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ManipalHospitals
+91 80 2222 1111
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GENERAL ORTHOPEDIC  

PMR is a medical specialty focused on the prevention, diagnosis and conservative treatment of disorders associated with disabilities such as musculoskeletal disorders and chronic pain. Department of PMR at Manipal Hospital Bangalore has been designed to provide comprehensive multidisciplinary rehabilitation for all age groups. Our goal is to help patients maximise their recovery from injury or illness using a combination of physical, occupational and speech therapy, as well as strong social support and family involvement.
Our unique and customised programs are designed to promote or enhance recovery, health and wellness that fit each patient's needs and helps individuals realise their fullest potential while enhancing their overall quality of life upon return to the community. Emphasis is placed on maximizing functional outcome in areas of mobility, self care, communication, cognition and psychosocial adjustment for patients.
What to Expect
When a patient first comes into our program, we conduct an evaluation to assess functioning in every area before we develop treatment objectives and specific plans for the patient. The patient and his/her family meet with the treatment team to set short-term and long-term goals.

Who We Can Help

We work with patients and their families who have lost function or who are impaired to deal with common functional problems including:
•    Difficulty in walking, climbing stairs, getting out of bed
•    Difficulty in swallowing
•    Loss of coordination and balance
•    Problems with speech or language
•    Memory deficits or judgment difficulties
•    Loss of bowel or bladder control
•    Limitations due to pain
•    Problems returning to work or everyday routine in the community

Types of Physical Therapy Treatments

•    Functional Mobility and Gait Training
•    Balance and Strength Training
•    Body Mechanics and Energy Conservation Training
•    Electrical Stimulation
•    Heat and Cold Therapy
•    Joint and Soft-tissue Mobilisation
•    Neuromuscular Re-education
•    Pulmonary and Cardiac Therapy
•    Sports Rehabilitation
•    Therapeutic Exercises
•    Use of Pain-relieving Modalities
•    Manual Therapy and Therapeutic Exercise
•    Lymphedema Management

Comprehensive Range of Care focused on your Orthopaedics need:

We provide a broad level of therapy and rehabilitation to patients following injury or illness and our specialties include:

  • HEEL PAIN

Heel pain is a very common complaint in any Orthopaedic hospital. There are 26 bones in the human foot, of which the heel bone (calcaneus) is the largest. The human heel is designed to provide a rigid support for the weight of the body. When we are walking or running it absorbs the impact of the foot when it hits the ground, and springs us forward into our next stride. Experts say that the stress placed on a foot when walking may be 1.25 times our body weight, and 2.75 times when running.Consequently, the heel is vulnerable to damage, and ultimately pain.
Heel pain is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel.
Symptoms
Pain typically comes on gradually, with no injury to the affected area. It is frequently triggered by wearing a flat shoe, such as flip-flop sandals with a hard insole. Flat footwear may stretch the plantar fascia to such an extent that the area near the heel becomes swollen (inflamed).
In most cases, the pain is under the foot, towards the front of the heel. Symptoms tend to be worse just after getting out of bed in the morning, and after a period of rest during the day.After a bit of activity symptoms often improve a bit. However, they may worsen again towards the end of the day.


Causes of heel pain
Common causes of heel pain include:
•    Plantar fasciitis
•    Heel pad wear and tear
•    Tendinitis
•    Bursitis
•    Pinched nerve
•    Rheumatoid arthritis
•    Stress fractures
•    Tarsal tunnel syndrome


When to see a doctor:
•    Severe pain accompanied by swelling near your heel
•    There is numbness or tingling in the heel
•    There is pain in your heel as well as fever
•    You are unable to walk normally


Treatment
Most cases are treated conservatively. Surgery is usually the last resort
Different modalities of treatment include rest, pain relief by anti-inflammatory medications, stretching exercises, modification of footwear depending on the problem and sometimes alteration of the insoles. Your doctor may also recommend cortisone injections in certain cases when indicated.
You may also be advised certain modalities of physical therapy like ultrasound therapy or extra corporeal shock wave therapy to help in controlling the inflammation.
Minor injuries recover quickly within a few weeks. More severe injuries and injuries in athletic individuals, may take a longer time to recover. Outcome is generally good and most patients heal from an ankle sprain and are able to get back to their normal lives, sports, and activities. Some people, however, who do not properly rehabilitate their ankle or have had a severe sprain, may go on to have ankle instability. Repeated episodes can be dangerous because they can lead to cartilage damage within the ankle and may require surgery.
Surgery is rarely indicated when in spite of appropriate conservative treatment and physical therapy, the ankle joint continues to feels unstable and frequently gives way. Here, the ligaments are either repaired or reconstructed (using tendon grafts which involves replacing damaged tendons by borrowing them from a different area in the body)

  • ANKLE SPRAIN

An ankle sprain refers to stretching or tearing of the ligaments of the ankle. Most common ankle sprain occurs on the lateral or outside part of the ankle. It can also be associated with fracture of the ankle occasionally.
 
