Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel – a narrow, rigid passageway of ligament and bones at the base of the hand – houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body’s peripheral nerves are compressed or traumatized.

What are the symptoms of carpal tunnel syndrome?

Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to “shake out” the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.

What are the causes of carpal tunnel syndrome?

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition – the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal.  In some cases no cause can be identified.

There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Other disorders such as bursitis and tendonitis have been associated with repeated motions performed in the course of normal work or other activities.. Writer’s cramp may also be brought on by repetitive activity.

Who is at risk of developing carpal tunnel syndrome?

Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body’s nerves and make them more susceptible to compression are also at high risk. Carpal tunnel syndrome usually occurs only in adults.

The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work – manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel.

How is carpal tunnel syndrome diagnosed?

Early diagnosis and treatment are important to avoid permanent damage to the median nerve. A physical examination of the hands, arms, shoulders, and neck can help determine if the patient’s complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy. Routine laboratory tests and X-rays can reveal diabetes, arthritis, and fractures.

Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. In the Tinel test, the doctor taps on or presses on the median nerve in the patient’s wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute. Doctors may also ask patients to try to make a movement that brings on symptoms.

Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle; electrical activity viewed on a screen can determine the severity of damage to the median nerve. Ultrasound imaging can show impaired movement of the median nerve. Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.

How is carpal tunnel syndrome treated?

Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor’s direction. Underlying causes such as diabetes or arthritis should be treated first. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling.

Non-surgical treatments

Medications – In special circumstances, various medications can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory medications, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. Orally administered diuretics (“water pills”) can decrease swelling. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Corticosteroids should not be taken without a doctor’s prescription). Additionally, some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.

Exercise – Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist, who is trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.

Alternative therapies – Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.

Surgery

Carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay. Many patients require surgery on both hands. The following are types of carpal tunnel release surgery:

Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.

Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about ½ inch each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. Single portal endoscopic surgery for carpal tunnel syndrome is also available and can result in less post-operative pain and a minimal scar.  It generally allows individuals to resume some normal activities in a short period of time.

Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.

Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.

How can carpal tunnel syndrome be prevented?

At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools and tool handles, and tasks can be redesigned to enable the worker’s wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. However, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.

 

Degenerative Disc Disease

Degenerative Disc Disease (DDD) is the term used to describe the normal changes in the spinal discs as the body ages. Vertebrae, which make up the spine, are separated by the soft disks. These discs act as shock absorbers. This condition occurs when one of these disks weakens.

Despite the name, it is not actually a disease. But that does not mean the pain it causes is less real. It can be very painful and can affect quality of life to a great extent. Disc degeneration is a normal part of aging, but for some individuals, it can cause severe and chronic pain.

Following are some of the causes of degenerative disc disease:

  • The loss of fluid in the discs can be a cause. This makes the disk less flexible and reduces its ability to absorb shocks. This also reduces the distance between the vertebrae.
  • Annulus or capsule (the outer layer of disc) may be damaged or cracked. As a result the nucleus (jelly-like material inside the disc) may be forced to flow out of the cracks or tears. This may cause the disc to rupture, break into fragments or bulge.
  • A sudden injury to the disc can start disc degeneration
  • Smoking, heavy physical work and obesity can also cause degeneration.

Symptoms and diagnosis

Symptoms of degenerative disc disease include:

  • Pain in lower back which radiates to hips
  • Pain in thighs or buttocks while walking
  • In some cases, irregular tingling or weakness through the knees
  • Pain in upper spine which may radiate to shoulders, arms and hands

This condition is diagnosed with a physical examination and a review of medical history. During physical examination, the surgeon looks for tenderness and changes related to nerves, for example changes in reflexes, numbness or tingling. Other conditions such as tumors, fractures and infections are also checked.

If symptoms of degenerative disc disease are suspected after initial examination, imaging tests may also be performed for diagnosis. These tests may include X-rays, MRIs or CT scans. Imaging tests are usually considered if the symptoms develop after injury or damage to nerves.

Treatment

Usually this condition can be successfully treated with non-surgical treatments. One or a combination of treatments like chiropractic manipulative therapy (CMT), physical therapy and anti-inflammatory medications can often provide relief.

Surgical treatment may be recommended if the non-surgical treatments fail to provide relief within two to three months. It may also be recommended if pain in legs or back restricts normal activity, if it is difficult to stand or walk, or if there is numbness or weakness in legs. Surgical treatment options include Anterior Cervical Discectomy with Fusion, Intervertebral Disc Annuloplasty, Intervertebral Disc Arthroplasty, etc.

Risks and benefits

The draw back of non-surgical treatment is that it can be slow and take a long time to provide complete relief. The benefit is less disruption to the patient’s routine life, as it does not require hospitalization or rehabilitation.

On the other hand, surgical treatments can be highly disruptive and they may require hospitalization and have activity restrictions for at least three to four weeks following surgery. Surgical treatment may be necessary if conservative treatments have not been successful or if the condition is too severe.

 

Sacroiliitis

Sacroiliitis

Sacroiliitis is an inflammation of one or both of your sacroiliac joints — the places where your lower spine and pelvis connect. Sacroiliitis can cause pain in your buttocks or lower back, and may even extend down one or both legs. The pain associated with sacroiliitis is often aggravated by prolonged standing or by stair climbing.

Sacroiliitis can be difficult to diagnose, because it may be mistaken for other causes of low back pain. It’s been linked to a group of diseases that cause inflammatory arthritis of the spine. Treatment of sacroiliitis may involve a combination of rest, physical therapy and medications.

