IMPINGEMENT SYNDROME

Impingement syndrome is a condition that affects the rotator cuff, which is a group of muscles and tendons that secures the arm to the shoulder joint and allows the arm to rotate. When muscle pressure increases it causes loss of blood flow in the small blood vessels. The compression and decreased blood flow results in muscle tissue that begins to fray like a rope. If these muscles are injured for a long period of time, they can tear in two, resulting in a rotator cuff tear. This condition is very painful and often seen in aging adults. It is also closely related to shoulder bursitis and rotator cuff tendonitis. These conditions may occur alone or in combination.

People who engage in physical activities that require repeated overhead arm movements can cause the rotator cuff to become inflamed and swollen. The swollen rotator cuff can get trapped and pinched under the acromion. Some people even rupture their bicep muscles as part of this continuing impingement process. This impingement syndrome results in shoulder pain that can extend from the top pf the shoulder to the elbow. Some of the typical symptoms are:
o Difficulty to elevate the arm
o Significant weakness of shoulder muscles
o Painful when reaching up overhead and behind the back
o Little range of motion
o Flare up during sleep due to pressure on the shoulder area

Diagnosis begins with a medical history that concerns your physical activities and a physical examination of both shoulders by your doctor. Diagnostic test may include:
o X-rays ---------- to check the condition of the bones in the shoulder area
o MRI ----------- to look for tears in the rotator cuff and show any changes in bone
o Ultrasound ----- to indicate muscle and tissue injury
Shoulder pain can sometimes be caused by a problem in the neck area. If impingement syndrome is suspected, the doctor may inject a small amount of pain relieving medication, such as lidocaine hydrochloride, into the space under the acromion. Pain relief from this injection usually indicates impingement syndrome.

The most common treatment for this condition remains to be oral anti-inflammatory medication. Nevertheless, it will not treat the underlying problem and the painful symptoms will come back. The response to any given anti-inflammatory medication differs from person to person. Therefore, if one medication doesn’t work in a couple of weeks, then another one will be given until one that provides relief is found. In addition to taking medications, RICE therapy may be required which consists of:
o Rest or reduced activity
o Ice or cold packs applied to the shoulder
o Compression of the shoulder, such as with ace bandages
o Elevation
Ultrasound therapy may also be recommended to warm the muscles, stimulate the tissues and improve blood flow. In some cases, patients benefit from a limited number of corticosteroid injections into the space under the acromion to reduce inflammation and pain. After the pain is gone, Physical therapy (recommended by your doctor) will help increase the strength of the tendons and muscle If this treatment is not successful within 6 to 12 months, Surgery maybe needed to release the ligament, followed by physical therapy to gradually increase your range of motion. Your physical activities will also need to be modified to reduce the possibility of a relapse.

http://www.hmc.psu.edu/healthinfo/i/impingementsyndrome.htm
http://www.healthopedia.com/rotator-cuff-tendinitis/treatment.html
http://www.webmd.com/osteoarthritis/guide/impingement-syndrome

Hiatal Hernia

Uterine Leiomyoma

Bronchiectasis

BRONCHIECTASIS

Bronchiectasis is an obstructive lung disease that causes irreversible dilation of part of the bronchial tree. This can affect just one section of one of your lungs or many sections of both lungs. There is no cure for this condition which damages the airways by causing them to widen, become flabby and scarred. In bronchiectasis, your airways slowly lose their ability to clear out mucus. This mucus build up creates an environment in which bacteria can grow. This leads to repeated, serious lung infections. Overtime, the airways lose their ability to move air in or out and also prevents enough oxygen from reaching your vital organs.

