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TREATMENTS OF SPECIFIC CONDITIONS Headaches: There are three major categories of headaches: primary headaches, secondary headaches, and

cranial neuralgias, facial pain, and other headaches What are primary headaches? Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache. Tension headaches are the most common type of primary headache. Up to 90% of adults have had or will have tension headaches. Tension headaches occur more commonly among women than men. Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience a migraine headache. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. It is estimated that 6% of men and up to 18% of women will experience a migraine headache in their lifetime. Cluster headaches are a rare type of primary headache affecting 0.1% of the population (1 in a 1,000 people). It more commonly affects men in their late 20s though women and children can also suffer these types of headache. Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly

while others are debilitated. While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes or intracerebral bleeding. Secondary headaches are those that are due to an underlying structural problem in the head or neck. There are numerous causes of this type of headache ranging from bleeding in the brain, tumor, or meningitis and encephalitis. What are the symptoms of tension headaches? The pain symptoms of a tension headache are: The pain begins in the back of the head and upper neck and is described as a band-like tightness or pressure. Often is described as pressure encircling the head with the most intense pressure over the eyebrows. The pain usually is mild (not disabling) and bilateral (affecting both sides of the head). The pain is not associated with an aura (see below), nausea, vomiting, or sensitivity to light and sound. The pain occurs sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people. The pain allows most people to function normally, despite the headache. Migraines: What are the symptoms of migraine headaches? Migraine is a chronic condition with recurrent attacks. Most (but not all) migraine attacks are associated with headaches. Migraine headaches usually are described as an intense, throbbing or pounding pain that involves one temple.

(Sometimes the pain is located in the forehead, around the eye, or at the back of the head). The pain usually is unilateral (on one side of the head), although about a third of the time the pain is bilateral (on both sides of the head). The unilateral headaches typically change sides from one attack to the next. (In fact, unilateral headaches that always occur on the same side should alert the doctor to consider a secondary headache, for example, one caused by a brain tumor). A migraine headache usually is aggravated by daily activities such as walking upstairs. Nausea, vomiting, diarrhea, facial pallor, cold hands, cold feet, and sensitivity to light and sound commonly accompany migraine headaches. As a result of this sensitivity to light and sound, migraine sufferers usually prefer to lie in a quiet, dark room during an attack. A typical attack lasts between 4 and 72 hours. An estimated 40%-60% of migraine attacks are preceded by premonitory (warning) symptoms lasting hours to days. The symptoms may include: sleepiness, irritability, fatigue, depression or euphoria, yawning, and cravings for sweet or salty foods. Patients and their family members usually know that when they observe these warning symptoms that a migraine attack is beginning.

Migraine aura An estimated 20% of migraine headaches are associated with an aura. Usually, the aura precedes the headache, although occasionally it may occur simultaneously with the headache. The most common auras are: flashing, brightly colored lights in a zigzag pattern (referred to as fortification spectra), usually starting in the middle of the visual field and progressing outward; and a hole (scotoma) in the visual field, also known as a blind spot. Some elderly migraine sufferers may experience only the visual aura without the headache. A less common aura consists of pins-and-needles sensations in the hand and the arm on one side of the body or pins-and-needles sensations around the mouth and the nose on the same side. Other auras include auditory (hearing) hallucinations and abnormal tastes and smells. For approximately 24 hours after a migraine attack, the migraine sufferer may feel drained of energy and may experience a low-grade headache along with sensitivity to light and sound. Unfortunately, some sufferers may have recurrences of the headache during this period. Sinusitis: What are the symptoms of a sinus headache? Pain is the primary symptom of a sinus headache, usually due to the increased pressure and decreased drainage from the affected sinus cavity. The pain of a sinus headache is often described as an increasing pressure sensation overlying the sinus that is blocked. The part of the face in the area of the affected sinus can be tender to touch. The pain can increase with changing position of the head, or when first getting up out of bed, again because of increased pressure within the sinus cavities.

Symptoms with sinus infection: If an infection is present, there may be fever, chills, malaise (feeling poorly) or myalgias (achy muscles). Greenish-yellow nasal drainage may occur. There may be post-nasal drainage in which secretions drip down to the back of the throat. This can cause a cough, and affected individuals sometimes complain about coughing up yellow sputum. They are actually coughing up the drainage that has dripped down from the sinuses. Swollen lymph nodes (swollen glands) may occur in the neck if an infection is present, no different than the swelling of lymph nodes that accompanies acute sore throat (pharyngitis) or ear infection (otitis media). Symptoms with sinus inflammation: If there is sinus inflammation without infection, the drainage may be clear. If the maxillary sinus is inflamed, pain also may be felt in the upper teeth since the sinus is located within the bone that holds those teeth. TMJ Syndrome/Dysfunction: What are common TMJ symptoms? TMJ pain disorders usually occur because of unbalanced activity, spasm, or overuse of the jaw muscles. Symptoms tend to be chronic, and treatment is aimed at eliminating the precipitating factors. Many symptoms may not appear related to the TMJ itself. The following are common symptoms. Headache: Approximately 80% of patients with a TMJ disorder complain of headache, and 40% report facial pain. Pain is often made worse while opening and closing the jaw.

Exposure to cold weather or air-conditioned air may increase muscle contraction and facial pain. Ear pain: About 50% of patients with a TMJ disorder notice ear pain and do not have signs of ear infection. The ear pain is usually described as being in front of or below the ear. Often, patients are treated multiple times for a presumed ear infection, which can often be distinguished from TMJ disorder by an associated hearing loss or ear drainage (which would be expected if there really was an ear infection). Because ear pain occurs so commonly, ear specialists are frequently called on to make the diagnosis of a TMJ disorder. Sounds: Grinding, crunching, clicking, or popping sounds, medically termed crepitus, are common for patients with a TMJ disorder. These sounds may or may not be accompanied by increased pain. Dizziness: Of patients with a TMJ disorder, 40% report a vague sense of dizziness or imbalance (usually not a spinning type vertigo). The cause of this type of dizziness is not well understood. Fullness of the ear: About 33% of patients with a TMJ disorder describe muffled, clogged, or full ears. They may notice ear fullness and pain during airplane takeoffs and landings. These symptoms are usually caused by eustachian-tube dysfunction, the structure responsible for the regulation of pressure in the middle ear. It is thought that patients with TMJ disorders have hyperactivity (spasms) of the muscles responsible for regulating the opening and closing of the eustachian tube. Ringing in the ear (tinnitus): For unknown reasons, 33% of patients with a TMJ disorder experience noise or ringing in the ears (tinnitus). Of those patients, half will have resolution of their tinnitus after successful treatment of their TMJ disorder.

Intra-Oral Massage:

Osteoporosis: What are osteoporosis symptoms and signs? Osteoporosis can be present without any symptoms for decades because osteoporosis doesn't cause symptoms until bone fractures. Moreover, some osteoporotic fractures may escape detection for years when they do not cause symptoms. Therefore, patients may not be aware of their osteoporosis until they suffer a painful fracture. The symptom associated with osteoporotic fractures usually is pain; the location of the pain depends on the location of the fracture. The symptoms of osteoporosis in men are similar to the symptoms of osteoporosis in women. Fractures of the spine (vertebra) can cause severe "band-like" pain that radiates from the back to the sides of the body. Over the years, repeated spinal fractures can lead to chronic lower back pain as well as loss of height and/or curving of the spine due to collapse of the vertebrae. The collapse gives individuals a hunched-back appearance of the upper back, often called a "dowager hump" because it commonly is seen in elderly women. A fracture that occurs during the course of normal activity is called a minimal trauma, or stress fracture. For example, some patients with osteoporosis develop stress fractures of the feet while walking or stepping off a curb. Hip fractures typically occur as a result of a fall. With osteoporosis, hip fractures can occur as a result of trivial slip-and-