Symptoms

The pain associated with sacroiliitis most commonly occurs in the buttocks and lower back. It can also affect the legs, groin and even the feet. Sacroiliitis pain can be aggravated by:

  • Prolonged standing
  • Bearing more weight on one leg than the other
  • Stair climbing
  • Running
  • Taking large strides

Causes

A wide range of factors or events may cause sacroiliac joint dysfunction, including:

  • Traumatic injury. A sudden impact, such as a motor vehicle accident or a fall, can damage your sacroiliac joints.
  • Arthritis. Wear-and-tear arthritis (osteoarthritis) can occur in sacroiliac joints, as can ankylosing spondylitis — a type of inflammatory arthritis that affects the spine.
  • Pregnancy. The sacroiliac joints must loosen and stretch to accommodate childbirth. The added weight and altered gait during pregnancy can cause additional stress on these joints and can lead to abnormal wear.
  • Infection. In rare cases, the sacroiliac joint can become infected.

Complications

Sacroiliitis may be part of an inflammatory arthritic condition known as ankylosing spondylitis. Complications of this condition can be very serious, including difficulty breathing, spine deformities, lung infections and heart problems.

Preparing for your appointment

You’re likely to start by seeing your family doctor. However, he or she may refer you to a rheumatologist or an orthopedic surgeon.

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

  • Has anyone in your immediate family had similar symptoms?
  • Have you fallen or been in a car accident recently?
  • What medications and supplements do you take regularly?

What to expect from your doctor

Your doctor may ask some of the following questions:

  • When did your symptoms start?
  • Where exactly does the pain occur?
  • Does any type of activity worsen or lessen the pain?

Tests and Diagnosis

During the physical exam, your doctor may try to pinpoint the cause of your pain by pressing directly on various places on your hips and buttocks. He or she may also move your legs into a variety of positions that will gently stress your sacroiliac joints.

Imaging tests

An X-ray of your pelvis can reveal signs of damage to the sacroiliac joint. If ankylosing spondylitis is suspected, your doctor might recommend magnetic resonance imaging (MRI) — a test that uses radio waves and a strong magnetic field to produce very detailed cross-sectional images of both bone and soft tissues.

Anesthetic injections

Because low back pain can be caused by so many different types of problems, your doctor may suggest using injections of anesthetics to help pinpoint the diagnosis. For example, if an injection of numbing medicine into your sacroiliac joint stops your pain, it’s likely that the problem is in your sacroiliac joint. However, the numbing medicine can leak into nearby structures, and that can reduce the reliability of this test.

Treatments and Drugs

The type of treatment your doctor will recommend depends on the signs and symptoms you’re having, as well as the underlying cause of your sacroiliitis.

Medications

Depending on the cause of your pain, your doctor may recommend:

  • Pain relievers. If over-the-counter pain medications don’t provide enough relief, your doctor may prescribe stronger versions of these drugs. Occasionally, a short course of narcotics may be prescribed. Narcotics are habit-forming and shouldn’t be used for long periods of time.
  • Muscle relaxants. Medications such as cyclobenzaprine (Flexeril, Amrix) may help reduce the muscle spasms often associated with sacroiliitis.
  • TNF inhibitors. Tumor necrosis factor (TNF) inhibitors — such as etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade) — often help relieve the type of sacroiliitis that’s associated with ankylosing spondylitis.

Therapy

Your doctor or physical therapist can help you learn range-of-motion and stretching exercises to maintain joint flexibility, and strengthening exercises to give your muscles additional stability.

Surgical and other procedures

If other methods haven’t relieved your pain, you doctor might suggest:

  • Joint injections. Corticosteroids can be injected directly into the joint to reduce inflammation and pain. But you can receive only a few joint injections a year because the steroids can weaken your joint’s bones and tendons.
  • Radiofrequency denervation. Radiofrequency energy can damage or destroy the nerve tissue causing your pain.
  • Electrical stimulation. Implanting an electrical stimulator into the sacrum may help reduce pain caused by sacroiliitis.
  • Joint fusion. Although surgery is rarely used to treat sacroiliitis, fusing the two bones together with metal hardware can sometimes relieve sacroiliitis pain.

Lifestyle and Home Remedies

Home treatments for sacroiliitis pain include:

  • Over-the-counter pain relievers. Drugs such as ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others) may help relieve pain associated with sacroiliitis. Some of these drugs can cause stomach upset, or kidney or liver problems.
  • Rest. Modifying or avoiding the types of activities that aggravate your pain may help reduce the inflammation in your sacroiliac joints. Proper posture is important.
  • Ice and heat. Alternating ice and heat may help relieve sacroiliac pain.

 

Sciatic Nerve Damage & Sciatica

Sciatic Nerve Damage and Sciatica

Sciatic Nerve Damage

The sciatic nerve is located in the back of the leg. It supplies the muscles of the back of the knee and lower leg. The sciatic nerve also provides sensation to the back of the thigh, part of the lower leg, and the sole of the foot. Partial damage to the nerve may demonstrate weakness of knee flexion (bending), weakness of foot movements, difficulty bending the foot inward (inversion), or bending the foot down (plantar flexion). A person’s reflexes may be abnormal, with weak or absent ankle-jerk reflex. Several different tests can be performed to find the cause of sciatic nerve dysfunction.

Sciatica

Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or pressure on the sciatic nerve. Sciatica is a symptom of another medical problem, not a medical condition on its own.

Causes

Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve starts in the lower spine and runs down the back of each leg. This nerve controls the muscles of the back of the knee and lower leg. It also provides sensation to the back of the thigh, part of the lower leg, and the sole of the foot.

Common causes of sciatica include:

  • Slipped disk
  • Spinal stenosis
  • Piriformis syndrome (a pain disorder involving the narrow muscle in the buttocks)
  • Pelvic injury or fracture
  • Tumors

Symptoms

Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or burning sensation. In some cases, the pain is severe enough to make a person unable to move.

The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak.

