

The herpes simplex virus or other viral infections

Diagnosis

If your doctor suspects achalasia from your symptoms, he or she may order three tests to confirm your diagnosis:

Endoscopy. This is an outpatient procedure during which a flexible telescope is passed through your mouth to examine your esophagus and the valve that opens into your stomach. This valve is called the lower esophageal sphincter (LES).

Esophogram. This is a special type of X-ray that takes pictures of your esophagus while you swallow a thick contrast material called barium. Signs of achalasia that your doctor looks for are widening of the esophagus, incomplete emptying, and tightness of your LES.

Manometry. This is an outpatient procedure during which a pressure-measuring tube is passed through your nose into your esophagus. Pressure measurements are taken as you swallow sips of water. This test may show weak and uncoordinated muscle contractions and pressure buildup at your LES.

Treatment

No treatment can restore normal esophageal movement, but treatments can help relieve your symptoms, open up your LES to improve emptying of your esophagus, and prevent complications. You may also need repeat treatments.

These are common treatments:

Pneumatic dilation. This is an outpatient procedure done under anesthesia. While your doctor looks into your esophagus through an endoscope, an air-filled balloon is passed through the valve between the esophagus and stomach and then inflated. You may need more than one treatment to get relief.

Botox injection. Botox is a medication that can paralyze muscles. Botox can be injected into the muscles that control your LES to relax the valve opening. This procedure is also done during endoscopy, but you don’t need to be asleep. The results usually wear off in three months to one year, so the procedure may need to be repeated.

Surgery. Surgery to open your LES is called myotomy. During myotomy, the muscles of that valve are cut. This type of surgery usually provides long-term relief from achalasia symptoms.

Complications

Although you can’t prevent achalasia, treatment can prevent long-term complications. Possible complications include:

Aspiration pneumonia. This type of pneumonia may be caused when food or liquids in your esophagus back up into your throat and you breathe them into your lungs.

Esophageal perforation. This complication may occur if the walls of your esophagus become weak and distended. Perforation may also occur during treatment. Esophageal perforation may cause a life-threatening infection.

Esophageal cancer. People with achalasia are at higher risk for esophageal cancer

When to call the doctor

Call your doctor if you have any questions about your medications or treatment. Let your doctor know right away if you have any of these symptoms:

Increased difficulty swallowing

Worsening regurgitation, especially if you are waking up coughing or choking at night

Symptoms of infection such as chills or fever

Chest pain or difficulty breathing

Living with achalasia

Achalasia is a long-term disease, so it's important to learn as much as you can about it and work closely with your medical team. Your health providers will need to follow you on a regular basis, usually once or twice a year, even after symptoms have been controlled. Keep all your appointments. Your doctor may also want to repeat endoscopy and an esophogram.

Here are some lifestyle changes that may help you if you have symptoms of dysphagia or regurgitation:

Stop smoking.

Avoid foods or beverages that give you heartburn.

Drink plenty of fluid when eating and chew your food well.

Eat more frequent, smaller meals.

Avoid eating for three hours before you go to bed.

Avoid sleeping in a flat position by elevating the head of your bed several inches.

https://www.hopkinsmedicine.org/healthlibrary/conditions/adult/digestive_disorders/achalasia_134,167

Paulskullate: RHEUMATOID ARTHRITIS

Paulskullate: RHEUMATOID ARTHRITIS: WHAT IS RHEUMATOID ARTHRITIS? Rheumatoid arthritis (RA) is a disease that causes pain, stiffness, swelling, and loss of movement in your ...

RHEUMATOID ARTHRITIS

WHAT IS RHEUMATOID ARTHRITIS?

Rheumatoid arthritis (RA) is a disease that causes pain, stiffness, swelling, and loss of movement in your joints. It happens most often in the wrists, knuckles, knees, and feet. It can also affect other parts of your body.

RA is a lifelong problem that usually starts in early adulthood or middle age. You may have just one attack, but more often the symptoms come and go. Repeated attacks can lead to permanent joint damage. You can relieve symptoms and prevent or slow down joint damage by following your healthcare provider’s treatment plan and taking good care of yourself.

WHAT IS THE CAUSE?

Rheumatoid arthritis is an autoimmune disease. This means that your body's defenses against infection attack your body's own tissue. When you have rheumatoid arthritis, the attack is mostly against the tissues that line the joints. The tissues get inflamed, causing pain, swelling, and stiffness. The inflammation also damages bone and cartilage (the cushioning in joints) and can change the shape of your joints.