fall accidents. Hip fractures also may heal slowly or poorly after surgical repair because of poor healing of the bone. What are the consequences of osteoporosis? Osteoporotic bone fractures are responsible for considerable pain, decreased quality of life, lost workdays, and disability. Up to 30% of patients suffering a hip fracture will require long-term nursing-home care. Elderly patients can develop pneumonia and blood clots in the leg veins that can travel to the lungs (pulmonary embolism) due to prolonged bed rest after the hip fracture. Osteoporosis has even been linked with an increased risk of death. Some 20% of women with a hip fracture will die in the subsequent year as an indirect result of the fracture. In addition, once a person has experienced a spine fracture due to osteoporosis, he or she is at very high risk of suffering another such fracture in the near future (next few years). About 20% of postmenopausal women who experience a vertebral fracture will suffer a new vertebral fracture of bone in the following year. Trigeminal Neuralgia: What Are the Symptoms of Trigeminal Neuralgia? Trigeminal neuralgia causes a sudden, severe, electric shocklike, or stabbing pain that lasts several seconds. The pain can be felt on the face and around the lips, eyes, nose, scalp, and forehead. Symptoms can be brought on when a person is brushing the teeth, putting on makeup, touching the face, swallowing, or even feeling a slight breeze. Trigeminal neuralgia is often considered one of the most painful conditions seen in medicine. Usually, the pain is felt on one side of the jaw or cheek, but some people experience pain at different times on both sides. The attacks of pain may be repeated one after the other. They may come and go throughout the day and last for days, weeks, or months at a time. At times, the attacks can disappear for months or years. The disorder is more

common in women than in men and rarely affects anyone younger than 50. Bells Palsy: What are the symptoms of Bell's palsy? The typical symptoms of Bell's palsy include: Acute unilateral paralysis of facial muscles is present; the paralysis involves all muscles, including the forehead. About half the time, there is numbness or pain in the ear, face, neck or tongue. There is a preceding viral illness in 60% of patients. There is a family history of Bell's palsy in 4% to 10% of patients. Less than 1% of patients have bilateral problems. There may be a change in hearing sensitivity (often increased sensitivity). What is the mechanism of injury in Bell's palsy? While the actual mechanism of injury of the facial nerve in Bell's palsy is unknown, one proposed mechanism of injury includes: Primary viral infection (herpes) sometime in the past. The virus lives in the nerve (geniculate ganglion) from months to years. The virus becomes reactivated at a later date. The virus reproduces and travels along the nerve. The virus infects the cells surrounding the nerve (Schwann cells) resulting in inflammation. The immune system responds to the damaged Schwann cells,

which causes inflammation of the nerve and subsequent weakness or paralysis of the face. The course of the paralysis and the recovery will depend upon the degree and amount of damage to the nerve. Other Neurological Conditions: A neurological disorder is any disorder of the body's nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord or other nerves can result in a range of symptoms. Examples of symptoms include paralysis, muscle weakness, poor coordination, loss of sensation, seizures, confusion, pain and altered levels of consciousness.There are many recognized neurological disorders, some relatively common, but many rare. They may be assessed by neurological examination, and studied and treated within the specialities of neurology and clinical neuropsychology. Interventions for neurological disorders include preventative measures, lifestyle changes, physiotherapy or other therapy, neurorehabilitation, pain management, medication, or operations performed by neurosurgeons. The World Health Organization estimated in 2006 that neurological disorders and their sequelae (direct consequences) affect as many as one billion people worldwide, and identified health inequalities and social stigma/discrimination as major factors contributing to the associated disability and suffering. Classifications: Neurological disorders can be categorized according to the primary location affected, the primary type of dysfunction involved, or the primary type of cause. The broadest division is between central nervous system (CNS) disorders and peripheral nervous system (PNS) disorders. The Merck Manual lists brain, spinal cord and nerve disorders in the

following overlapping categories: Nervous system The Human Nervous System. Brain: Brain damage according to cerebral lobe (see also 'lower' brain areas such as basal ganglia, cerebellum, brainstem): Frontal lobe damage Parietal lobe damage Temporal lobe damage Occipital lobe damage Brain dysfunction according to type: Aphasia (language) Dysarthria (speech) Apraxia (patterns or sequences of movements) Agnosia (identifying things/people) Amnesia (memory) Spinal cord disorders (see spinal pathology, injury, inflammation) Peripheral nervous system disorders Cranial nerve disorders Autonomic nervous system disorders Seizure disorders such as epilepsy Movement disorders such as Parkinson's disease Sleep disorders

Headaches (including migraine) Lower back and neck pain (see Back pain) Other pain (see Neuropathic pain) Delirium and dementia such as Alzheimer's disease Dizziness and vertigo Stupor and coma Head injury Stroke (CVA, cerebrovascular attack) Tumors of the nervous system (e.g. cancer) Multiple sclerosis (MS) and other demyelinating diseases Infections of the brain or spinal cord (including meningitis) Prion diseases (a type of infectious agent) Complex regional pain syndrome (CRPS) (a chronic pain condition.)

Rib Fixations:

Intercostal Neuralgia:

Constipation: Constipation facts Constipation is defined medically as fewer than three stools

per week and severe constipation as less than one stool per week. Constipation usually is caused by the slow movement of stool through the colon. There are many causes of constipation including medications, poor bowel habits, low fiber diets, abuse of laxatives, hormonal disorders, and diseases primarily of other parts of the body that also affect the colon. The two disorders limited to the colon that cause constipation are colonic inertia and pelvic floor dysfunction. Medical evaluation for the cause of constipation should be done when constipation is of sudden onset, severe, worsening, associated with other worrisome symptoms such as loss of weight, or is not responding to simple, safe treatments. Medical evaluation of constipation may include a history, physical examination, blood tests, abdominal X-rays, barium enema, colonic transit studies, defecography, ano-rectal motility studies, and colonic motility studies. The goal of therapy for constipation is one bowel movement every two to three days without straining. Treatment of constipation may include dietary fiber, nonstimulant laxatives, stimulant laxatives, enemas, suppositories, biofeedback training, and surgery. Stimulant laxatives should be used as a last resort because of the possibility that they may permanently damage the colon and worsen constipation. Most herbal laxatives contain stimulant-type laxatives and should be used, if at all, as a last resort. Dysmenorrhea: ( AKA Menstral cramp )

What are the symptoms of menstrual cramps? Menstrual cramps are pains that begin in the lower abdomen and pelvis. The discomfort can extend to the lower back or legs. The cramps can be a quite painful or simply a dull ache. They can be periodic or continual. Menstrual cramps usually start shortly before the menstrual period, peak within 24 hours after the onset of the bleeding, and subside again after a day or two. Menstrual cramps may be accompanied by a headache and/or nausea, which can lead, although infrequently, to the point of vomiting. Menstrual cramps can also be accompanied by either constipation or diarrhea because the prostaglandins which cause smooth muscles to contract are found in both the uterus and intestinal tract. Some women experience an urge to urinate more frequently. Gastrointestinal Concerns:

Carpal Tunnel: What conditions and diseases cause carpal tunnel syndrome? For most patients, the cause of their carpal tunnel syndrome is unknown. Any condition that exerts pressure on the median nerve at the wrist can cause carpal tunnel syndrome. Common conditions that can lead to carpal tunnel syndrome include obesity, pregnancy, hypothyroidism, arthritis, diabetes, and trauma. Tendon inflammation resulting from repetitive work, such as uninterrupted typing, can also cause carpal tunnel symptoms. Carpal tunnel syndrome from repetitive maneuvers has been referred to as one of

the repetitive stress injuries. Some rare diseases can cause deposition of abnormal substances in and around the carpal tunnel, leading to nerve irritation. These diseases include amyloidosis, sarcoidosis, multiple myeloma, and leukemia. What are carpal tunnel syndrome symptoms? People with carpal tunnel syndrome initially feel numbness and tingling of the hand in the distribution of the median nerve (the thumb, index, middle, and part of the fourth fingers). These sensations are often more pronounced at night and can awaken people from sleep. The reason symptoms are worse at night may be related to the flexed-wrist sleeping position and/or fluid accumulating around the wrist and hand while lying flat. Carpal tunnel syndrome may be a temporary condition that completely resolves or it can persist and progress. As the disease progresses, patients can develop a burning sensation, and/or cramping and weakness of the hand. Decreased grip strength can lead to frequent dropping of objects from the hand. Occasionally, sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also lead to wasting (atrophy) of the hand muscles, particularly those near the base of the thumb in the palm of the hand. Nerve Lesions:

Tenosynovitis: Inflammation of the tendon sheath Tenosynovitis is inflammation of the lining of the sheath that surrounds a tendon (the cord that joins muscle to bone).