The pain often starts slowly. It may get worse:

  • After standing or sitting
  • At night
  • When sneezing, coughing, or laughing
  • When bending backward or walking more than a few yards, especially if caused by spinal stenosis

Exams and Tests

The health care provider will perform a physical exam. This may show:

  • Weakness when bending the knee
  • Difficulty bending the foot inward or down
  • Difficulty bending forward or backward
  • Abnormal or weak reflexes
  • Loss of sensation or numbness
  • Pain when lifting the leg straight up off the examining table

Tests are often not needed unless pain is severe or long-lasting. If tests are ordered, they may include:

  • Blood tests
  • X-rays
  • MRIs or other imaging tests

Treatment

Because sciatica is a symptom of another medical condition, the underlying cause should be identified and treated.

In some cases, no treatment is required, and recovery occurs on its own.

Conservative treatment is best in many cases. Your doctor may recommend the following steps to calm your symptoms and reduce inflammation.

  • Apply heat or ice to the painful area. Try ice for the first 48 to 72 hours, then use heat.
  • Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).

Measures to take care of your back at home:

  • Bed rest is not recommended.
  • Reduce your activity for the first couple of days. Then, slowly start your usual activities.
  • Do not do any heavy lifting or twisting of your back for the first 6 weeks after the pain begins.
  • Start exercising again after 2 to 3 weeks. Include exercises to strengthen your abdomen and improve flexibility of your spine.

If these measures do not help, your doctor may recommend injections to reduce inflammation around the nerve. Other medicines may be prescribed to help reduce the stabbing pains of sciatica.

Physical therapy may also be recommended. Additional treatments depend on the condition that is causing the sciatica.

Nerve pain is exceedingly difficult to treat. If you have ongoing problems with pain, you may want to see a neurologist or a pain specialist to ensure that you have access to the widest range of treatment options.

Outlook (Prognosis)

Often, sciatica gets better on its own. But it is common for it to return.

Possible Complications

More serious complications depend on the cause of sciatica, such as slipped disc or spinal stenosis.  

When to Contact a Medical Professional

Call your doctor right away if you have:

  • Unexplained fever with back pain
  • Back pain after a severe blow or fall
  • Redness or swelling on the back or spine
  • Pain traveling down your legs below the knee
  • Weakness or numbness in your buttocks, thigh, leg, or pelvis
  • Burning with urination or blood in your urine
  • Pain that is worse when you lie down, or awakens you at night
  • Severe pain and you cannot get comfortable
  • Loss of control of urine or stool (incontinence)

Also call if:

  • You have been losing weight unintentionally
  • You use steroids or intravenous drugs
  • You have had back pain before, but this episode is different and feels worse
  • This episode of back pain has lasted longer than 4 weeks

Prevention

Prevention varies, depending on the cause of the nerve damage. Avoid prolonged sitting or lying with pressure on the buttocks.

 

Lumbar Medial Branch Block

What is a facet joint pain?

The spine is made of vertebrae, which makes up the spine. The vertebrae are connected to each other with facet joints, which allows the bending and rotational spine movements. As the joints become inflamed and irritated, there is a small medial branch nerve that transmits the pain signal from the joint to the brain. Furthermore, spine pain may worsen during the extension of spine.

How does lumbar medial branch block bring pain relief?

The pain is produced due to inflammation lumbar facet joint which is transmitted via medial branch nerve to the central nervous system. By injection local anesthetic which helps numbs out the medial branch nerve, this results in decreased low back pain caused by the facet joints.

What are risks for the lumbar medial branch block?

Among many, here are few listed: increased pain, infection, bleeding, nerve damage, weakness, numbness.

How is the lumbar medial branch block performed?

After sterile preparation of the lumbar region, the injection site is localized under X-ray. Following the local anesthetic applied to the injection site, which can help decrease the injection site pain, the needle is guided toward the target lumbar facet joint area with the help of X-ray. After the target is reached, it can be further confirmed with liquid contrast. Thereafter, small amount of local anesthetic is injected, and the needle is taken out at the end of the procedure.

What to expect after the procedure?

This is an outpatient procedure. Patient should expect to receive instant 50-60% relief in 5-10 minutes from the nerve block.

How long the relief from the lumbar MBB would last for?

It varies from patient to patient. Usually, the pain relief can last for few hours to few months.

What is the purpose of the lumbar medial branch block?

Lumbar MBB is a diagnostic procedure NOT therapeutic procedure. It helps confirm the pain arising from the lumbar joints. If patient receives > 50-60% relief from two separate lumbar medial branch block, then patient may be an excellent candidate for lumbar radiofrequency ablation of the medial branch nerves which can bring 6-12 months of pain relief. Please tell your pain physician if you are taking any blood thinners. For example: Coumadin, Plavix, Heparin, Lovenox and etc. The blood thinners need to be stopped before the interventional procedure, and the time frame will be prescribed by your pain physician

Bursitis of the heel

Bursitis of the heel is swelling of the fluid-filled sac (bursa) at the back of the heel bone under the Achilles tendon.

 

Causes

A bursa acts as a cushion and lubricant between tendons or muscles sliding over bone. There are bursas around most large joints in the body, including the ankle. The retrocalcaneal bursa is located in the back of the ankle by the heel. It is where the large Achilles tendon connects the calf muscles to the heel bone. Repeated or too much use of the ankle can cause this bursa to become irritated and inflamed. Possible causes are too much walking, running, or jumping. This condition is usually linked to Achilles tendinitis. Sometimes retrocalcaneal bursitis may be mistaken for Achilles tendinitis. Risks for this condition include starting an aggressive workout schedule, or suddenly increasing activity level without the right conditioning.

 

Symptoms

  • Pain in the heel, especially with walking, running, or when the area is touched
  • Pain may get worse when rising on the toes (standing on tiptoes)
  • Red, warm skin over the back of the heel

 

Exams and Tests

Your health care provider will take a history to find out if you have symptoms of retrocalcaneal bursitis. Examining your ankle can find the location of the pain. The physician will look for tenderness and redness in the back of the heel.
The pain may be worse when the doctor bends the ankle upward (dorsiflex). Or, the pain may be worse when you rise on your toes. You will not usually need imaging studies such as x-ray and MRI at first. If the first treatment does not improve the symptoms, your health care provider may recommend these tests. MRI may show inflammation.