Symptoms and Clinical Presentation
Most patients present with a twisting injury of the ankle. This is mostly an inversion injury, which means the foot rolls underneath the ankle or leg which can commonly occur during sports. There is pain on the outside of their ankle along with some swelling and bruising. Depending on the severity of the sprain, a person may or may not be able to put weight on the foot and walk.


Diagnosis
It can be diagnosed fairly easily given that they are common injuries. The location of pain on the outside of the ankle with tenderness and swelling just below the prominent bone on the outside of the ankle called the lateral malleolus. Normal x-rays suggest that the bone has not been broken and instead the ankle ligaments have been torn or sprained.
An ankle sprain is graded based on severity of injury. It may only involve stretching of a few fibres, may be partially or completely torn. A complete tear of the ligaments is uncommon.
However it is very important, not to simply regard any ankle injury as an "ankle sprain" because other injuries can occur as well, for example, the peroneal tendons (the tendons that are behind the outer ankle bone) can be torn, fractures in other bones around the ankle could be a possibility.
In some cases, an MRI may be warranted to rule out other problems in the ankle such as damage to the cartilage (a flexible connecting tissue). An MRI, however, is not necessary to diagnose a sprain.


Treatment Procedures
The grade of the sprain will dictate treatment. Surgery is not required in the vast majority of ankle sprains. Primary treatment of ankle sprains includes RICE which is a combination of rest, ice, compression bandaging and limb elevation. A temporary cast may also be required in order to provide immobilization of the ankle joint. Physiotherapy to strengthen the muscles around the ankle may be necessary after the primary treatment.
Minor injuries recover quickly within a few weeks. More severe injuries and injuries in athletic individuals, may take a longer time to recover. Outcome is generally good and most patients heal from an ankle sprain and are able to get back to their normal lives, sports, and activities. Some people, however, who do not properly rehabilitate their ankle or have had a severe sprain, may go on to have ankle instability. Repeated episodes can be dangerous because they can lead to cartilage damage within the ankle and may require surgery.
Surgery is rarely indicated when in spite of appropriate conservative treatment and physical therapy, the ankle joint continues to feels unstable and frequently gives way. Here, the ligaments are either repaired or reconstructed (using tendon grafts which involves replacing damaged tendons by borrowing them from a different area in the body)

  • CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome is a condition where a nerve called the median nerve gets compressed within the carpal tunnel at the wrist. Clinical findings are dependent on the duration and severity of nerve compression.
The carpal tunnel is an opening in the wrist which is surrounded by bones on 3 sides and by the transverse carpal ligament which forms the roof. It contains many tendons and the median nerve. The median nerve provides sensation of the thumb, index finger, long finger, and half of the ring finger. It also helps us move the thumb by providing motor power to the thenar muscles.

Causes
CTS can be caused by any condition which either reduces the space inside the carpal tunnel or makes the size of the containing structures bigger.
Most of the times, the cause is unknown, but it can happen in rheumatoid arthritis, hypothyroidism, pregnancy, previous wrist fractures, tumours or cysts within the wrist, infection or burns. It can also occur in diabeticswhich may be due to problems with the nerve as a part of peripheral neuropathy rather than compression of the nerve.

Symptoms
•    Tingling and numbness in the area of median nerve supply which is usually the palmar surface of the thumb, index finger, long finger, and half of the ring finger.
•    Vague pains particularly at night when the patient may wake up and try shaking the numbness off which usually does not help.
•    Clumsiness of fumbling when trying to pick things up
•    Frequent dropping of objects due to weakness
•    Difficulty in performing certain finer activities like picking things out of a purse or fastening buttons or zippers

Diagnosis
Clinical examination can show altered sensation in the region of the median nerve. There may also be muscle wasting in this region. Tapping on the wrist crease near the median nerve may cause shooting type of pins and needles into the fingers.
The diagnosis is confirmed by performing a nerve conduction velocity test which shows how fast the nerve impulses move across a nerve.

Treatment
Treatment is usually conservative to start with by providing wrist braces and analgesics, and such a Bone cancer treatment, in Bangalore, could be cumbersome too.
The Cortisone injections into the carpal tunnel have also been shown to be helpful in some studies. This can also act as a test to confirm that your symptoms are due to carpal tunnel syndrome.
If the clinical findings indicate severe compression of the nerve or if conservative treatment is unsuccessful, You may be recommended to undergo surgery in the form of carpal tunnel decompression which can be performed as a day case. Here a small incision is made over the proximal aspect of the palm and the transverse carpal ligament is divided throughout its length to ensure that the median nerve is free. The skin is then sutured and a bulky dressing will be applied which is temporary. Sutures are usually removed after 7-10 days depending on surgeon preference.
Recovery usually takes several months and depends on the severity of nerve compression. If there has been nerve damage, there may be residual symptoms. Generally the area of the scar is quite tender for several months. Results are satisfactory in patients when the diagnosis is convincing.

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