There are three types of brochiectasis, which vary by level of severity:
1. Fusiform (cylindrical) bronchiectasis ----- the most common type where mildly inflamed bronchi fail to taper distally
2. Saccular (cystic) bronchiectasis ----- severe and irreversible ballooning of the bronchi peripherally, with or without air-fluid levels
3. Varicose bronchiectasis ----- bronchial walls appear beaded, because areas of dilation are mixed with areas of constriction

In 1819, Rene Theophile Hyacinthe Laennec, the man who invented the stethoscope, used his creation to first discover bronchiectasis. This disease was researched in greater detail by Sir William Osler in the late 1800s. In fact, he is suspected to have actually died of complications from undiagnosed bronchiectasis. Today bronchiectasis can be congenital or acquired. Congenital is usually the result of a problem with how the lungs form in a fetus. It affects infants and children. Acquired bronchiectasis occurs as a result of another medical condition. which affects adults and older children. Other acquired causes that involve environmental exposures include:
• Respiratory infections and obstructions
• Inhalation and aspiration of ammonia and other toxic gases
• Pulmonary aspiration and various allergies
• Alcoholism and drug use

The most common signs and symptoms of bronchiectasis are daily cough (over months or years), shortness of breath and wheezing, chest pain, clubbing (the flesh under your fingernails and toenails gets thicker) and daily production of large amounts of sputum (spit).

Early diagnosis and treatment of bronchiectasis are important. The most commonly used test to diagnose bronchiectasis is a chest CT scan. Others tests include:

• Chest X Ray
• Blood tests
• Sputum culture (lab tests)
• Lung function tests
• Bronchoscopy

The sooner your doctor can start treating this and underlying conditions, the better the chances of preventing further damage to your lungs. Bronchiectasis is often treated with:

• Medicines such as antibiotics, bronchodilators, expectorants, decongestants, or mucus thinners
• Hydration which helps prevent airway mucus from becoming thick and sticky
• Chest Physical Therapy and or other combined therapies
• Oxygen
• Surgery

In the U S an estimated 110,000 people are living with bronchiectasis. Overall, two-thirds of the people with this condition are women. However, in children it is more common in boys than girls. Even though there is no cure, most people who have this condition can enjoy a good quality of life

http://www.nhlbi.nih.gov/health/dci/Diseases
http://en.wikipedia.org/wiki/Bronchiectasis

UTERINE LEIOMYOMAS

Uterine Leiomyomas are benign (non-cancerous) tumors. They arise from the overgrowth of smooth muscle and connective tissue in the uterus. Their common name is fibroids. Since their growth is promoted by estrogen and progestin receptors which are in fibroids, leiomyomas generally grow during pregnancy and cease growth with menopause. Estrogen replacement therapy (used after menopause) and oral contraceptives may also cause some re-growth of these fibroid tumors. Even though the causes of leiomyomas are yet unknown, they still most commonly occur as follows:
 In the body and the fundus of the uterus
 Only 3% in the cervix
 In groups instead of just a single one
 In more black women (3:1) than white (9:1)
 In half the women older than 40 years, but can develop in females at any age

Leiomyomas are distinct, round, firm, differ in size and are classified according to their location;
1. Intramural leiomyomas -------------- located within the muscular wall of the uterus
2. Submucosal leiomyomas ------------ located on the inside of the uterus lining
3. Subserous leiomyomas -------------- located on the outside surface of the uterus
Some leiomyomas may even be detached from the uterus
1. Intraligamentous leiomyomas ------ found within the broad ligaments
2. Pedunculated leiomyomas- attached by a stem making it subject to twisting or infection
3. Parasitic leiomyomas ------------ obtain its blood supply from other abdominal organs

Fibroid symptoms are related to the number of tumors, as well as their size and location. Most women with uterine fibroids have no symptoms, but some may experience symptoms as follows:
 Pain ----- abdominal cramps usually felt during menstruation
 Bleeding ----- excessive (menorrhagia) or between menstrual periods
 Frequent Urination ----- interfere with normal urinary retention and release
 Ureteral Obstruction ------ obstruct ureters, risking infection, stones and renal disease
 Constipation --------- pelvic pressure and heaviness
 Infertility --------- fibroids can interfere with fertility, depending on their location

The preferred imaging modality for the evaluation of uterine fibroids is ultrasonography (US). CT scanning is limited by their similar attenuation characteristics of fibroids. MRI and hysteroscopy (examination of the inside of the uterine cavity done with special viewing instrument) can depict the number, size, and location of the tumors.