 

Treatment

Your health care provider may recommend the following treatments:

    • Avoid activities that cause pain.
    • Ice the heel several times a day.
    • Take nonsteroidal anti-inflammatory medications (for example, ibuprofen).
    • Try over-the-counter or custom heel wedges to help decrease the stress on the heel.
    • Try ultrasound treatment during physical therapy to reduce inflammation.
    • Use physical therapy to improve flexibility and strength around the ankle, which can help the bursitis improve and prevent it from coming back.

If these treatments don’t work, your health care provider may inject a small amount of steroids into the bursa. After the injection, you should avoid stretching the tendon too much because it can break open (rupture).

If the condition is connected with Achilles tendinitis, casting the ankle for several weeks to keep it from moving can be effective. Very rarely, surgery may be needed to remove the inflamed bursa.

 

Outlook (Prognosis)

This condition usually gets better in several weeks with the proper treatment.

 

When to Contact a Medical Professional

If you have heel pain or symptoms of retrocalcaneal bursitis that do not improve with rest, contact your health care provider for evaluation and treatment.

 

Prevention

Maintain proper form when exercising, as well as good flexibility and strength around the ankle to help prevent this condition.

Proper stretching of the Achilles tendon helps prevent injury.

 

Displacement of Lumbar Disc Without Myelopathy

Displacement, Lumbar Intervertebral Disc Without Myelopathy

Displacement of a lumbar disc refers to protrusion or herniation of the nucleus pulposus, of the cushion-like disc resting between any two of the five lumbar vertebrae (vertebrae L1 through L5) in the lower spine. The intervertebral disc is comprised of an outer ring (annulus fibrosus) made of layers of collagen that surrounds and contains an inner gel-like material (nucleus pulposus). The intervertebral disc, along with the facet joints at the back of a motion segment created by two vertebral bodies, allows for movement of the segment. 

Displacement describes the nucleus pulposus pushing through the annulus and deforming the disc. A well-localized deformation of the disc is also referred to as a protrusion or herniation. This is differentiated from a “bulging” disc, which describes deformity of the annulus concentrically. A disc herniation usually occurs on one side of the midline at the posterior part of the disc. 

Herniated discs are most common in the lower levels of the lumbar spine (L4-L5 and L5-S1). Symptoms may begin as back and leg pain related to a specific trauma or the individual may have had prior episodes of back pain for months or years before leg pain develops.

Disc degeneration occurs with aging of the spine. Disc herniations may occur during the degenerative process, in stages: (1) desiccation, in which age-related changes in the collagen that forms the nucleus pulposus cause the disc to lose water and weaken, without rupture. At this stage, there are most likely annular fissures or tears that disrupt the integrity of the annulus, and the disc may appear to bulge on imaging studies; (2) prolapse (protrusion, herniation), in which the nucleus pushes through layers of the annulus, but remains contained by the outermost layers, causing a localized deformity of the disc, which may project into the spinal canal; (3) extrusion, in which the gel-like nucleus pulposus escapes the surrounding annulus fibrosus; and (4) sequestration, in which the extruded gel-like material loses contact with its disc of origin and is sequestered in the spinal canal. 

Disc herniations may cause low back pain; however, when the disc herniation causes stretching or inflammation of an overlying nerve root, it may also cause leg pain or numbness and tingling and even weakness in the distribution of the nerve root. It is also possible to have an asymptomatic disc bulge, protrusion, or herniation since not all herniated discs cause irritation of the adjacent spinal nerve. 

Lumbar disc herniation is associated with degenerative changes associated with normal aging. The individual may be able to identify a precipitating event or trauma; however, trauma is not necessary for a disc herniation to occur. Degenerative changes in the discs, including disc herniations, are commonly observed on diagnostic imaging; however, these findings may not be related to symptoms of back pain.

Incidence and Prevalence: About 85% of individuals will experience low back pain in their lifetime (Hills). Herniation of lumbar discs that results in symptomatic sciatica occurs in anywhere from 1% to 10% of the population (Baldwin).

Causation and Known Risk Factors

Increased risk for disc herniation is associated with smoking, lack of exercise, poor nutrition, repetitive stress sustained in the individual's occupation, poor mental health, aging, pregnancy, poor posture, and incorrect body mechanics. Several genetic defects have also been identified that significantly increase the risk of lumbar disc herniation.

Lumbar disc displacement occurs most commonly in individuals between the ages of 30 and 50.

Diagnosis

History: The individual may report the onset of symptoms with trauma such as a fall, a twist, a blow to the spine, or a strain as the result of lifting or symptoms may develop without a history of trauma. Lower back pain is a common early symptom of a herniated lumbar disc. Pain may radiate from the back to the sacroiliac area and buttocks and down the back of the thigh and calf. Radicular pain consistent with nerve root irritation frequently extends below the knee into the foot (sciatica). Central disc herniation is less common, and may cause, low back pain without radiating leg pain.

The individual may report that pain is aggravated by sitting, standing, walking, or bending and is relieved by lying down with the knees flexed and supported. Coughing or sneezing may also make the pain worse. Individuals may report numbness (sensory loss) over the thigh, leg, or foot. Some individuals report a sensation of pins and needles (paresthesia) in the affected lower extremity. The location of leg pain and leg numbness helps to identify which nerve root is involved.

Rarely, some individuals report pain in the back, legs and numbness in the perineum, with disturbances in bowel or bladder function (sphincter incontinence) indicative of massive disc herniation or extrusion. In this condition, multiple nerve roots, bilaterally, are compressed causing cauda equina syndrome, which is a surgical emergency.