Things that may cause or contribute to rheumatoid arthritis are:

Genes you have inherited. Genes are inside each cell of your body and are passed from parents to children. They contain the information that tells your body how to develop and work.
Infection, such as infection with the Epstein-Barr virus or rubella (measles) virus
Levels of female hormones. RA is more common in women. The symptoms tend to get better with the higher hormone levels that happen during pregnancy. Then the symptoms often come back after delivery, when hormone levels return to normal.
Smoking, which may trigger an auto-immune reaction
Long-term exposure to chemicals, like silica or asbestos
WHAT ARE THE SYMPTOMS?

Symptoms may include:

Joints that are red, tender, warm, and swollen, usually on both your right and left sides
Joint pain and stiffness that lasts 1 hour or longer, especially in the morning or after a rest
Joint pain on both sides of your body but that may be more severe on one side
Changes in the shape of your joints over time
Mild fever, feeling tired, or generally not feeling well
Small lumps under the skin near affected joints (called rheumatoid nodules)
HOW IS IT DIAGNOSED?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

Blood tests (The most precise blood tests are the rheumatoid factor test and a test for substances called CCP antibodies.)
X-rays
Joint aspiration, which uses a needle to take fluid from a joint for testing
You may have other tests or scans to check for other possible causes of your symptoms.

Your provider may refer you to a rheumatologist, a doctor who specializes in treating diseases like rheumatoid arthritis.

HOW IS IT TREATED?

There is no cure for rheumatoid arthritis, but treatment can help:

Relieve pain and stiffness
Reduce swelling
Keep the shape of the joints more normal so they move well and you can do your usual activities
Stop or slow down damage to the joints
There are many ways to treat rheumatoid arthritis.

Medicine

Many drugs are used to treat the symptoms of rheumatoid arthritis. For example:

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, can help relieve pain and swelling. NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.
Steroid medicine may be prescribed to decrease pain and swelling. It can be given as a pill, cream or ointment, or shot. Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.
Disease-modifying antirheumatic drugs (DMARDs) slow down or stop damage to the joints. They can help lessen pain and inflammation in the joints. Your healthcare provider will check you regularly to see how these medicines are working. DMARDs may cause infection or other serious side effects.
Hyaluronic acid may be injected into your knee if you have arthritis in your knee. It helps your knee move more easily.
Some RA medicines can hurt an unborn baby. Whether you are a man or a woman, talk to your healthcare provider if you are thinking of having a child. You may need to stop certain medicines if you want to have a child. Make sure you ask about using birth control methods to prevent pregnancy so you can prevent birth defects from the medicines you are taking. Tell your provider right away if pregnancy occurs while one of the parents is taking medicine for rheumatoid arthritis.

Exercise

Three types of exercise may help:

Range-of-motion exercises are gentle stretching exercises that help you move each joint as far as possible. Examples include low-speed bike riding, tai chi, and yoga. Range-of-motion exercises help you keep or improve your flexibility and relieve stiffness.
Strengthening exercise, such as weight training, makes muscles and tendons stronger. Strong muscles and tendons support joints better. You will be able to move more easily and with less pain.
Aerobic or endurance exercise at a moderate pace, such as walking or bicycle riding, improves your overall health and helps control your weight. Exercising in a warm swimming pool is another option. The water supports your weight while you move, and the warmth helps improve joint movement.
Talk with your healthcare provider before you start an exercise program. Too much exercise too soon or even at the wrong time of day may make arthritis worse. Your provider may refer you to a physical therapist to design a program that is right for you.

Surgery

Your provider may advise arthroscopy, which is a type of surgery done with a small scope inserted into your joint. Your provider can look directly at your joint and sometimes do small repairs of the joint without having to cut open the joint.

If your joints are severely damaged, surgery may be done to remove inflamed joint tissue or realign or replace a joint.

Other treatments

Your healthcare provider may recommend physical or occupational therapy to treat pain and help you have better use of your joints.
Sometimes it may help to use a splint or brace to rest a joint and protect it from injury.
HOW CAN I TAKE CARE OF MYSELF?