Causes, incidence, and risk factors The synovium is a lining of the protective sheath that covers tendons. Tenosynovitis is inflammation of this sheath. The cause of the inflammation may be unknown, or it may result from: Infection Injury Overuse Strain The wrists, hands, and feet are commonly affected. However, the condition may occur with any tendon sheath. Note: An infected cut to the hands or wrists that causes tenosynovitis may be an emergency requiring surgery. Symptoms Difficulty moving a joint Joint swelling in the affected area Pain and tenderness around a joint, especially the hand, wrist, foot, or ankle Pain when moving a joint Redness along the length of the tendon Fever, swelling, and redness may indicate an infection, especially if a puncture or cut caused these symptoms. Epicondylitis: Lateral epicondylitis (tennis elbow) The lateral epicondyle is the outside bony portion of the elbow where large tendons attach to the elbow from the muscles of the forearm. These tendons can be injured, especially

with repetitive motions of the forearm, such as using a manual screwdriver, washing windows, or hitting a backhand in tennis play. Tennis elbow then leads to inflammation of the tendons, causing pain over the outside of the elbow, occasionally with warmth and swelling but always with local tenderness. The elbow maintains its full range of motion, as the inner joint is not affected, and the pain can be particularly noticed toward the end of the day. Repeated twisting motions or activities that strain the tendon typically elicit increased pain. The treatment of lateral epicondylitis may include ice packs, resting the involved elbow, and anti-inflammatory medications. Anti-inflammatory medications typically used include aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Naprosyn), diclofenac (Voltaren), and ibuprofen (Motrin). Ice application after activity can reduce or prevent recurrent inflammation. Medial epicondylitis (golfer's elbow) Medial epicondylitis is inflammation at the point where the tendons of the forearm attach to the bony prominence of the inner elbow. As an example, this tendon can become strained in a golf swing, but many other repetitive motions can injure the tendon. Golfer's elbow is characterized by local pain and tenderness over the inner elbow. The range of motion of the elbow is preserved because the inner joint of the elbow is not affected. Those activities which require twisting or straining the forearm tendon can elicit pain and worsen the condition. The usual treatment involves combinations of ice packs, resting the elbow, and medications including aspirin and other NSAIDs. With severe inflammation, local corticosteroid (cortisone) injections are sometimes given.

Olecranon bursitis: Olecranon bursitis (inflammation of the bursa at the tip of the elbow) can occur from injury or minor trauma as a result of systemic diseases such as gout or rheumatoid arthritis, or it can be due to a local infection. Olecranon bursitis is typically associated with swelling over the tip of the elbow, while range of motion of the inner elbow joint is maintained. Fractures: The bones of the elbow can break (fracture) into the elbow joint or adjacent to the elbow joint. Typically, elbow fracture causes sharp pain in the elbow and X-ray imaging is used to make a diagnosis. Fractures generally require immobilization and casts and can require orthopedic surgery involving pinning or open joint procedures. Sprain: A sprain is a stretch or tear injury to a ligament. One or more ligaments can be injured during a sprain. This might occur when the elbow is hyperextended or simply jammed, such as in a "stiffarm" collision. The severity of the injury will depend on the extent of injury to a single ligament (whether the tear is partial or complete) and the number of ligaments involved. Treatment involves rest, ice, immobilization, compression, and anti-inflammation medications. Sciatica & Pseudo Sciatica: What are risk factors for sciatica? Risk factors for sciatica include degenerative arthritis of the lumbar spine, lumbar disc disease, and trauma or injury to the lumbar spine. What are sciatica symptoms? Sciatica causes pain, a burning sensation, numbness, or tingling radiating from the lower back and upper buttock

down the back of the thigh to the back of the leg. The result is lumbar pain, buttock pain, hip pain, and leg pain. Sometimes the pain radiates around the hip or buttock to feel like hip pain. While sciatica is often associated with lower back pain (lumbago), it can be present without low back pain. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down. The pain relief by changing positions can be partial or complete. Piriformis Syndrome & other compression syndromes:

Strains:

Sprains:

What are sprain symptoms and signs? The first symptom of a sprain or strain injury is usually pain, though there may be a delay in onset of the symptom and the person who is injured may not recall the specific event that caused the injury. For example, a person who paints a room may develop shoulder pain the day after the repetitive effort of brushing overhead. This is because inflammation, swelling, and spasm can take time (from minutes to hours) to develop. Pain is always a symptom that indicates that there is something wrong with the body. It is the message to the

brain that warns that a muscle or joint should be protected from further harm. In work, exercise, or sport, the pain may come on after a specific incident, or it may gradually progress after many repetitions of a motion. Swelling almost always occurs with injury, but it may take from minutes to hours to be noticed. Anytime fibers of a ligament, muscle, or tendon are damaged, some bleeding occurs. The bleeding (such as bruising on the surface of the skin) may take time to be noticed. Because of pain and swelling, the body starts to favor the injured part. This may cause the muscles that surround the injured area to go into spasm. Hard knots of muscle might be felt near the site of the injury. The combination of pain, swelling, and spasm causes the body to further protect the injured part, which results in difficulty with use. Limping is an example of the body trying to protect an injured leg. Contusions: What is a bruise? You fall off your bike, bang your shin on the coffee table (that you swore you would move months ago), or run into a wall and wake up with a wallop of a bruise. What is a bruise, and what can you do about it? A bruise is caused when tiny blood vessels are damaged or broken as the result of a blow to the skin (be it bumping against something or hitting yourself with a hammer). The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. A bruise is medically referred to as a contusion. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis. Why do bruises occur more frequently in some people than in

others? The injury required to produce a bruise varies with age. Bruising occurs more easily in the elderly. While it may take quite a bit of force to cause a bruise in a young child, even minor bumps and scrapes may cause extensive bruising in an elderly person. Blood vessels become more fragile as we age, and bruising may even occur without prior injury in the elderly. The amount of bruising may also be affected by medications which interfere with blood clotting (and thus cause more bleeding into the skin or tissues). These drugs include many arthritis medications called nonsteroidal anti-inflammatories (for example, ibuprofen [Advil, Nuprin] and naproxen [Aleve]) and over-the-counter medications, such as aspirin. Warfarin (Coumadin) is often prescribed by doctors specifically to prevent clotting in patients who have had blood clots in their legs or heart. Warfarin can cause severe bruising, especially if the level of the medication becomes too high. Cortisone medications, such as prednisone, promote bruising by increasing the fragility of the tiny blood vessels in the skin. Patients with inherited clotting problems (such as in hemophilia) or acquired clotting problems (such as in patients with liver diseases like cirrhosis) can develop extensive bruising, unexplained bruising, or even lifethreatening bleeding. Bursitis: What are bursitis symptoms and signs? What is bursitis?: Bursitis is inflammation of a bursa. A bursa (the plural form is bursae) is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. There are 160 bursae in the body. The major bursae are