Physical exam: Examination of the individual while standing may reveal flattening of the normal curvature (lordosis) of the lumbar area of the back, slight hip and knee flexion, and a tendency for the individual to avoid putting weight on the affected leg when walking (antalgic gait) if radiculopathy is present. Physical findings vary with acute vs. chronic back pain and disc herniation; for example, paraspinal spasm may be present in acute conditions but diminish significantly as the acute condition subsides. The physician will put pressure on the spine (palpation) and will tap on the affected area (percussion). Spinal motion generally will be decreased if a disc herniation has occurred. Examination of the deep tendon reflexes will be performed. The ankle jerk reflex or the knee jerk reflex is diminished when lumbar disc herniations compress the S1 nerve root, or the L3 or L4 nerve root, respectively.

Sensory examination of the lower limbs may reveal decreased sensation in the distribution of a single lumbar nerve root. Manual muscle testing may demonstrate weakness in muscles principally supplied by a single nerve root. The straight leg-raising test (SLR) is one of the most important tests in the diagnosis of a herniated lumbar disc. With the individual in a reclining position, the examiner raises the affected leg with the knee extended. This will produce radiating leg pain along the path of the sciatic nerve if herniation is present. The test may be confirmed by performing the SLR while dorsiflexing the ankle (Lasègue's sign), which places increased stretch along the nerve. The test is then repeated with the knee bent; in this position, the maneuver should not reproduce sciatic pain. It is not possible to distinguish which nerve root is affected by this test. Another reliable, valid test is the well leg-raising test, in which a SLR of the asymptomatic leg reproduces painful symptoms in the low back and/or symptomatic leg. If leg pain is less intense than back pain, or unusual pain patterns occur, the diagnosis of symptomatic herniated disc is not likely to be confirmed with applicable tests. Differential diagnosis of low back and leg pain is extensive and complex, including referred pain from spinal diseases and diseases of the urogenital, gastrointestinal, vascular, endocrine and nervous systems, as well as tumors, infection, congenital abnormalities and diseases of aging.

Tests: MRI is considered the most useful imaging modality for diagnosing a herniated lumbar disc, although myelography followed by enhanced CT scan may be useful for visualizing subtle lesions. Normal (asymptomatic) individuals frequently have findings of disc herniations on MRI or CT scan, and the findings on an imaging study must correlate exactly with the clinical nerve root syndrome to be meaningful. X-rays are generally helpful if trauma is suspected, and may be used to rule out spinal deformity or other structural lesions. Electromyography and nerve conduction studies may be performed to verify the specific nerve root involved. In questionable cases, these studies may confirm that, despite anatomic disc changes on MRI or myelography, there is no evidence of physiologic nerve root involvement.

Treatment

Based on clinical suspicion of a disc herniation, conservative treatment, which may range from simple rest to elaborate traction devices is recommended initially, except when signs of severe or progressive nerve compression (radiculopathy) are present. The individual is instructed to avoid aggravating activities such as heavy lifting, bending, twisting, or prolonged sitting. A corset may be worn during the day to provide support. For relief of pain and inflammation, treatment may include nonsteroidal anti-inflammatory drugs (NSAIDs) and, if pain is severe, a narcotic or an anticonvulsant for its analgesic effects. Muscle relaxants are frequently prescribed for their sedative effects. Other treatments such as ice, heat, massage, and ultrasound therapy may help relieve pain and muscle spasm.

As symptoms subside, an increase in activity is recommended, including physical therapy and/or a home exercise program to strengthen the lower back and abdominal muscles and improve aerobic capacity (walking). The individual may attend "back school" to learn correct posture and body mechanics. Many individuals recover completely; however, recurrences of back pain and sciatica are common. Therefore, preventive and maintenance measures such as exercise and proper body mechanics may be continued indefinitely.

If little or no improvement is seen after 4 to 6 weeks of treatment, and if the pain is severe and debilitating, further evaluation is appropriate. If imaging studies have not yet been performed, MRI or CT/myelogram are indicated. 

Individuals who have leg pain (radicular pain) as the predominant symptom may gain relief through the administration of epidural corticosteroid injections. If non-operative measures are unsuccessful in relieving the individual’s symptoms, surgery consisting of a laminectomy and disc excision or a minimally invasive disc excision, may be considered. Proper patient selection is the key to favorable surgical results, and good outcomes are more highly associated with correlation between clinical findings of radiculopathy and imaging studies. Central disc herniations generally present with low back pain and without radicular complaints; they, rarely benefit from a lumbar laminectomy and discectomy. Individuals who have persistent back pain as the predominant symptom usually do not benefit from surgery intended for disc herniation (discectomy). Individuals with chronic low back pain may benefit from a rehabilitation program, and/or pain management. 

Emergent disc excision (discectomy) is indicated in the patient with cauda equina syndrome, which presents with bilateral severe leg pain, saddle anesthesia, and bowel and/or bladder incontinence. Surgery is also indicated in the individual with progressive muscle weakness; severe unilateral leg pain with objective signs of nerve root compression (nerve tension signs and/or loss of neurological function) that has not improved during an adequate trial of conservative treatment, with an imaging study that correlates with the clinical findings for nerve root compression; or recurrent episodes of severe leg pain with objective signs of nerve root compression and a matching defect on imaging studies. Microdiscectomy or minimally invasive discectomy are alternative procedures that may be done on an outpatient basis and may have shorter recovery periods. However, the indications for these procedures are the same as the indications for open laminectomy.

Prognosis

Fewer than 20% of individuals become surgical candidates, and discectomy gives good or excellent results in 80% to 90% of individuals (Ellenberg; Canale). Up to 90% of lumbar disc herniations improve without surgery. In most cases, the herniation resorbs. Even if the herniation remains, the symptoms often subside. Recurrence, even after discectomy, is reported in 3% to 7% of individuals (Canale).

Rehabilitation

Individuals who experience a displacement in one of the lumbar intervertebral discs may benefit from a short course of rehabilitation.

