It is sero-negative progressive inflammatory arthrities of the spine.it also may involve hip and shoulder joint.

Ankylosing Spondylities

Actiology:
Males are more affected than the female
Age: 16-40 years

Cause: unknown

Investigation:
HLA-B 27 positive

Pathology: 
Ist affected the sacroilliac joint then in lumber spine from lumber joint runs to thoracic, then cervical the hip and shoulder then pain in spread
spinal-hip-shoulder joint

Pathological change

Climical feature:

1. Lumber backache
2. Pain and stiffness,after rest and early morning
3. Sacroilliac joint tender to force  extendedmovement.
4. Stiffness back, progressive rigidity
5. Loss of lumber curvature
6. Progressive thoracic khyphosis
7. Forward extended head

8. Decrease chest expansion
9. Flextion contracture of hip and shoulder.
10 .Achilies tendinities


X-ray shown:

1. Sacro-illiac erosion lateral fusion
2. Arthrities change in apophyseal joint
3. Ligamentus ossification
4. Squaring of vertebral bodies
5. New bone  growth between two vertebrae.


Problem:

1. Low back pain.
2. Vertebral joint stiffness
3. Muscular pain and contracture
4. Decrease chest expansion
5. Respiratory complication
6. Spinal deformity
7. Tendinities and tendo-achilies
8. Muscle power decrease


Sensory Complication:

1. Chest infection
2. Atlanto-axial subluxation
3. Possible spinal cord damage
4. Heart disease
5. Decrease hight
6. Loss of mobility

Management:

1.To reduce pain sacro-illiac joint

• apply ice
• ultra-sound
• back extension

Lumber region:

• Apply heat
• Grade I mobilization
• IRR 
• SWD
• Ultra-sound

Vertebral joint stiffness:

• Heat compression
• Accessory movement of lumber spine
• Rotatioal movement
• Posterior to anterior
• Back extension in lying to repeatation

To reduce muscle pain:

• Messege transversely

To reduce contracture:

• Back flextion, patient in prone lying place pillow under the abdomen.

Chest complication:

• Lateral costal breathing exercise.

Respiratory complication:
.
1. Deep breathing:apical,lateral costal, abdominal
2. Hulfing/FET
3. Coughing:at least 5times with rest
4. Lordosis-back extension
5. Kyphosis-back extension place towel under lumbrg region.
6. Tendinities-at firest hot compression,GTFM,DTFM message
7. Muscle power decrease-all kind of strengthening exercise
8. Lower limb-static cycle,swimming


Advise:

1. Advice daily activiting
2. Avoid heavy weight lifting
3. Patient will continue his/her home exercise.

















 mobility

This is the comonest of the deformities occuring at the region of the ankle,subtaloid and midtarsal joint.the foot is planter fiexed at the ankle joint adducted and inverted at the subtaloid and midtarsal joint.
the condition may be unilateral or bilateral.

Cause:

• Genetic
• Intrauterine pressure
• Drugs:steroid specially
• Infection on uterus
• Congenital neuromascular abnormalities

Pathology:initially there may be littlt bony abnormalities although there is usually a subluxations at the talo-navicular joint


the soft tissues on the medial side of the foot are underdeveloped and shorten than the normal

the calf and the peroneal muscle are underdeveloped

symtome and sign: planter flexed at the ankle
addected and inverted at the subtaloid and midtarsal joint.


problem list:
deformity
muscle contracture:
ADL decrease(limping gait)

plane and treatment:

1. deformity:

•  mobilization and manupulation
•  Surgical

Ganglion Cyst

Definition

A ganglionic cyst is a noncancerous lump or bump that most commonly develops in the tendons or wrist or hand joint. This cyst is often oval in shape, usually containing a soft substance such as a gel. 



Complications

A cyst can promote the occurrence of carpal tunnel syndrome.
 
Treatments

If the cyst is not painful or does not affect movement, usually no treatment is offered, according to the Sonia Physiotherapy Clinic.

On the other hand, if the cyst is problematic, the doctor can use the following methods:
- Immobilization. Immobilizing the forearm can help decrease cyst growth. You can use a wrist brace.
- Needle puncture. A needle is used by the doctor to drain the liquid in the cyst. Sometimes the doctor injects an enzyme into the cyst to facilitate removal of the gel (cyst contents). In addition, after the puncture the doctor sometimes injects a steroid to limit its recurrence.
- Surgery. If the other methods do not work, the doctor may perform surgery to remove the rod that attaches the cyst to a joint or tendon. 

Good advice

- Avoid drilling a cyst with a needle yourself. In addition to being unlikely to be effective, there is a risk of infection.