located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees. The symptoms of bursitis are directly related to the degree of inflammation present in the bursa. The inflamed bursa can cause localized pain and tenderness. If the bursa is so inflamed that swelling occurs, it can cause local swelling and stiffness, sometimes associated with local redness and warmth. The inflammation can make it painful to support body pressure. For example, hip bursitis can make it difficult to lay on the affected side of the hip. Bursitis in the knee, for another example, can make it painful to lay with the knees touching each other. Tendonitis: "Tennis elbow" is a common term for a condition caused by overuse of arm, forearm, and hand muscles that results in elbow pain. You don't have to play tennis to get this, but the term came into use because it can be a significant problem for some tennis players. Tennis elbow is caused by either abrupt or subtle injury of the muscle and tendon area around the outside of the elbow. Tennis elbow specifically involves the area where the muscles and tendons of the forearm attach to the outside bony area (called the lateral epicondyle) of the elbow. Your doctor may call this condition lateral epicondylitis. What are the symptoms of tennis elbow? Symptoms of tennis elbow include: Pain slowly increasing around the outside of the elbow. Less often, pain may develop suddenly. Pain is worse when shaking hands or squeezing objects. Pain is made worse by stabilizing or moving the wrist with force. Examples include lifting, using tools, opening jars, or even handling simple utensils such as a toothbrush or knife

and fork. Adhesive Capsulitis: ( Frozen shoulder ) Frozen shoulder facts Frozen shoulder is the result of scarring, thickening, and shrinkage of the joint capsule. Any injury to the shoulder can lead to a frozen shoulder. A frozen shoulder is usually diagnosed during an examination. A frozen shoulder usually requires aggressive treatment. What is a frozen shoulder? A frozen shoulder is a shoulder joint with significant loss of its range of motion in all directions. The range of motion is limited not only when the patient attempts motion but also when the doctor attempts to move the joint fully while the patient relaxes. A frozen shoulder is medically referred to as adhesive capsulitis. What causes a frozen shoulder? Frozen shoulder is the result of inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the normal shoulder joint. Any injury to the shoulder can lead to a frozen shoulder, including tendinitis, bursitis, and rotator cuff injury (rotator cuff syndrome). Frozen shoulders occur more frequently in patients with risk factors of diabetes, chronic inflammatory arthritis of the shoulder, or after chest or breast surgery. Long-term immobility of the shoulder joint can put people at risk to develop a frozen shoulder. What are symptoms and signs of a frozen shoulder? Symptoms and signs of a frozen shoulder include pain, stiffness, and loss of range of motion of the shoulder. The shoulder range of motion is limited when either the patient or an examiner attempts to move the joint. The shoulder

can develop increased pain with use. These symptoms can make sleep very uncomfortable. Contractures What are the symptoms and signs of a Dupuytren's contracture? A Dupuytren's contracture initially may cause only a minor painless lump in the palm of the hand near the base of the finger(s). A Dupuytren's contracture most commonly affects the ring (fourth) finger, but it can affect any finger. A Dupuytren's contracture can also affect one or both hands. As a Dupuytren's contracture progresses, it can lead to an inability to fully extend the affected finger from the flexed position. This can result in a loss of normal grasping. A Dupuytren's contracture is seldom associated with much, if any, pain unless the affected fingers are inadvertently forcefully hyperextended. Is a Dupuytren's contracture limited to the hands? Interestingly, a Dupuytren's contracture is sometimes associated with inflammation and thickening of the fascia tissue in a similar manner of the sole of the foot. This condition is called Ledderhose disease, or plantar fascial fibromatosis, and is sometimes associated with plantar fasciitis. It can sometimes be felt as a nodule or group of nodules in the middle of the sole of the foot. Patellofemoral: / Chondromalacia Chondromalacia patella facts Chondromalacia patella is the most common cause of chronic knee pain. Chondromalacia patella has also been called patellofemoral syndrome. The pain of chondromalacia patella is aggravated by activity or

prolonged sitting with bent knees. Abnormal "tracking" allows the kneecap (patella) to grate over the lower end of the thighbone (femur), causing chronic inflammation and pain. Treatment involves improving the alignment of the patella during contraction of the thigh muscle. What is the chondromalacia patella? Chondromalacia patella is abnormal softening of the cartilage of the underside the kneecap (patella). It is a cause of pain in the front of the knee (anterior knee pain). Chondromalacia patella is one of the most common causes of chronic knee pain. Chondromalacia patella results from degeneration of cartilage due to poor alignment of the kneecap (patella) as it slides over the lower end of the thighbone (femur). This process is sometimes referred to as patellofemoral syndrome. What causes chondromalacia patella? The patella (kneecap) is normally pulled over the end of the femur in a straight line by the quadriceps (thigh) muscle. Patients with chondromalacia patella frequently have abnormal patellar "tracking" toward the lateral (outer) side of the femur. This slightly off-kilter pathway allows the undersurface of the patella to grate along the femur, causing chronic inflammation and pain. Certain individuals are predisposed to develop chondromalacia patella: females, knock-kneed or flat-footed runners, or those with an unusually shaped patella undersurface. Chondromalacia patella facts Chondromalacia patella is the most common cause of chronic knee pain. Chondromalacia patella has also been called patellofemoral syndrome.

The pain of chondromalacia patella is aggravated by activity or prolonged sitting with bent knees. Abnormal "tracking" allows the kneecap (patella) to grate over the lower end of the thighbone (femur), causing chronic inflammation and pain. Treatment involves improving the alignment of the patella during contraction of the thigh muscle. What is the chondromalacia patella? Chondromalacia patella is abnormal softening of the cartilage of the underside the kneecap (patella). It is a cause of pain in the front of the knee (anterior knee pain). Chondromalacia patella is one of the most common causes of chronic knee pain. Chondromalacia patella results from degeneration of cartilage due to poor alignment of the kneecap (patella) as it slides over the lower end of the thighbone (femur). This process is sometimes referred to as patellofemoral syndrome. What causes chondromalacia patella? The patella (kneecap) is normally pulled over the end of the femur in a straight line by the quadriceps (thigh) muscle. Patients with chondromalacia patella frequently have abnormal patellar "tracking" toward the lateral (outer) side of the femur. This slightly off-kilter pathway allows the undersurface of the patella to grate along the femur, causing chronic inflammation and pain. Certain individuals are predisposed to develop chondromalacia patella: females, knock-kneed or flat-footed runners, or those with an unusually shaped patella undersurface. Cruciate/meniscal injuries: What causes a meniscus to tear? A forceful twist or sudden stop can cause the end of the femur to grind into the top of the tibia, pinching and potentially

tearing the cartilage of the meniscus. This injury can also occur with a deep squatting or kneeling, especially when lifting a heavy weight. Meniscus tear injuries often occur during athletic activities, especially in contact sports like football and hockey. Motions that require pivoting and sudden stops, such as tennis, basketball, and golf, can also cause meniscus damage. The risk of developing a torn meniscus increases with age because cartilage begins to gradually wear, lose its blood supply and its resilience. Increasing body weight also puts more stress on the meniscus. Routine daily activities like walking and climbing stairs increase the potential for wear, degeneration, and tearing. Because some of the fibers of the cartilage are interconnected with those of the ligaments that surround the knee, meniscus injuries may be associated with tears of the collateral and cruciate ligaments, depending upon the mechanism of injury. What are symptoms and signs of a torn meniscus? Some people with a torn meniscus know exactly when they hurt their knee. There may be acute onset of pain and the patient may actually hear or feel a pop in their knee. As with any injury, there is an inflammatory response, including pain and swelling. The swelling within the knee joint from a torn meniscus usually takes a few hours to develop. Depending upon the amount of pain and fluid accumulation, the knee may become difficult to move. When fluid accumulates, it may be difficult and painful to fully extend or straighten the knee. In some situations, the amount of swelling may not necessarily be enough to notice. Sometimes, the patient isn't aware of the initial injury but starts complaining of symptoms that develop later.