The therapy protocol will focus on decreasing pain as well as on regaining mobility and strength in that particular region of the spine. The therapy program will include instruction in a home exercise program that focuses on postural alignment, proper body mechanics, trunk endurance, and trunk strength. Moist heat or electric stimulation may be used to control pain in order to promote activity and progress with the exercise program.

The exercise program should combine coordination, aerobic conditioning, and flexibility exercises (Danielsen). A short course of cognitive pain management may be beneficial for individuals experiencing psychological distress or lack of improvement with treatment. An ergonomic evaluation with modifications may enable the individual to reduce the risk of re-injury while continuing or returning to work. Vocational services should be available for individuals who cannot return to their previous job title or do not have a job to which to return.

Complications

Worsening of the condition may result in pressure on the spinal cord (L1 to L2 discs) as well as on the nerve roots (lower discs) and may lead to degenerative radiculopathy and chronic back pain syndrome. Rarely, large disc herniation may lead to cauda equina syndrome in 0.2% of individuals (Henriques). Complications of discectomy can include thromboembolism and infection or, rarely, laceration of major blood vessels. The most serious complication of a tear in the annulus fibrosus is internal leakage of spinal fluid.

Low Cholesterol Diet

Low Cholesterol Diet

Fat is a major energy source for the body. However, it is not the body’s only source of energy.  Too much fat in the diet can be harmful. It is especially bad for the circulatory system because it raises blood cholesterol levels that can contribute to heart attack or stroke. This diet is designed to reduce fat and cholesterol blood levels.  The diet goals are:

  • -Decrease total dietary fat, especially saturated and trans-fat, also known as hydrogenated fat

    -Decrease Dietary Cholesterol

    -Limit Sodium Intake

    -Increase intake of fiber, especially complex carbohydrates, and prebiotic fibers

    -Decrease calories, if needed, to reach a healthy body weight

Cholesterol in the Diet

The heart pumps blood through blood vessels called arteries. This blood carries vital oxygen and nutrients needed by tissues and organs throughout the body. The heart itself is supplied with blood vessels called coronary arteries. When cholesterol levels rise above normal limits and stay high, some cholesterol is left behind in the arteries. Over the years, waxy cholesterol plaques build up on the artery walls, and so reduce or block blood flow. When blood flow to the brain is blocked, a stroke occurs.  When plaque blocks a coronary artery, angina or a heart attack may be the outcome.

Cholesterol in the body comes from two sources. Most cholesterol is made by the liver from various nutrients and especially from ingested fats. The liver makes just about all the cholesterol the body will ever need. Since all animals can make their own cholesterol, some cholesterol in the human body comes directly from eating animal foods. These foods include meats, poultry, egg yolks, organ meats, whole milk, and milk products. This cholesterol is absorbed through the intestines and added to what the liver makes. It is also known that a diet high in saturated fat increases cholesterol production in the body. Therefore, reducing dietary cholesterol and fats helps to keep blood cholesterol levels within a healthy range.  Most important of all is to significantly reduce the amount of animal meat, meat products, and trans-fat in the diet.

Fats in the Diet

Dietary fats can be saturated (bad) or unsaturated (good). An easy way to remember the difference is that saturated fats solidify or remain solid at room temperature. Unsaturated fats do not; they are soft or liquid at room temperature. To reduce blood cholesterol levels, it is especially important to limit saturated fats. Saturated fats are found mainly in meats and dairy products made with whole milk.

Unsaturated fats (polyunsaturated and monounsaturated) are found mostly in plants and are less likely to raise blood cholesterol levels. In fact, monounsaturated fats such as olive, peanut, or canola oils may even help to lower blood cholesterol. There are a few vegetable fats such as coconut oil, palm oil, and cocoa butter (found in chocolate) that act like saturated fats in the body, so they should be avoided.

In the past, food manufacturers “hydrogenated” vegetable oils to prevent rancidity and increase shelf life.  These chemically derived oils are commonly known as trans-fats.  They act in the body exactly as do the saturated animal fats, raising cholesterol and, especially, the bad LDL cholesterol.  These trans-fats should be avoided.  Always read the ingredients label on foods.  For example, coconut and palm oils are bad, as are saturated fats, and should be avoided.  Mono- and polyunsaturated oils like olive oil, canola and cottonseed are good.

Butter and Spreads

Butter is a highly saturated fat and should be avoided.  Most of the stick margarines contain trans-fat; these, too, should be avoided.  Tub spreads generally contain mono- or polyunsaturated fats, so these are suitable.  However, even some of these may contain trans-fats so it is important to read the label and ingredients.  The tub spreads, Promise and Smart Balance, can particularly be recommended.

Gut Bacteria and Prebiotic Fibers

The human intestine, especially the colon, is home to huge numbers of bacteria.  These bacteria are part of the normal physiology within the gut.  There are good and bad bacteria present.  When the good colon bacteria are fed healthy prebiotic plant fibers, they thrive and produce many health benefits.  The fibers that do this best are the prebiotic fibers present in vegetables such as artichoke, banana, onions, garlic, asparagus, leeks, and many others.  Eating 25-35 grams of varied fruits and vegetables a day will usually provide lots of these beneficial fibers.

Fiber in the Diet

Fiber in the diet is now known to be increasingly important for cholesterol control and for those with known or suspected heart disease – heart attacks and angina.  These are two reasons that 30 grams of fiber a day is important.  First, ingested fiber blunts hunger, gives a feeling of fullness and in so doing, helps to control weight.  Secondly, certain types of food fiber help to reduce cholesterol and triglyceride levels.

There are two main types of fiber – insoluble and soluble.  All fiber moves through the gut into the colon unchanged.  Within the colon, insoluble fiber, as present in wheat and corn, is not fermented by colon bacteria but rather clings to water and helps provide a bulky stool.  Soluble fiber, on the other hand, is fermented by the good colon bacteria and, in so doing, helps to lower cholesterol and especially triglyceride, another nasty fat that is of concern to some heart patients.

