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Dr. Ebraheim’s educational animated video describes conditions associated with ankle pain.
.

What are the common causes of ankle pain?
We are going to group all of the causes of ankle pain into 4 groups:

Anterior ankle pain (in front of the ankle)
Anterior lateral impingement: This is painful limitation of full range of motion of the ankle due to soft tissue thickening or tibial bony spur impinging on the talus, limiting dorsiflexion of the ankle.

Arthritis of the ankle: Arthritis of the ankle can occur due to injury or due to inflammation. It can be diagnosed by examination or by an x-ray.

Osteochondritis dissecans of the talus: A little chip fracture inside the ankle that causes pain, swelling, and stiffness.

Medial ankle pain (inside of the ankle)
Tarsal tunnel syndrome: Compression on the posterior tibial nerve produces symptoms of pain and numbness on the medial (inside) side of the ankle. When conservative treatment fails, surgical treatment of the tarsal tunnel release may be needed.

Posterior tibial tendon tendonitis or rupture: Posterior tibial tendon problems can occur from overuse activities, from degeneration, or trauma. The posterior tibial tendon is one of the major supporting structures of the foot. The tendon helps to keep the arch of the foot in its normal position. When there is insufficiency or rupture of this tendon, the arch begins to sag, and a flatfoot deformity can occur associated with a tight Achilles tendon. The posterior tibial tendon rupture occurs in the hypovascular area, which is distal to the medial malleolus. The patient will have painful swelling on the posteriomedial aspect of the ankle. The patient will be unable to perform a single heel toe raise, too many toes sign, or flatfoot or fixed deformity of the hindfoot. Rupture of this tendon could be missed!

Flexor hallucis longus tendonitis: Pain, swelling, and weakness posterior to the medial malleolus. Dorsiflexion of the big toe may be reduced when the ankle is placed in dorsiflexion. Triggering and pain along the tendon sheath may also occur with toe flexion.

Posterior ankle pain (behind the ankle)
Posterior ankle impingement (os trigonum): Os trigonum is a nonunited piece of accessory bone seen posterior to the talus. Tenderness in the posterior lateral aspect of the ankle posterior to the peroneal tendons, especially with passive plantarflexion of the ankle, may be seen in association with Flexor hallucis longus (FHL) tenosynovitis.

Achilles tendonitis: Irritation and inflammation occurs due to overuse. Pain, swelling, and tears within the tendon. It is usually treated with therapy and eccentric exercises. It is rarely treated with surgery.

Achilles tendon rupture: The Achilles tendon can become prone to rupture with age, lack of use, or by aggressive exercises. Rupture of the Achilles tendon is diagnosed by the Thompson test or by an MRI. Treatment may be conservative without surgery by doing early functional rehab. Or it can be treated with surgery by approximation of the torn ends of the tendon. The risk of surgery is infection and skin/wound complications. The risk of conservative treatment is a high rate of rerupture of the tendon.

Lateral ankle pain (outside of the ankle)
The cause of ankle pain on the outer side of the ankle may be a sprained ankle, but diagnosis of a sprained ankle may be the wrong diagnosis. There are other structures in this area that can mimic an ankle sprain, but it is not an ankle sprain.

Ankle sprain: When the pain is anterior and around the fibula, it can be attributed to ligament sprain. Ankle sprain can be high ankle sprain (rare) or a low ankle sprain (common). Both types of ankle sprains are seen in this diaphragm.

High ankle sprain: High ankle sprain is a syndesmotic injury and requires surgery. The high ankle sprain is a serious injury because it injures the ligament that connects the tibia to the fibula at the ankle joint. The diagnosis is usually done by the use of external rotation stress views or by CT scan.

Low ankle sprain: A low ankle sprain is not a serious injury and it does not require surgery. Low ankle sprain is collateral ligament injury. With an ankle sprain, although the condition is painful, the patient will be able to walk. When there is a fracture of the ankle, the patient will be unable to walk due to severe pain. The treatment of ankle sprains will include immobilization, ice therapy, physical therapy, and rarely surgery.

Diagnosis of a sprained ankle may be the wrong diagnosis. So, let us see what else can cause pain on the outside of

the ankle.

Peroneal tendon subluxation: Occurs due to rupture of the superior peroneal retinaculum.

Rupture of the peroneus longus tendon: The os peroneum displaces proximally.

Peroneal tendinitis

Anterior process of the calcaneus fracture

Lateral process of the talus fracture
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In this QUAH Sal, Adam, & Justin answer the question “If I lift heavy will it cause my joints to hurt over time? If so, is there any way to prevent it?”