After the injury, the knee joint irritation may gradually settle down and feel relatively normal as the initial inflammatory response resolves. However, other symptoms may develop over time, including any or all of the following: Pain with running or walking longer distances Intermittent swelling of the knee joint: Many times, the knee with a torn meniscus feels "tight." Popping, especially when climbing up or down stairs Giving way or buckling (the sensation that the knee is unstable and a sense that the knee will give way): Less commonly, the knee actually will give way and cause the patient to fall. Locking (a mechanical block where the knee cannot be fully extended or straightened): This occurs when a piece of torn meniscus folds on itself and blocks full range of motion of the knee joint. The knee gets "stuck," usually flexed between 15 and 30 degrees and cannot bend or straighten from that position. Plantar Fascitis: What is a heel spur? What are symptoms of a heel spur? A heel spur is a pointed bony outgrowth of the bone of the heel (the calcaneus bone). They are attributed to chronic local inflammation at the insertion of soft tissue tendons or fascia in the area. Heel spurs can be located at the back of the heel or under the heel, beneath the sole of the foot. Heel spurs at the back of the heel are frequently associated with inflammation of the Achilles tendon (tendinitis) and cause tenderness and pain at the back of the heel made worse while pushing off the ball of the foot. How do heel spurs relate to plantar fasciitis? What causes heel spurs and plantar fasciitis? Heel spurs under the sole of the foot (plantar area) are

associated with inflammation of the plantar fascia (fasciitis), the "bowstring-like" tissue stretching underneath the sole that attaches at the heel. Plantar heel spurs cause localized tenderness and pain made worse when stepping down on the heel. Heel spurs and plantar fasciitis can occur alone or be related to underlying diseases that cause arthritis (inflammation of the joints), such as reactive arthritis (formerly called Reiter's disease), ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. It is important to note that heel spurs may cause no symptoms at all and may be incidentally discovered during X-ray exams taken for other purposes. Compartment Syndrome: What are the symptoms and signs of compartment syndrome? The symptoms of compartment syndrome, plus the circumstances that led to their development assist to make the clinical diagnosis. Pain out of proportion to the injury (or physical examination of the muscle compartment) often is the clue to make the diagnosis of compartment syndrome. Increased pressure within the muscle compartment causes loss of blood supply and nerve inflammation. This causes significant pain and numbness or paresthesia. (para=abnormal + ethesia=feeling). The diagnosis should be always considered when there is either an associated fracture, high velocity injury like a gunshot wound or a crush injury. Individuals who are taking anticoagulant medications such as warfarin (Coumadin) or enoxaparin (Lovenox) are at higher risk for bleeding into a compartment spontaneously or after injury. Historically, the pneumonic memory device for compartment syndrome is the "5 Ps" (pain, paresthesia [change in

sensation], pallor [pale coloration], paralysis, and poikilothermia [inability to control temperature]; some authors include pulselessness), but should not be relied upon to make the diagnosis. Only pain and change in sensation (parathesia) may be symptoms that point to the diagnosis of a developing compartment syndrome. Examination of the extremity often reveals tense and shiny skin that may be significantly bruised. Pain occurs with minimal range of motion of the foot, hand, or any of the extremity with compartment syndrome. The patient may have difficulty moving the extremity without assistance and pain is provoked when the care practitioner takes the affected limb though any range of motion In chronic compartment syndrome, there may be pain with range of motion of the extremity and muscle bulging may be noticed. Numbness is common but all symptoms usually resolve within a few minutes of discontinuing exercise. - Compartment syndrome describes increased pressure within a muscle compartment of the arm, leg or other extremity, most often due to injury, that causes muscle and nerve damage due to decreased blood supply. - Symptoms include excessive amounts pain, numbness, and decrease range of motion. - Surgery (fasciotomy) is the only treatment for acute compartment syndrome. The muscle compartment is cut open to allow muscle tissue to swell, decrease pressure and restore blood flow. - Complications may include muscle loss, amputation, infection, nerve damage, and kidney failure. - Prevention efforts include ice and elevation of the affected extremity. - Chronic compartment syndrome usually requires no

treatment or surgery. IT Band Friction Syndrome: What are iliotibial band syndrome symptoms and signs? Pain on the outer side of the knee is the most common symptom of iliotibial band syndrome and is due to inflammation of the area where the band crosses back and forth at the femoral epicondyle. Initially, there may be a sensation of stinging or needle-like pricks that are often ignored. This can gradually progress to pain every time the heel strikes the ground and finally can become disabling with pain when walking or when climbing up or down steps. Some patients may feel a snapping or popping sound at the knee, and there may be some swelling either where the band crosses the femoral epicondyle or below the knee where it attaches to the tibia. Occasionally, the pain may radiate along the course of the IT band all the way up to the outer side of the thigh to the hip. What causes iliotibial band syndrome? Iliotibial band inflammation is an overuse syndrome that occurs often in long-distance runners, bicyclists, and other athletes who repeatedly squat. The iliotibial band syndrome may be the result of a combination of issues from poor training habits and poor flexibility to muscle and other mechanical imbalances in the body. Anatomy issues may include differences in the lengths of the legs (a leg-length discrepancy), an abnormal tilt to the pelvis, or bowed legs (genu varum). These situations can cause the iliotibial band to become excessively tight, leading to excess friction when the band crosses back and forth across the femoral epicondyle during activity. Runners can develop iliotibial band syndrome symptoms should they make mistakes in their training. Roads are

canted or banked with the center of the road higher than the outside edge to allow for water runoff. If a runner always runs on the same side of the road, it produces the same effect on the body as having a leg-length discrepancy. One leg is always downhill compared to the other, and the pelvis has to tilt to accommodate the activity. Running too many hills can also cause inflammation of the IT band. Bicyclists may develop IT band inflammation should they have improper posture on their bike and "toe in" when they pedal. This can cause the same effect as bowed legs, increasing the angle of the IT band as it crosses the knee, increasing the risk of inflammation. Other activities with increased knee flexion can cause symptoms and include rowing and weight lifting, especially with excessive squatting. Whiplash: What causes whiplash? Whiplash is most commonly caused by a motor vehicle accident in which the car the person is riding in is not moving, and is struck from a vehicle from behind without notice. It is commonly thought the rear impact causes the head and neck to be forced into hyperextension as the seat pushes the person's torso forward - and the unrestrained head and neck fall backwards. After a short delay the head and neck then recover and are thrown into a hyperflexed position. After the rear impact the lower cervical vertebrae (lower bones in the neck) are forced into a position of hyperextension while the upper cervical vertebrae (upper bones in the neck) are in a hyperflexed position. This leads to an abnormal S-shape in the cervical spine after the rear impact that is different from the normal motion. It is thought that this abnormal motion causes damage to the

soft tissues that hold the cervical vertebrae together (ligaments, facet capsules, muscles). What are the symptoms of whiplash? The most common symptoms related to whiplash include: neck pain and stiffness, headache, shoulder pain and stiffness, dizziness, fatigue, jaw pain (temporomandibular joint symptoms), arm pain, arm weakness, visual disturbances, ringing in the ears (tinnitus), and back pain. In the more severe and chronic case of "whiplash associated disorder" symptoms can include: - depression, - anger, - frustration, - anxiety, - stress, - drug dependency, - post-traumatic stress syndrome,