The treatment of choice during child bearing years is a myomectomy (removal of fibroids) because future pregnancies are possible. Small asymptomatic leiomyomas are usually not treated, but should be observed at six-month intervals. Leiomyomas don’t usually require surgery unless they cause significant pressure on adjacent organs (bladder, ureters, or bowels), severe bleeding leading to anemia, or they‘re growing rapidly. Nevertheless, under certain circumstances, leiomyomas may recur, and a hysterectomy may be performed and cures the problem.

http://www.nmihi.com http://emedicine.medscape.com http://www.brooksidepress.org

HIATAL HERNIA

The hiatus is an opening in the diaphragm. A hernia occurs any time an internal body part pushes into an area where it doesn’t belong. A hiatus hernia forms at the opening where your esophagus joins your stomach. Part of the stomach pushes through this opening up into the chest. There are two main types of hiatal hernias:
1. Sliding hiatal hernia ---- the stomach and the section of the esophagus that joins the stomach slides up into the chest through the hiatus.
2. Para esophageal hernia ---- the stomach and the esophagus stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus.

The cause of a hiatus hernia is most time unknown. Some people develop this due to the following:
• after sustaining an injury to that area of the body
• increased pressure in the abdomen from coughing or lifting heavy objects
• straining during bowel movements
• pregnancy and delivery
• substantial weight gain
• born with an inherent weakness or unusually large hiatus opening
In addition to the increased occurrence in overweight people (especially women), hiatal hernias also occur more often in people over fifty and smokers.

Most small hiatal hernias don’t cause any problems. But if you’re experiencing recurrent gastro esophageal reflux, there are some medications and self-care measures that can usually relieve your symptoms. Larger hernias may cause the following signs and symptoms when stomach acids back up into your esophagus (GERD):
• heartburn
• chest pain
• nausea
• belching
• bleeding and anemia

These signs and symptoms tend to become worse when you lean forward, strain, lie down, lift heavy objects and during pregnancy. Nevertheless, a variety of lifestyle changes can ease or relieve these symptoms. Some or all of the following measures may help:
• sit up after you eat at least 3 hrs. so that most of the food in your stomach will have emptied into your small intestines and it can’t flow back into your esophagus
• elevate the head of your bed six to nine inches so that gravity will help prevent acid reflux
• limit fatty foods which relax the lower esophageal sphincter and slow stomach emptying
• avoid problems foods (chocolate, onions, spicy foods, citrus fruits, tomato-based foods, spearmint and peppermint, decaffeinated drinks and alcohol
• eat small meals because large meals can distend the stomach pushing it into your chest
• lose weight (most important) and avoid tight fitting clothes to help reduce the pressure on the stomach
• stop smoking which increases acid reflux and dries your saliva
• take time to relax because stress slows digestion which makes GERD symptoms worse
• avoid certain medications, if possible such as aspirin, ibuprofen, sedatives, tranquilizers, quinidine, alendronate, naproxen sodium, nonsteroidal anti-inflammatory drugs, antibiotic tetracycline, calcium channel blockers and theophylline

A hiatal hernia can be diagnosed with specializes X-ray studies (barium swallow) or CT of the abdomen and with endoscopy.

Treatments if lifestyle changes that were mentioned above aren’t effective include the following:
• medications ---- antacids, H-2 blockers, proton pump inhibitors (PPIs)
• surgical repair

http://www.medicinenet.com/hiatal http://www.mayoclinic.com/health/hiatal-hernia
http://www.webmd.com/heartburn-gerd http://www.acg.gi.org/patients/women/whatisgerd.asp?