- Avoid typing with a heavy object on the cyst, this alternative method has not proven and it can even aggravate the situation by destroying the structures around the cyst.


Treatment of a synovial cyst

A cyst that occurs for no particular reason should be monitored but not necessarily treated. After the push, it happens that the cyst stabilizes, evolves and then regress spontaneously after 6 months. "It is estimated that 30 to 40% of wrist cysts spontaneously fade after the first 4 months," recalls Dr. Sonia Chowdhury

If the pain and discomfort are not too important, it is better not to intervene and see how the cyst evolves over time. The doctor then simply recommends the wearing of a splint to put the wrist at rest.

A puncture is always possible but often discouraged for different reasons. There is a risk of infection and the solution is only partially satisfactory: "You empty the liquid but the pocket remains present," adds Dr. Sonia. For the same reasons, it is not recommended to crush the cyst: the pocket remains and the cysts then tend to recur, becoming larger.

In case of traumatic cyst, recurrence and particularly troublesome pains, an excision (removal of the cyst by surgical intervention) can then be considered. This is the most effective solution. Surgery is performed on an outpatient basis under local anesthesia. The surgeon removes the lesion and then has it analyzed.

The patient then keeps a bandage for a few days and keeps the joint immobilized for a fortnight. During the entire convalescence, it is advisable to avoid carrying heavy loads, gestures of strength and to protect the joint (especially for the toilet). In principle, the resumption of normal activities becomes possible after 4 to 5 weeks.

Whether regressing on their own or being treated by surgery, synovial cysts tend to recur in about 10% of cases. The recurrence is treated in the same way as the initial situation, ie local surgery in case of pain or severe discomfort. It is possible to consider a second surgery if the cyst is located in the same place.



 

 Back Pain In Pregnancy

This is the evil of the century ... No wonder that during pregnancy, where the balance of our body is turned upside down, back pain is even more common. Thus, more than 80% of pregnant women would be confronted. Our advice to limit the damage of these pains in the back, very frequent during the pregnancy.


Pain in the back during pregnancy: what is it?

Back pain usually appears during the 2nd trimester, to intensify until the end of the pregnancy. The pains mainly affect the lumbar, that is to say the lower back. Sometimes they go down to the buttocks and upper thighs: it is sciatica, back pain very common in pregnant women. Fatigue, long car journeys, prolonged standing station, but also the number of pregnancies: all factors that promote these pains. Changes in position - getting up off the couch for example! - are also tough. On D-day, some mothers feel severe pain in the lower back. Behind this back pain are hidden contractions. This is the famous "childbirth in the kidneys".

Pain in the back during pregnancy: the causes

The explanation is mechanical: while your belly rounds, your back is arching. With the weight of the baby, your center of gravity is projected forward, but your abs, stretched by pregnancy, no longer play the game. Result: it is the entire lower back that compensates. And as always during pregnancy, the hormones also put their grain of salt: at the approach of the term, some prepare your body for the day by causing a loosening of the ligaments, especially in the lower back and joints of the sacrum and pelvis.

Pain in the back during pregnancy: what to do


Fighting lumbar pain requires above all a healthy lifestyle that will spare your back. Is :

- rest: getting pregnant well is also the key to well-being!
- reasonable weight gain (10 to 12 kg)
- good postures in everyday life: get up gently by going to the side, do not bend forward but bend your knees to bend down, avoid sudden movements, do not carry heavy loads. Standing, tilt your pelvis forward to correct your arch. Sessions with a physiotherapist, on prescription of your gynecologist, are the best way to adopt these good gestures.
- if pregnant, you have sore back, make sure to keep your back straight, using a cushion
- comfortable shoes: we put his stiletto heels in the closet and we opt for small heels (2-3cm) stable
- physical activity: walking, swimming (preferably on the back), soft gymnastics, pelvic tilting exercises, yoga
- wearing a seat belt (ask your doctor or midwife for advice)
- a special pregnant woman massage: it will not solve your back pain ... but you will do good!
- one or two sessions in the osteopath or chiropractor who, by various manipulations, will help your body to adapt to its new morphology (to avoid however around 12SA)
- If pregnant, you have back pain at night, make sure to sleep on a firm mattress, preferably on the left side, in a rifle, with a cushion under your knee bent. The nursing pillow will be your best companion at night!

Juvenile Chronic Arthritis and Physiotherapy: Living and Moving

Juvenile Chronic Arthritis, or Juvenile Idiopathic Arthritis (JIA),
is a disease that affects one in every 1,000 children in Canada.
Real source of concern for parents,
it is nevertheless possible today for children to live well with this disease.