The supplement psyllium and also oats are especially important in lowering cholesterol.  Both  fibers, along with the healthy prebiotic fibers, are present in Prebiotin-Heart Health™.

Special Considerations

The following are some practical considerations to help you reach a heart healthy diet.

Labels

Fresh foods purchased at a local market are almost always the best.  However, we usually cannot avoid getting some packaged foods.  Food labels provide a wealth of information, read them, you will find:

  • Serving size – Many manufacturers will have an unrealistically low serving size simply so they can artificially lower the amounts listed in the Nutrition Fact portion of the label.  Be sure the serving size conforms to what you eat at a sitting.

  • Nutrition Facts – Here is where you get information on calories, cholesterol, fat, fiber, and sodium.  It is best to avoid foods with an unrealistic low serving size and high fat content.

  • Ingredients – In the very smallest print, you will find all the ingredients in the product.  They must be placed in the order of the highest to lowest amounts within the food.  Packaged foods with perhaps 8 or more ingredients, many of which you do not recognize, may be packed with calories and fat in hidden ways.  Be wary!  An example of how one can be misled on labels is to see that there are 0 grams of trans fat in a product.  The FDA allows the manufacturer to say this even when there is 0.5 gm of trans fat per serving.  So, you must read the ingredients part of the label.

Packaged and Fast Foods

Packaged foods, fast food restaurants, and the readily available sugar and calorie laden liquids are always in front of us.  To the extent you can, restrict your consumption of those foods you have control over.  It may not be as fast as packaged food and fast food restaurants, but the enjoyment of food preparation and taking control of your eating has its own rewards.

Sugar and High Fructose Corn Syrup

Nature never intended us to have so much sugar.  Honey, molasses, and sweet fruits were natural flavors.  Now, enormous amounts of simple table sugars (sucrose) are put into many foods.  The body processes these as calories, and the weight and cholesterol may both go up.

As bad as sugar has been, high fructose corn syrup (HFCS) may be worse, as our bodies were never designed to receive such large amounts of fructose, a natural fruit sugar; the advice is to limit sugar and HFCS.  Together, excess sugar and HFCS may cause weight gain, metabolic syndrome and accompanying atherosclerosis.  Read the labels.

Meats

The meat industry and farming has been one of the enormously successful businesses in the Western World.  Not too many generations ago, meat on the dinner table was a rarity. Then, families in the US raised their own meat on farms.  Finally, the meat industry, helped enormously by subsidized corn-based feed, was able to supply cuts of meat at very affordable prices.  The answer for a cholesterol/weight concerned person is to cut back drastically on the frequency and the amount of meat.  Remember, marbling in meat is saturated fat, and prepared and processed meats such as bacon, sausage, scrapple, bologna, etc., are very high in saturated fat.  So, one should restrict the frequency of meats, where possible, trim away the fat, and select those meats with the lowest amounts of saturated fats.

Fish and Fish Oil

It is now well-known that fish, and especially certain types of fish such as salmon, albacore tuna, lake trout, herring, and mackerel, contain very healthy types of oils that actually lower cholesterol.  The oils in these and other fish are particularly healthy for the heart patient. Fish should be consumed 3-4 times a week, preferably baked or broiled rather than sautéed or deep-fried with extra fats.

Fish oil capsules are a concentrated form of this oil and many cardiologists now recommend them for heart patients.

Whole Grains

Complex carbohydrates come from natural plants and not from processed foods.  Sugar and high fructose corn syrup are simple carbohydrates and, to the extent possible, should be restricted.  In particular, one should select whole wheat or grain foods.  The FDA has strict requirements when this phrase is used.  Almost every other term such as multigrain, 7 grain, grain plus, etc., can mean almost anything the manufacturer wants.  Read the labels, avoid foods where the word “enriched” is used.  What this means is that the flour has been refined down to white flour (no fiber and few complex carbohydrates) and it has been “enriched” by adding a few vitamins.  It is a bit of a deceit.

Sodium and Salt

Excess sodium is quite often linked closely to high cholesterol and heart disease, as well as being directly related to high blood pressure.  Low sodium versions of foods are now widely available, in addition to many other spices that can be used other than table salt.  Again, read the labels and especially the salt/sodium content on the nutrition part of the label.

Restaurants

In restaurants, ask the server how items are prepared.  It should be remembered that tubs of butter sit around the kitchen simply because adding butter increases flavor and is used copiously by most chefs.  Tell your server you are on a low saturated fat, low butter diet.

Food Groups

Meat, Poultry, Fish, Other Protein

Choose

Avoid

Lean Meats: Select meats with minimal marbling.  Trim away excess fat.  Generally, a serving size is about the size of a deck of cards.  Broil or grill to allow excess fat to drip away.

Fatty Meats: Corned beef, mutton, ham, bacon, luncheon meat, short ribs, spareribs, sausage, hot dogs, scrapple, sandwich spreads, all organ meats

Poultry: Chicken and turkey with skin removed.

Self-basted poultry; processed poultry products such as turkey franks or bacon; chicken frankfurters, or scrapple

Eggs: Egg whites and low cholesterol egg substitutes.  Whole eggs as recommended by a physician or nutritionist.

Check with your physician or nutritionist regarding how many whole eggs per week.

Seafood: Fish oils are particularly heart healthy.  Those with the highest fish oil include swordfish, mackerel, albacore tuna, salmon, walleye, Pollack, and blue fish.  Fish should be eaten at least 3 times per week. 

Any seafood that is sautéed or deep fried

Cheese: Select low fat cheese such as cottage cheese, pot cheese, mozzarella, ricotta and Swiss. 

Most cheeses are high in saturated fat.  Avoid cream cheese, processed cheese, and cheese spreads.

Wild Game: Elk, deer (venison), Bison, pheasant, rabbit, wild duck, and squirrel. 