Follow the full course of treatment prescribed by your healthcare provider.
Rest your body often during the day, as well as at night.
Rest your joints, especially when they are warm, swollen, or painful.
Learn how to move in ways that are easier on your joints. Be open to using devices to help you. Helpful devices include canes and walkers; bath seats and grab bars for the bathtub; and larger grips on tools, eating utensils, pens, and pencils. Velcro fasteners on clothes and shoes can be very useful, too.
Eat a healthy diet. Ask your provider about the benefits of talking to a dietician to learn what you need in a healthy diet.
Try to keep a healthy weight. If you are overweight, lose weight. Losing some weight can reduce the pain and stress on your joints.
Stay fit with the right kind of exercise for you. Talk with your healthcare provider before you start an exercise program.
If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
Try to get at least 7 to 9 hours of sleep each night.
Join a support group or take classes on how to manage your arthritis.
Learn ways to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, or take walks. Try deep breathing exercises when you feel stressed.
Be sure to let all of your healthcare providers know what medicines you are taking, especially if you are going to have surgery.
Ask your healthcare provider:
How and when you will hear your test results
What activities you should avoid and when you can return to normal activities
What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.
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Published by RelayHealth.
Copyright ©2014 McKesson Corporation and/or one of its subsidiaries. All rights reserved.

BAROTRAUMA

Barotrauma refers to injury sustained from failure to equalize the pressure of an air-containing space with that of the surrounding environment. The most common examples of barotrauma occur in air travel and scuba diving. Although the degree of pressure changes are much more dramatic during scuba diving, barotraumatic injury is possible during air travel.

Barotrauma can affect several different areas of the body, including the ear, face and lungs. Here we will focus on barotrauma as it relates to the ear.

What are the Symptoms of Barotrauma?

Symptoms of barotrauma include “clogging” of the ear, ear pain, hearing loss, dizziness, ringing of the ear (tinnitus), and hemorrhage from the ear.

Dizziness (or vertigo) may also occur during diving from a phenomenon known as alternobaric vertigo. It is caused by a difference in pressure between the two middle ear spaces, which stimulates the vestibular (balance) end organs asymmetrically, thus resulting in vertigo. The alternobaric response can also be elicited by forcefully equalizing the middle ear pressure with the Politzer maneuver, which can cause an unequal inflation of the middle ear space.

Inner Ear Decompression Sickness

Inner ear decompression sickness (IEDCS) is an injury that closely resembles inner ear barotrauma; however, the treatment is different. This injury is more common among commercial and military divers who breathe a compressed mixture of helium and oxygen. Symptoms include hearing loss, ringing of the ears, and/or dizziness during ascent or shortly thereafter.

IEDCS most often occurs during decompression (ascent), or shortly after surfacing from a dive. In contrast, barotrauma most often occurs during compression (descent) or after a short, shallow dive. Patients with IEDCS should be rapidly transported to a hyperbaric chamber for recompression. A significant correlation exists between early recompression and recovery.

What Causes Barotrauma?

Barotrauma is caused by a difference in pressure between the external environment and the internal parts of the ear. Since fluids do not compress under pressures experienced during diving or flying, the fluid-containing spaces of the ear do not alter their volume under these pressure changes. However, the air-containing spaces of the ear do compress, resulting in damage to the ear if the alterations in ambient pressure cannot be equalized. Rarely, barotrauma may be the result of hyperbaric oxygen therapy. Slow compression hyperbaric oxygen therapy is associated with a lower risk of otic barotraumas than traditional hyperbaric oxygen therapy (Vahidova et al 2006).Barotrauma can affect the outer, middle, or inner ear.

Outer Ear

The outer ear is an air-containing space that can be affected by changes in ambient pressure (see Figure 1). During diving, water normally replaces the air in the external ear canal. An obstruction such as wax, a bony growth, or earplugs can create an air-containing space that can change in volume in response to changes in ambient pressure. During descent, the volume of this space decreases causing the tympanic membrane to bulge outward (toward the outer ear canal). This can cause pain, small hemorrhages in the ear drum, or blebs (small blisters).

Middle Ear

The most common problem that occurs in diving and flying is the failure to equalize pressure between the middle ear and the ambient environment (see Figure 2). Equalization of pressure occurs through the eustachian tube, which is the soft tissue tube that extends from the back of the nose to the middle ear space. The extent of injury depends upon the degree and speed of the ambient pressure changes. The greatest relative pressure changes in diving occur near the surface. Therefore, the largest proportional volume changes, and thus the most injuries, occur at shallow depths.

As a diver descends to only 2.6 feet with difficulty equalizing the pressure of his middle ear space, the tympanic membrane and ossicles are retracted, and the diver experiences pressure and pain (see Figure 3). At higher pressures the eustachian tube may become “locked” closed by the negative pressure in the middle ear. This can occur at about 3.9 feet of water. Further increases in pressure, at depths of only 4.3 to 17.4 feet of water, can cause the tympanic membrane to rupture.