Chronic juvenile arthritis in a nutshell

Juvenile chronic arthritis is an inflammatory disease that affects children 16 and under. It is found in boys and girls, but they are affected four times more often by this problem.

This autoimmune disease disrupts the immune system, which then attacks healthy tissues of different parts of the body instead of protecting them. In the case of juvenile chronic arthritis, it is the joints that are affected. Although this problem is widespread, its causes are still unknown; however, some genetic, infectious and immunological factors seem to be associated with it.



There are several categories of juvenile chronic arthritis
If you have researched this disease, you may have heard of several types of juvenile chronic arthritis such as systemic arthritis or rheumatoid arthritis. It is important to know that all these names refer to juvenile idiopathic arthritis.

However, to facilitate research, but also to promote treatment, juvenile chronic arthritis has been classified into seven categories. The latter make it possible to discern the various forms of the disease and its characteristics. Thus, some forms will be more frequent in boys than in girls, they will be triggered at a more or less advanced age and they will be more or less serious.

The various forms of juvenile chronic arthritis: systemic arthritis, oligoarthritis, rheumatoid arthritis positive, rheumatoid arthritis, psoriatic arthritis, enthesitis arthritis and undifferentiated arthritis.



Does my child have juvenile chronic arthritis?

The symptoms of juvenile chronic arthritis are often difficult to identify in young children, but also adolescents. Generally, we notice pain, swollen joints, heat zones, limitation of movement or muscle weakness. Morning stiffness, although often perceived as mundane, can also be an important symptom.

It is important to mention that these symptoms must last more than six weeks before being associated with juvenile arthritis.

In young children, the symptoms of this disease are difficult to interpret and identify quickly. In addition, because arthritis is an irregular disease, symptoms may be more or less constant. The child can limp, refuse to move or play, have a drop in energy or mood changes.

On the adolescent side, symptoms can also be difficult to identify because they are often associated with other issues. The pain or joint stiffness that will be suffered by the adolescent will often be interpreted as growth pains or injuries due to the many activities they practice.


Good Reflex

If you find that your child is moving less or seems to be experiencing pain while performing daily activities (walking down stairs, walking, standing, sitting, etc.) and that pain persists for more than six weeks, then recommended to consult a Physiotherapist.



Your child has been diagnosed with juvenile chronic arthritis: do not lose hope!
Although chronic juvenile arthritis is a disease that can not be cured, it is quite possible to live comfortably by keeping it in remission. Ms. Sonia Hossain Chowdhury is also very optimistic about the quality of life of her patients and is reassuring about their future. Thanks to advances in medication, children's lives are greatly improved and it is not uncommon for them to be able to fully resume their activities.

This medication acts on the immunity of the child and helps to stabilize his situation in the long term. Some parents quickly see improvements and it often happens to Ms. Sonia Hossain Chowdhury to hear "he is happier, he starts playing again and we find our child! ".

While new treatments have proved successful for many children, it will take a few more years to decide on their effectiveness in the very long term. Nevertheless, the current results bring hope to children and their parents.


Juvenile chronic arthritis and physiotherapy: keep moving

Once a child has been diagnosed with juvenile chronic arthritis and prescribed medication, he or she is often referred for physiotherapy. The physiotherapist will have a role in preventing symptoms as well as improving the quality of life. Its goal will be to minimize inflammation to avoid repercussions on the joints and bones.

It can intervene on the pain, the improvement of the articular amplitude and the muscular reinforcement. While adapting to his patient, the physiotherapy professional will prescribe several simple exercises, easy to perform daily. He will also give valuable advice to parents.

In addition, the physiotherapist will recommend that the child be physically active. Indeed, contrary to popular belief, juvenile chronic arthritis is not synonymous with sedentary lifestyle. On the contrary, staying active will allow the child to improve his range of motion and muscle strength, which will have an impact on the pain. The activity should simply be adapted to the child and his state of health.

In times of crisis (episode of pain), the professional will tend to reduce the activities of the young, but it will encourage him to gradually resume these once the young will be stabilized. In order to reduce morning stiffness, he will recommend hot water baths in the morning, which will help the muscles warm up.



What is the best sport for children with juvenile chronic arthritis?

The most recommended sports for children with chronic juvenile arthritis are water sports (swimming, aqua-fit, aqua-stretching, etc.) and non-impact sports such as cycling.

However, it is important to take into account the psychological impact and not to prevent a child from practicing an activity that he loves and that he had started before suffering from this disease.

Ms. Sonia Hossain Chowdhury then recommends adjusting the activity to the child's condition and adapting its frequency according to its tolerance.