- sleep disturbance (insomnia), - litigation, and - social isolation. DDD: What causes degenerative disc disease? As we age, the water and protein content of the cartilage of the body changes. This change results in weaker, more fragile, and thin cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). The gradual deterioration of the disc between the vertebrae is referred to as degenerative disc disease, sometimes abbreviated DDD. Wear of the facet cartilage and the bony changes of the adjacent joint is referred to as degenerative facet joint disease or osteoarthritis of the spine. Trauma injury to the spine can also lead to degenerative disc disease. What are the symptoms of degenerative disc disease? Degeneration of the disc tissue makes the disc more susceptible to herniation. Degeneration of the disc can cause local pain in the affected area. Any level of the spine can be affected by disc degeneration. When disc degeneration affects the spine of the neck, it is referred to as cervical disc disease. When the mid-back is affected, the condition is referred to as thoracic disc disease. Disc degeneration that affects the lumbar spine can cause chronic low back pain (referred to as lumbago) or irritation of a spinal nerve to cause pain radiating down the leg (sciatica). Lumbago causes pain localized to the low back and is common in older people. Degenerative arthritis (osteoarthritis) of the facet joints that can be detected with plain X-ray testing is also a cause of localized lumbar pain. The pain from degenerative disc or joint disease of the

spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation. Scoliosis: Scoliosis facts Scoliosis is an abnormal curve in the spine. There are several types of scoliosis based on the cause and age when the curve develops. Depending on the severity of the curve and the risk for it getting worse, scoliosis can be treated with observation, bracing, or surgery. What is scoliosis? Scoliosis is a disorder that causes an abnormal curve of the spine, or backbone. The spine has normal curves when looking from the side, but it should appear straight when looking from the front. Kyphosis is a curve seen from the side in which the spine is bent forward. There is a normal kyphosis in the middle (thoracic) spine. Lordosis is a curve seen from the side in which the spine is bent backward. There is a normal lordosis in the upper (cervical) spine and the lower (lumbar) spine. People with scoliosis develop additional curves to either side, and the bones of the spine twist on each other, forming a "C" or an "S" shape in the spine. Scoliosis is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over 10 years of age. Scoliosis is hereditary in that people with scoliosis are more likely to have children with scoliosis; however, there is no correlation between the severity of the curve from one generation to the next. What causes scoliosis?

Scoliosis can affect about 2% of females and 0.5% of males. In most cases, the cause of scoliosis is unknown (idiopathic). This type of scoliosis is described based on the age when scoliosis develops. If the person is less than 3 years old, it is called infantile idiopathic scoliosis. Scoliosis that develops between 3 and 10 years of age is called juvenile idiopathic scoliosis, and people that are over 10 years old have adolescent idiopathic scoliosis. More than 80% of people with scoliosis have idiopathic scoliosis, and the majority of those are adolescent girls. There are three other main types of scoliosis: Functional: In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back. Neuromuscular: In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely or they fail to separate from each other during fetal development. This type of scoliosis develops in people with other disorders, including birth defects, muscular dystrophy, cerebral palsy, or Marfan's disease. People with these conditions often develop a long C-shaped curve and have weak muscles that are unable to hold them up straight. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis. Degenerative: Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. It is caused by changes in the spine due to arthritis known as spondylosis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine. The spine can also be affected by osteoporosis, vertebral compression fractures, and disc degeneration. Others: There are other potential causes of scoliosis, including spine tumors such as osteoid

osteoma. This is a benign tumor that can occur in the spine and cause pain. The pain causes people to lean to the opposite side to reduce the amount of pressure applied to the tumor. This can lead to a spinal deformity. Postural abnormalities (kyphotic, lordotic, military): What is kyphosis? The spine has a series of normal curves when viewed from the side. These curves help to better absorb the loads applied to the spine from the weight of the body. The cervical spine (neck) and lumbar spine (lower back) are have a normal inward curvature that is medically referred to as lordosis or "lordotic" curvature by which the spine is bent backward. The thoracic spine (upper back) has a normal outward curvature that is medically referred to as kyphosis or the "kyphotic" curve by which the spine is bent forward. The spine is normally straight when looking from the front. An abnormal curve when viewed from the front is called scoliosis. Scoliosis can occur from design at birth or from rotation or an abnormal twisting of the vertebrae as from pain. The normal curves of the spine allow the head to be balanced directly over the pelvis. If one or more of these curves is either too great or too small, the head may not be properly balanced over the pelvis. This can lead to back pain, stiffness, and an altered gait or walking pattern. What are the symptoms of kyphosis? The most common symptoms for patients with an abnormal kyphosis are the appearance of poor posture with a hump appearance of the back or "hunchback," back pain, muscle fatigue, and stiffness in the back. Most often, these symptoms remain fairly constant and do not become progressively worse with time.

In more severe situations, the patient may notice their symptoms worsening with time. The kyphosis can progress, causing a more exaggerated hunchback. In rare cases, this can lead to compression of the spinal cord with neurologic symptoms including weakness, loss of sensation, or loss of bowel and bladder control. Severe cases of thoracic kyphosis can also limit the amount of space in the chest and cause cardiac and pulmonary problems leading to chest pain and shortness of breath. Dislocations/Subluxations: Dislocations and subluxations refer to the displacement of bones that form a joint. Such conditions most often result from trauma causing adjoining bones to no longer touch each other. A partial or incomplete dislocation is called a subluxation. Fractures (including pediatric, with cast and post cast): Buckle fracture? Psychopathologies: Psychopathology is the study of mental illness, mental distress, and abnormal/maladaptive behavior. Addiction: What are symptoms and signs of drug abuse and addiction? In order to be diagnosed with drug abuse, an individual must exhibit a destructive pattern of drug abuse that leads to significant problems or stress but not enough to qualify as being addicted to a drug. This pattern is manifested by at least one of the following signs or symptoms in the same one-year period: Recurrent drug use that results in a lack of meeting important

obligations at work, school, or home Recurrent drug use in situations that can be dangerous Recurrent legal problems as a result of drug use Continued drug use despite continued or repeated social or relationship problems as a result of the drug's effects In order to be diagnosed with a drug addiction, an individual must exhibit a destructive pattern of drug abuse that leads to significant problems as manifested by at least three of the following signs or symptoms in the same one-year period: Tolerance is either a markedly decreased effect of the substance or a need to significantly increase the amount of the substance used in order to achieve the same high or other desired effects. Withdrawal is defined as either physical or psychological signs or symptoms consistent with withdrawal from a specific drug, or taking that drug or one chemically close to that drug in order to avoid developing symptoms of withdrawal. Larger amounts of the drug are taken or for longer than intended. The individual experiences a persistent desire to take the drug or has unsuccessful attempts to decrease or control the substance use. Significant amounts of time are spent either getting, using, or recovering from the effects of the substance. The individual significantly reduces or stops participating in important social, recreational, work, or school activities as a result of using the substance. The individual continues to use the substance despite being aware that he or she suffers from ongoing or recurring physical or psychological problems that are caused or

worsened by the use of the drug. Depression: / Mania: What are the types of depression, and what are depression symptoms and signs? Depressive disorders are mood disorders that come in different forms, just as do other illnesses, such as heart disease and diabetes. Three of the most common types of depressive disorders are discussed below. However, remember that within each of these types, there are variations in the number, timing, severity, and persistence of symptoms. There are sometimes also differences in how individuals express and/or experience depression based on age, gender, and culture. Major depression Major depression is characterized by a combination of symptoms that last for at least two weeks in a row, including sad and/or irritable mood (see symptom list), that interfere with the ability to work, sleep, eat, and enjoy oncepleasurable activities. Difficulties in sleeping or eating can take the form of excessive or insufficient of either behavior. Disabling episodes of depression can occur once, twice, or several times in a lifetime. Dysthymia Dysthymia is a less severe but usually more long-lasting type of depression compared to major depression. It involves long-term (chronic) symptoms that do not disable but yet prevent the affected person from functioning at "full steam" or from feeling good. Sometimes, people with dysthymia also experience episodes of major depression. This combination of the two types of depression often is referred to as double-depression. Bipolar disorder (manic depression)

Another type of depression is bipolar disorder, which encompasses a group of mood disorders that were formerly called manic-depressive illness or manic depression. These conditions show a particular pattern of inheritance. Not nearly as common as the other types of depressive disorders, bipolar disorders involve cycles of mood that include at least one episode of mania or hypomania and may include episodes of depression as well. Bipolar disorders are often chronic and recurring. Sometimes, the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, the person can experience any or all of the symptoms of a depressive disorder. When in the manic cycle, any or all of the symptoms listed later in this article under mania may be experienced. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, indiscriminate or otherwise unsafe sexual practices or unwise business or financial decisions may be made when an individual is in a manic phase. A significant variant of the bipolar disorders is designated as bipolar II disorder. (The usual form of bipolar disorder is referred to as bipolar I disorder.) Bipolar II disorder is a syndrome in which the affected person has repeated depressive episodes punctuated by what is called hypomania (mini-highs). These euphoric states in bipolar II do not fully meet the criteria for the complete manic episodes that occur in bipolar I. Symptoms of depression and mania Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms and some many symptoms. The severity of symptoms also varies with individuals. Less severe symptoms that precede the more debilitating symptoms are called warning signs.