Inner Ear

Inner ear injury during descent is directly related to impaired ability to equalize the middle ear pressure on the affected side. Sudden, large pressure changes in the middle ear can be transmitted to the inner ear, resulting in damage to the delicate mechanisms of the inner ear. This can cause severe vertigo and even deafness. More material about inner ear damage is available here. Two mechanisms are theorized to explain inner ear barotrauma: the “implosive” and the “explosive” mechanisms.
The implosive mechanism theory (see Figure 4) involves clearing of the middle ear during descent. The pressure is transmitted from an inward bulging eardrum, causing the ossicles to be moved toward the inner ear at the oval window. This pressure wave is transmitted through the inner ear and causes an outward bulging of the other window, the round window membrane. If a diver performs a forceful Politzer maneuver and the eustachian tube suddenly opens, a rapid increase in middle ear pressure occurs. This causes the ossicles to suddenly return to their normal positions, causing the round window to implode.

The explosive theory (see Figure 5) suggests that when a diver attempts to clear a blocked middle ear space by performing a Politzer maneuver and the eustachian tube is blocked and locked, a dramatic increase in the intracranial pressure occurs. Since the fluids surrounding the brain communicate freely with the inner ear fluids, this pressure may be transmitted to the inner ear. A sudden rise in the inner ear pressure could then cause the round or oval window membrane to explode.
How is Barotrauma Diagnosed?
Diagnosis is initially based on careful history. If the history indicates ear pain or dizziness that occurs after diving or an airplane flight, barotrauma should be suspected. The diagnosis may be confirmed through ear examination, as well as hearing and vestibular testing.

How is Barotrauma Treated?
For outer ear barotrauma, the treatment consists of clearing the ear canal of the obstruction, and restricting diving or flying until the blockage is corrected and the ear canal and drum return to normal.

For middle ear barotrauma, treatment consists of keeping the ear dry and free of contamination that could cause infection. Topical nasal steroids and decongestants may be started in an attempt to decongest the eustachian tube opening. The presence of pus may prompt the use of appropriate antibiotics. Most tympanic membrane perforations due to barotrauma will heal spontaneously. If the eustachian tube demonstrates chronic problems with middle ear equalization, the likelihood of recovery is drastically reduced.

Prevention of air barotraumas to the middle ear has been attempted with dasal decongestants or vasoconstrictors with mixed results. “Pressure equalizing” ear plugs claiming to prevent in-flight barotrauma are available in many airports for purchase (Klokker et al 2005, Mirza & Richardson 2005). A trial evaluating the effect of these earplugs found them to have no effect on eustachain tube function (Jumah et al 2010).

For inner ear barotrauma, treatment consists of hospitalization and bed rest with the head elevated 30 to 40 degrees. Controversy exists whether this type of injury needs immediate surgery, though success has been reported with careful patient selection (Park et al 2012). Once healed, a diver should not return to diving until hearing and balance function tests are normal

.

SHORT SUMMARY OF THE BODY

Number of bones - 206
Number of muscles - 639
Number of kidneys - 2
Number of milk teeth - 20
Number of ribs - 24 (12 pairs)
Number of chambers in the heart - 4
Largest artery - Aorta
Normal Blood pressure - 120 - 80
Ph of blood - 7.4
Number of vertebrae in the spine - 33
Number of vertebrae in the Neck - 7
No of bones in middle Ear - 6
Number of bones in Face - 14
Number of bones in Skull - 22
Number of bones in Chest - 25
Number of bones in Arms - 6
Number of bones in each human ear - 3
Number of muscles in the human arm - 72
Number of pumps in heart - 2
Largest organ - Skin
Largest gland - Liver
Smallest cell - Blood cell
Biggest cell - Egg cell (ovum)
Smallest bone - Stapes
First transplanted organ - Heart
Average length of small intestine - 7 m
Average length of large intestine - 1.5 m
Average weight of new born baby - 2.6 kg.
Pulse rate in one minute - 72 times
Body Temperature - 36.9o C (98.4o F)
Average blood volume - 4 - 5 liters
Average life of RBC - 120 days
Pregnancy period - 280 days
Number of bones in human foot - 33
Number of bones in each wrist - 8
Number of bones in hand - 27
Largest endocrine gland - Thyroid
Largest lymphatic organ - Spleen
Largest cell - Nerve cell
Largest part of brain - Cerebrum
Largest & strongest bone - Femur
Smallest muscle - Stapedius (Middle ear )
Number of chromosomes in human cell - 46 (23
pairs)
Number of bones in New born body - 300
Largest muscle - Buttock (Gluteus Maximus)