Domestic duck or goose

Beans: Beans of almost any type, peas, lentils, tofu, peanut butter. 

Canned baked beans (sugar and extra calories added).  Check labels.

Milk: Skim, non-fat (fluid, powdered, evaporated, condensed), buttermilk, lactose-reduced and sweet Acidophilus made from skim milk 

Any milk product made with whole or 2% milk, chocolate milk, milkshakes, eggnog, coconut milk.

Yogurt: Made from skim or non-fat milk 

Made from whole milk or custard style

Creamers: Only those containing polyunsaturated oils 

Any containing coconut or palm oils; whipped, sour, light, heavy, half & half creams

Cereals, Grains, Complex Carbohydrates

Choose

Avoid

Cereals, Dry or Cooked: Oat cereals are particularly heart healthy.  Check labels on all cereals for total calories, sugar, and sodium.  Cereal grains are low in saturated fat.

Coconut containing cereals, instant hot cereals, granola

Pasta & Rice: Noodles, spaghetti, macaroni, brown rice (preferred), wild rice.

Prepared with whole eggs, cream and cheese sauces; canned or boxed noodle and macaroni dishes; canned spaghetti dishes.

Baked Goods: Whole grain breads and rolls, low fat or homemade muffins, pancakes, waffles and biscuits using polyunsaturated spread or oil and non-fat milk.

Butter or cheese rolls and breads, croutons, commercial biscuits, muffins, pancakes, pastries, sweet rolls, donuts, croissants, popovers.

Tortillas: Corn, soft flour made with unsaturated oils 

Soft flour tortillas made with lard, shortening, hydrogenated fats, coconut and palm oils

Crackers/Snacks: Unsalted crackers, pretzels, popcorn prepared with air popper or mono/polyunsaturated oil

Salted crackers or snacks; fried snack foods; any snacks or crackers containing saturated fats, coconut or palm oils, hydrogenated or partially hydrogenated fats; cheese crackers or snacks; potato chips; corn chips; tortilla chips; chow mein noodles; commercial buttered popcorn

Fruits and Vegetables

Choose

Avoid

Vegetables: Fresh, frozen or low sodium canned, low-sodium tomato and vegetable juices

Spaghetti sauce, creamed, breaded or deep-fat fried vegetables, vegetables in sauces

Fruit: Fresh, unsweetened dried fruits, canned or frozen packed in water, own juice or light syrup preferred, all fruit juices (unsweetened preferred)

Canned or frozen packed in syrup, sweetened dried fruits, coconut, fried snack chips

Fats

Fats in nuts, seeds and avocado are mostly unsaturated and healthy.  They are high in vitamins and minerals, but they also contain high calories and should be limited.

Choose

Avoid

Polyunsaturated Fats: Sunflower, safflower, corn, soybean, cottonseed, sesame oils.
Monosaturated Fats: Canola, olive, peanut oils

Butter, lard, beef tallow, salt pork, bacon, bacon drippings, ham hock, animal fat, shortening, suet, chocolate, cocoa butter, coconut, coconut oil, palm and palm kernel oil, hydrogenated fat

Spreads: Tub type vegetable spreads made with canola or other mono- or poly- unsaturated fats

Hardened stick margarine or butter, any spread made with saturated or trans-fat

Salad Dressings: Olive oil and balsamic vinaigrette.  Check labels for saturated or trans-fats. 

Made with saturated or trans-fats, egg yolks

Seeds and Nuts: Unsalted, pumpkin, sesame, sunflower and others not on avoid list 

Cashews, macadamia, pistachio, Brazil

Miscellaneous

Choose

Avoid

Desserts: Homemade baked goods made with unsaturated oils or spreads, skim or 1% milk and egg substitute or egg whites; gelatin; angel food cake; ginger snaps; fruit ice, fruit whips, sorbet, sherbet; low-fat frozen desserts; puddings, custards or junkets made with non-fat milk and egg allowances

Made with whole milk, cream, butter, chocolate and egg yolk; commercially prepared cakes, pies, cookies, pastries; ice cream; chocolate desserts; frozen cream pies; commercial dessert mixes such as cake and brownie mixes; chocolate; candies made with cream fillings

Beverages: Sparkling or mineral water, seltzer, club soda – unsweetened preferred, coffee, tea, Postum

Tonic, commercially or home softened water, instant cocoa mixes, Dutch processed cocoa

Soups & Sauces: Fat-free, low-salt broth, consommé and bouillon, homemade soup skimmed of fat, cream soup and sauces made with non-fat milk and fat allowance

Soup made with whole milk or cream, broth containing fat, canned soups, dehydrated soup mixes, bouillon not labeled low-sodium, gravy and sauces made with butter, other animal fat and whole milk

Other: Spices, herbs, pepper, lemon juice, garlic and onion powder, Tabasco, ketchup, mustard, vinegar, relishes, jam, jelly, marmalade (unsweetened preferred)

Commercially fried foods, pickles, any foods containing items not allowed

Osteoarthritis (OA)

Osteoarthritis (OA)

Osteoarthritis, or OA, makes your joints hurt or feel stiff after you rest and after activity. It usually affects the hands, lower back, neck, hips, and knees. OA can cause bad pain, disability, and may lead to a need for surgery. Here’s what you can do.

Try these tips so your joints will not hurt so much and will make your joints move better:

  • If you are overweight, try to lose 5 to 10 pounds.
    • Eating smaller food portions helps you lose weight.
  • Be active for 2-3 hours a week.
    • Walk, swim, or ride a bike.
    • Stretch your muscles and joints.
    • Exercise your hands.

Tell your doctor if you are having very bad pain in your joints.

Ask your doctor about:

  • What exercises you can do.
  • How to lose weight.
  • How to help your pain.

Ask your doctor if you need:

  • Radiology
  • Braces or a cane.
  • To see a diet specialist.
  • To see a physical therapist.
  • To see an arthritis doctor (a rheumatologist).