Depression symptoms of major depression or manic depression Persistently sad, anxious, angry, irritable, or "empty" mood Feelings of hopelessness or pessimism Feelings of worthlessness, helplessness, or excessive guilt Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex Social isolation, meaning the sufferer avoids interactions with family or friends Insomnia, early morning awakening, or oversleeping Decreased appetite and/or weight loss, or overeating and/or weight gain Fatigue, decreased energy, being "slowed down" Crying spells Thoughts of death or suicide, suicide attempts Restlessness, irritability Difficulty concentrating, remembering, or making decisions Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and/or chronic pain Mania symptoms of manic depression Inappropriate elation Inappropriate irritability or anger Severe insomnia or decreased need to sleep Grandiose notions, like having special powers or importance Increased talking speed and/or volume

Disconnected thoughts or speech Racing thoughts Severely increased sexual desire and/or activity Markedly increased energy Poor judgment Inappropriate social behavior Schizophrenia: What are schizophrenia symptoms and signs? According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), symptoms of schizophrenia include the following: Positive, more overtly psychotic symptoms Beliefs that have no basis in reality (delusions) Hearing, seeing, feeling, smelling, or tasting things that have no basis in reality (hallucinations) Disorganized speech Disorganized behaviors Catatonic behaviors Negative, potentially less overtly psychotic symptoms: Inhibition of facial expressions Lack of speech Lack of motivation Anxiety Disorders: What are anxiety symptoms and signs? Common symptoms and signs of anxiety can include:

restlessness or feeling edgy, becoming tired easily, trouble concentrating, feeling as if the mind is going "blank," irritability, muscle tension, sleep problems (trouble falling or staying asleep or having sleep that is not restful). Anxiety that is associated with specific (specific or simple phobia) or social fears (social phobia) may also result in avoidance of certain situations or an elevation to the level of panic symptoms. In addition to the more general symptoms of anxiety previously described, worry that is associated with a traumatic event (posttraumatic stress disorder) may also result in the following symptoms: Avoidance of people, places, or situations that are reminiscent of the traumatic event Re-experiencing the trauma in repeated nightmares or flashbacks Difficulty trusting others Excessive attention to staying safe or keeping loved ones safe (for example, hypervigilance) A tendency to startle easily A sense of a bleak or foreshortened future When anxiety intensifies to the level of becoming a panic attack, signs and symptoms can include: palpitations; chest pain, chest tightness, feeling like one is having a heart

attack; shortness of breath or trouble breathing; sweating of the palms; nausea or other stomach upset; trembling or shaking; feeling dizzy, unsteady, lightheaded, or faint; derealization (feelings of unreality) or depersonalization (feeling detached from oneself); fear of losing control or going insane; numbness or tingling sensations; chills or hot flashes; feeling like one is choking; a sense of impending doom; feeling like one is dying. Anxiety symptoms and signs in children and teenagers: The similarities and differences in symptoms of anxiety in adults compared to children and adolescents depend on the specific condition that is causing the anxiety. For example, symptoms of obsessive compulsive disorder (OCD) are quite similar in children and teens compared to adults except that children and teens are less likely to recognize that their thoughts or behaviors are irrational. That is also true of minors who suffer from social phobia or specific phobia. In addition to some of the differences in the symptoms themselves, before puberty, males seem to develop OCD more commonly than girls, and after puberty, females seem to have OCD more often than males. In children and adolescents, boys and girls seem to develop panic disorder

and generalized anxiety disorder at equal rates. Disorders that tend to occur with OCD (co-morbid) are more commonly attention deficit hyperactivity disorder (ADHD) and tics in prepubescent people, versus other anxiety disorders and depression in teens and adults. Symptoms of anxiety in children and teens tend to be consistent with how they express feelings in general. For example, lacking the higher ability to express feelings verbally compared to older children, younger children tend to express anxiety by complaining of physical symptoms like stomach upset or headaches. They are also more likely to cry, have tantrums, or become clingy. Compared to anxiety symptoms in children, in teens, the symptoms of anxiety will more closely approximate those in adults. However, adolescents are more likely than adults to exhibit anxiety by becoming irritable or angry. Children with an anxiety disorder tend to develop the illness in early childhood, with symptoms being persistent, coming and going into adulthood. Anxiety symptoms and signs in men and women Studies indicate that men seem to experience different types of effects of anxiety compared to women. Specifically, men tend to exhibit more psychological symptoms of anxiety, like tension, irritability, and a sense of impending doom. In contrast, women tend to develop more physical symptoms like chest pain, palpitations, shortness of breath, and nausea. Further, it seems that women with such physical symptoms of anxiety are more at risk for developing heart problems. Huntington disease: What are the symptoms and major effects of Huntington's disease? Early signs of the disease vary greatly from person to

person. A common observation is that the earlier the symptoms appear, the faster the disease progresses. Family members may first notice that the individual experiences mood swings or becomes uncharacteristically irritable, apathetic, passive, depressed, or angry. These symptoms may lessen as the disease progresses or, in some individuals, may continue and include hostile outbursts or deep bouts of depression. HD may affect the individual's judgment, memory, and other cognitive functions. Early signs might include having trouble driving, learning new things, remembering a fact, answering a question, or making a decision. Some may even display changes in handwriting. As the disease progresses, concentration on intellectual tasks becomes increasingly difficult. In some individuals, the disease may begin with uncontrolled movements in the fingers, feet, face, or trunk. These movements--which are signs of chorea--often intensify when the person is anxious. HD can also begin with mild clumsiness or problems with balance. Some people develop choreic movements later, after the disease has progressed. They may stumble or appear uncoordinated. Chorea often creates serious problems with walking, increasing the likelihood of falls. The disease can reach the point where speech is slurred and vital functions, such as swallowing, eating, speaking, and especially walking, continue to decline. Some individuals cannot recognize other family members. Many, however, remain aware of their environment and are able to express emotions. Some physicians have employed a recently developed Unified HD Rating Scale, or UHDRS, to assess the clinical features, stages, and course of HD. In general, the duration of the illness ranges from 10 to 30 years. The most common

causes of death are infection (most often pneumonia), injuries related to a fall, or other complications. Pregnancy Treatments: A normal pregnancy lasts about 40 weeks and is grouped into three trimesters. Symptoms of early pregnancy include the absence of menstrual periods, breast changes, tiredness, nausea, mood swings, or other symptoms. A pregnancy test measures the hormone human chorionic gonadotropin in the urine or blood. Symptoms of late pregnancy can include heartburn, difficulty sleeping, swelling of the ankles or fingers, hemorrhoids, and mild contractions. By the end of 37 weeks, a baby is considered full term and its organs are ready to function on their own. As you near your due date, your baby may turn into a headdown position for birth. Most babies "present" head down. Babies at birth typically weigh between 6 pounds 2 ounces and 9 pounds 2 ounces and are 19 to 21 inches long. Most fullterm babies fall within these ranges. Edema: What is edema? Edema is observable swelling from fluid accumulation in body tissues. Edema most commonly occurs in the feet and legs, where it is referred to as peripheral edema. The swelling is the result of the accumulation of excess fluid under the skin in the spaces within the tissues. All tissues of the body are made up of cells and connective tissues that hold the cells together. This connective tissue around the cells and blood vessels is known as the interstitium. Most of the body's