In conclusion, juvenile chronic arthritis is a disease that is not easy to manage, both for the child who suffers from it and for his parents. However, it is important to remember that scientific advances allow children to have a better quality of life and continue to engage in activities that stimulate and make them happy.

 What are the causes of Down syndrome?

Down syndrome is caused by a random error in the division of cells that results in the presence of an extra copy of chromosome 21.

This type of error is called non-disjunction. Usually, when a cell divides into two, the pairs of chromosomes are separated so that one chromosome goes to one cell and the other to the other cell. In non-disjunction, an error occurs and both chromosomes of the pair go to the same cell and the other cell does not receive any chromosome of that pair.

Most of the time, this occurs because of a random error during the formation of the egg or sperm. To date, there is no known environmental or behavioral factor for parents known to cause Down syndrome.1,2

After extensive research on these errors in the division of cells, the researchers discovered that:
 In more than 90% of cases, the extra copy of chromosome 21 comes from the mother's egg.
In about 4% of cases it is the father who provides the extra copy of chromosome 21 through the sperm.
    In the rest of the cases, the error occurs after fertilization, while the embryo grows.

Chromosomal changes that can cause Down syndrome

Studies show that there are three types of chromosomal changes that can cause Down syndrome.

    Complete Trisomy 21 In this case, an error during the formation of the ovum or sperm causes one of the two to have an extra chromosome. Therefore, after the egg and sperm come together, the resulting cells will also have three copies of chromosome 21. The complete copy of extra chromosome 21 is found in all the cells of that person - that is, there is a complete trisomy . Complete trisomy 21 is the cause of approximately 95% of Down syndrome cases.1,2,3
    Trisomy 21 mosaic. The cells of the body are not exactly the same. In about 1% of cases of Down syndrome, most of the cells in the body have the extra chromosome, but some do not. This is called "mosaicism." Trisomy 21 mosaic occurs when the error in cell division occurs at an early stage of development but after the union between a normal egg and sperm. It can also occur during an early stage of development when some cells lose an extra chromosome 21 that was present at the time of conception. The symptoms of a person with mosaic trisomy 21 may be different from those of people with complete trisomy 21 or trisomy 21 by translocation, depending on the number of cells in which there is an extra chromosome.1,2
    Trisomy 21 by translocation. In this type of chromosome change, the cells have only a part of the extra copy of chromosome 21. The extra part of the chromosome "sticks" to another chromosome and is transmitted to other cells as the cells divide. This type of change causes approximately 4% of cases of Down syndrome. People with trisomy 21 by translocation do not have specific cognitive or medical characteristics that differentiate them from people with complete trisomy 21.

    Sometimes, a parent who does not have Down syndrome can be a carrier of a translocation on chromosome 21 that can transmit to their children and cause Down syndrome. Studying the chromosomes of the parents allows us to know if this is the cause of the syndrome. A genetic counselor could help families affected by trisomy 21 by translocation to understand the risk of transmitting the syndrome in future pregnancies.1,2,3 .

How do doctors diagnose Down syndrome?

Health professionals can detect the presence of Down syndrome during pregnancy or after the birth of the baby. There are two types of tests to detect Down syndrome during pregnancy:

    Prenatal screening test. This test may show that there is a greater chance that the fetus has Down syndrome, but it can not be determined for sure. If this test indicates a greater probability, the health professional could indicate that a diagnostic test is performed.
    Prenatal diagnostic test. This test can accurately determine the presence of Down syndrome. Diagnostic tests carry a slightly higher risk to the fetus than screening tests.

The American College of Obstetricians and Gynecologists (ACOG) again recommends that all pregnant women be offered screening for Down syndrome.1

Down syndrome prenatal screening test

There are several options for screening for Down syndrome. These are:

    A blood test and an ultrasound test during the first trimester of pregnancy. This is the most accepted detection approach during the first trimester. The blood test allows the health professional to detect the presence of "markers," such as certain proteins, in the mother's blood that might suggest a greater likelihood of the baby having Down syndrome.2 Then the professional of health performs an ultrasound test that uses high-frequency sound waves, to obtain images of the fetus. Ultrasound can detect fluid in the nape of the fetus, which sometimes indicates the presence of Down syndrome. This ultrasound test is called nuchal translucency. During the first quarter, this combined method is more efficient in terms of detection rates than the methods used during the second quarter.3
    Blood tests during the second trimester of pregnancy. As in the first trimester, a blood test allows the health professional to detect the presence of markers in the mother's blood. The triple screening test analyzes the levels of three different markers; The quadruple screening test analyzes the levels of four different markers.3,4
    Combined test (sometimes called integrated test). This approach uses a blood test and an ultrasound test during the first trimester along with a blood test in the second trimester. Health professionals then combine all the results to obtain a risk score for Down syndrome.2