fluids that are found outside of the cells are normally stored in two spaces; the blood vessels (as the "liquid" or serum portion of your blood) and the interstitial spaces (not within the cells). In various diseases, excess fluid can accumulate in either one or both of these compartments. The body's organs have interstitial spaces where fluid can accumulate. An accumulation of fluid in the interstitial air spaces (alveoli) in the lungs occurs in a disorder called pulmonary edema. In addition, excess fluid sometimes collects in what is called the third space, which includes cavities in the abdomen (abdominal or peritoneal cavity called "ascites") or in the chest (lung or pleural cavity called "pleural effusion"). Anasarca refers to the severe, widespread accumulation of fluid in the all of the tissues and cavities of the body at the same time. What is pitting edema and how does it differ from nonpitting edema? Pitting edema can be demonstrated by applying pressure to the swollen area by depressing the skin with a finger. If the pressing causes an indentation that persists for some time after the release of the pressure, the edema is referred to as pitting edema. Any form of pressure, such as from the elastic in socks, can induce pitting with this type of edema. In non-pitting edema, which usually affects the legs or arms, pressure that is applied to the skin does not result in a persistent indentation. Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulation that may occur after a mastectomy, lymph node surgery, or congenitally. Another cause of non-pitting edema of the legs is called pretibial myxedema, which is a swelling over the shin that occurs in some patients with hyperthyroidism. Non-pitting edema of the legs is difficult to treat. Diuretic medications are generally not effective, although elevation of the legs periodically during the day

and compressive devices may reduce the swelling. Edema Causes What Causes Pitting Edema? Edema is caused by either systemic diseases, that is, diseases that affect the various organ systems of the body, or by local conditions involving just the affected extremities. The most common systemic diseases associated with edema involve the heart, liver, and kidneys. In these diseases, edema occurs primarily because of the body's retention of too much salt (sodium chloride). The excess salt causes the body to retain water. This water then leaks into the interstitial tissue spaces, where it appears as edema. The most common local conditions that cause edema are varicose veins and thrombophlebitis (inflammation of the veins) of the deep veins of the legs. Lymphatic Drainage:

Cardiovascular/Circulatory Concerns:

Hypertension: What are the signs and symptoms of high blood pressure? Uncomplicated high blood pressure usually occurs without any symptoms (silently) and so hypertension has been labeled

"the silent killer." It is called this because the disease can progress to finally develop any one or more of the several potentially fatal complications such as heart attacks or strokes. Uncomplicated hypertension may be present and remain unnoticed for many years, or even decades. This happens because there are no symptoms, and those affected fail to undergo periodic blood pressure screening. Some people with uncomplicated hypertension, however, may experience symptoms such as headache, dizziness, shortness of breath, and blurred vision usually with blood pressure that is very high. The presence of symptoms can be a good thing in that they can prompt people to consult a doctor for treatment and make them more compliant in taking their medications. Often, however, a person's first contact with a physician may be after significant damage to the body has occurred. In many cases, a person visits or is brought to the doctor or an emergency department with a heart attack, stroke, kidney failure, or impaired vision (due to damage to the back part of the retina). Greater public awareness and frequent blood pressure screening may help to identify patients with undiagnosed high blood pressure before significant complications have developed. About one out of every 100 (1%) people with hypertension is diagnosed with severe high blood pressure (accelerated or malignant hypertension) at their first visit to the doctor. In these patients, the diastolic blood pressure (see the following section) exceeds 140 mm Hg! Affected persons often experience severe headache, nausea, visual symptoms, dizziness, and sometimes kidney failure. Malignant hypertension is a medical emergency and requires urgent treatment to prevent a stroke (brain damage). Angina: What is angina, and what are the symptoms of angina?

Angina is chest discomfort that occurs when there is decreased blood oxygen supply to an area of the heart muscle. In most cases, the lack of blood supply is due to a narrowing of the coronary arteries as a result of arteriosclerosis. Angina is usually felt as: pressure, heaviness, tightening, squeezing, or aching across the chest, particularly behind the breastbone. This pain often radiates to the neck, jaw, arms, back, or even the teeth. Patients may also suffer: indigestion, heartburn, weakness, sweating, nausea, cramping, and shortness of breath. Angina usually occurs during exertion, severe emotional stress, or after a heavy meal, when the heart muscle demands more blood oxygen than the narrowed coronary arteries can deliver. Angina typically lasts from 1 to 15 minutes and is relieved by rest or by placing a nitroglycerin tablet under the tongue, which relaxes the blood vessels and lowers blood pressure. Both rest and nitroglycerin

decrease the heart muscles demand for oxygen, relieving angina. Angina is classified in one of two types: 1) stable angina or 2) unstable angina. Stable angina Stable angina is the most common type of angina, and what most people mean when they refer to angina. People with stable angina have angina symptoms on a regular basis and the symptoms are somewhat predictable (for example, walking up a flight of steps causes chest pain). For most patients, symptoms occur during exertion and commonly last less than five minutes. They are relieved by rest or medication, such as nitroglycerin under the tongue. Stable angina is one of many causes of chronic chest pain. Unstable angina Unstable angina is less common but more serious. The symptoms are more severe and less predictable than the pattern of stable angina. Pain is more frequent, lasts longer, occurs at rest, and is not relieved by nitroglycerin under the tongue (or the patient needs to use more nitroglycerin than usual). Unstable angina is not the same as a heart attack, but warrants an immediate visit to your physician or hospital emergency department as further cardiac testing is urgently needed. Unstable angina is often a precursor to a heart attack. CCHF: What causes a fever? Fever is the result of an immune response by your body to a foreign invader. These foreign invaders include viruses, bacteria, fungi, drugs, or other toxins. These foreign invaders are considered fever-producing substances (called pyrogens), which trigger the body's

immune response. Pyrogens tell the hypothalamus to increase the temperature set point in order to help the body fight off the infection. Fever is a common symptom of most infections. In children, immunizations or teething in may cause low-grade fever. Autoimmune disorders, medication reactions, seizures, or cancer may also cause fevers. What are the signs and symptoms of a fever? A fever can cause you to feel very uncomfortable. Signs and symptoms of a fever include the following: Temperature greater than 100.4 F (38 C) in adults and children Shivering, shaking, chills Aching muscles and joints Headache Intermittent sweats Rapid heart rate or palpitations Skin flushing Feeling faint, dizzy, or lightheaded Weakness With very high temperature (> 104 F/40 C), convulsions, hallucination, or confusion is possible. Seek medical attention. Meniscus: Some people with a torn meniscus know exactly when they hurt their knee. There may be acute onset of pain and the patient may actually hear or feel a pop in their knee. As with any injury, there is an inflammatory response, including pain and swelling. The swelling within the knee joint from a torn meniscus usually takes

a few hours to develop. Depending upon the amount of pain and fluid accumulation, the knee may become difficult to move. When fluid accumulates, it may be difficult and painful to fully extend or straighten the knee. In some situations, the amount of swelling may not necessarily be enough to notice. Sometimes, the patient isn't aware of the initial injury but starts complaining of symptoms that develop later. After the injury, the knee joint irritation may gradually settle down and feel relatively normal as the initial inflammatory response resolves. However, other symptoms may develop over time, including any or all of the following: Pain with running or walking longer distances Intermittent swelling of the knee joint: Many times, the knee with a torn meniscus feels "tight." Popping, especially when climbing up or down stairs Giving way or buckling (the sensation that the knee is unstable and a sense that the knee will give way): Less commonly, the knee actually will give way and cause the patient to fall. Locking (a mechanical block where the knee cannot be fully extended or straightened): This occurs when a piece of torn meniscus folds on itself and blocks full range of motion of the knee joint. The knee gets "stuck," usually flexed between 15 and 30 degrees and cannot bend or straighten from that position.