If a woman is pregnant with twins or triplets, the blood test will not be as reliable because the substances of a fetus with Down syndrome would be more difficult to detect.2,3

Prenatal diagnosis test of Down syndrome

If the screening test shows a high probability that a fetus has Down syndrome, a diagnostic test may be performed. The ACOG recommends that pregnant women of all ages have the option to skip the screening test and get a diagnostic test directly. Until recently, this option was only offered to women over 35 and other high-risk women, since the diagnostic test carries a slight risk of miscarriage.1 Before a diagnostic test is performed, the pregnant woman and Your family may want to meet with a genetic counselor to discuss family history and the risks and benefits of having such a test in your specific situation.

The diagnostic test for Down syndrome involves obtaining a sample of genetic material. After the extraction, the sample is analyzed to check for extra material from chromosome 21, which could indicate that the fetus has Down syndrome. Usually, parents will receive test results one or two weeks later. The following procedures are used to obtain the samples.

    Amniocentesis. A health professional extracts a sample of amniotic fluid, which is then analyzed to rule out the presence of the extra chromosome. This test can not be done until weeks 14 to 18 of pregnancy.
    Chorionic villus sampling (CVS for its acronym in English). A health professional removes a sample of cells from a part of the placenta, the organ that connects the mother to the fetus and then analyzes the sample to rule out the presence of the extra chromosome. This test is performed between weeks 9 and 11 of pregnancy.
    Percutaneous umbilical cord blood sample (PUBS). A health professional removes a sample of fetal blood in the umbilical cord through the uterus. Then, the blood is analyzed to rule out the presence of the extra chromosome. The PUBS is the most accurate diagnostic method and allows confirming the results of CVS or amniocentesis. However, PUBS can not be performed until later in pregnancy, between weeks 18 and 22.5

Tests and in vitro fertilization

Another diagnostic approach is used in conjunction with in vitro fertilization. Preimplantation Genetic Diagnosis (PGD) allows doctors to detect chromosomal imbalances and other genetic diseases in the fertilized egg before implanting it into the uterus.

This technique is useful in particular for couples who are at risk of transmitting certain genetic diseases to their children, including disorders associated with the X chromosome, as well as for couples who have suffered repeated spontaneous abortions, subfertile couples or at risk of having disorders of one's own. only gene.

Couples interested in the PDG should consult a genetic counselor and closely monitor the pregnancy, as well as perform additional tests during pregnancy, since they are at higher risk of suffering chromosomal abnormalities after the process of in vitro fertilization.

Diagnosis of Down syndrome after birth

The diagnosis of Down syndrome after birth is usually based, in the first instance, on the physical signs of the syndrome.

But since individuals with Down syndrome may not have these symptoms and many of these symptoms are common in the general population, the health professional will take a sample of the baby's blood to confirm the diagnosis. The blood sample is analyzed to determine the number of chromosomes of the baby.11

The different diseases of the back

Sciatica (or sciatica) is characterized by intense pain from the buttock, then the thigh and finally the foot, stiffness of the spine and symptoms increased by effort, coughing or sneezing. From an anatomical point of view, sciatic pain (or sciatica) corresponds to compression of the anterior motor root of the sciatic nerve. They cause a sudden and throbbing pain, the most common example of which is the terrible "kidney tower" that one contracts while trying to lift a card too heavy, during a move for example. How to recognize it? How to avoid it or relieve it? Discover the characteristic symptoms of sciatica and the remedies and treatments to remedy it.

The symptoms of sciatica

The symptoms of sciatica In the process of moving, you lift a cardboard heavier than expected and all of a sudden, an electric shock paralyzes your leg. You have just been struck by sciatica. Discover the basics about the symptoms of sciatica

Sciatic pain: 

exercises and stretching to relieve it

Do you feel pain from the lower back and radiate down the buttocks and legs? We offer exercises to relieve it. They are recommended when the pain is moderate and there is no paralysis. This represents 90% of low back pain. Follow the advice of Yann Chapotton, physiotherapist and osteopath, to relieve and prevent the sciatica crisis.

Caution: Exercises should not under any circumstances reproduce or increase pain. During each exercise, you must feel that you are working the targeted area but this should not be painful. If this is the case, it is better to stay at rest. Equip yourself with a sports mat and preferably wear a snug fit so as not to impede movement.

If the pain persists or worsens despite exercise, consult a doctor promptly.