If you would like to get your own question answered, follow us on Instagram where we post QUAH requests weekly.
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Physical activity is a proven way to relieve the pain and disability associated with arthritis, but many people do not have the confidence or knowledge about how to exercise safely. This video will help people with arthritis learn more about the benefits of physical activity and the types and amounts of exercise helpful for people with arthritis.

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In this episode the surgeons discuss what is the best topical medicine for pain. They discuss the components they believe can help control musculoskeletal pain symptoms. Oral pain medicine can have side effects. Topical treatments are very safe.
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Medical emergency
Do NOT use the Video for medical emergencies. If you have a medical emergency, call a physician or qualified healthcare provider, or CALL 911 immediately. Under no circumstances should you attempt self-treatment based on anything you have seen or read on the Video.

General information is not medical advice
The general information provided on the Video is for informational purposes only and is not professional medical advice, diagnosis, treatment, or care, nor is it intended to be a substitute therefore. Always seek the advice of your physician or other qualified health provider properly licensed to practise medicine or general healthcare in your jurisdiction concerning any questions you may have regarding any information obtained from this Video and any medical condition you believe may be relevant to you or to someone else. Never disregard professional medical advice or delay in seeking it because of something you have read on this Video. Always consult with your physician or other qualified healthcare provider before embarking on a new treatment, diet, or fitness program. Information obtained on the Video is not exhaustive and does not cover all diseases, ailments, physical conditions, or their treatment.
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Joint Pain is nothing but the Joint inflammation, which causes due to the wear and tear of the joint. There are many joints in the human body, and it can appear in any part and leave you irritated with the continuous pain. There are certain medications available that reduce the pain and inflammation, but the treatment is lifelong.

Dr. Nitiraj Oberoi, Consultant-Orthopedic Surgeon, Dharamshila Narayana Superspeciality Hospital, Delhi talks about the Joint Pain Causes, Symptoms and Treatment Options. He also emphasizes the need for following a healthy lifestyle to reduce the risk of Joint Pain and inflammation.

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Dr. Ebraheim’s educational animated video describes painful conditions associated with the knee, the etiology, signs and symptoms, diagnostic tests and special maneuvers, and treatment options.
Common knee problems:
Patellar chondromalacia
•chronic pain due to softening of the cartilage beneath the kneecap.
•Chronic knee pain from mild to complete erosion of the cartilage in the back of the kneecap.
•Pain in the front of the knee.
•Occurs more in young people.
•Becomes worse from climbing up and down the stairs.
•Treatment: usually therapy, NSAIDS.
Patellar bursitis
•Pain and inflammation located in the front of the kneecap.
•The bursa becomes inflamed and fills with fluid at the top of the knee.
•Causes pain, swelling, tenderness and a lump in the area on top of the kneecap.
Ligament injury
Lateral collateral ligament rupture: usually occurs as a result of sports activities.
Medial collateral ligament rupture: injury to the ligament on the inner part of the knee. The most commonly injured knee ligament.
Anterior cruciate ligament tear:
•involves a valgus stress to the knee.
•Usually the patient will have swelling and hematoma.
•Lachman’s test is positive.
•MRI is diagnostic.
Patellar tendonitis
•Inflammation and pain located inferior to the knee cap area.
Meniscal Tear
•Meniscus is a cushion that protects the cartilage of the knee.
•Injury will cause pain on the medial or lateral side of the knee.
•Outer 30% of meniscus has blood supply.
•mcMurrays test is positive.
•History of locking, swelling and instability of the knee.
•MRI is helpful.
Arthritis of the knee joint
•Characterized by progressive wearing away of the cartilage of the joint.
•The knee is a common part of the body that is most affected by arthritis.
•Decreased joint space.
Baker’s cyst
•Swelling in the back of the knee filled with synovial fluid.
•Cyst between the semimembranous and medial gastrocnemius muscles.
Gout
•Type of arthritis or joint inflammation caused by an excessive level of uric acid in the blood.
•Can affect any joint especially the big toe.
•Crystals look like needles and have a negative birefringence.

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Millions suffering from chronic pain are turning to CBD for relief, with Google searches for CBD reaching 6.5 million in just one month.

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The best pain relief creams and gels for arthritis, soreness, stiffness, nerve pain and more! I have tried all kinds of pain relief products through the years and here are the ones that work the best:

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In this video Doctor Andrea Furlan explains why is Vitamin B12 so important, and how to diagnose its deficiency. The talks about megaloblastic anemia, pernicious anemia and microcytic anemia. She also talks about the blood tests and normal ranges. She explains how to obtain Vitamin B12 from diet and supplementation, including oral, sublingual and intra-muscular injections.

00:00 Introduction
00:55 Why is Vitamin B12 important
01:12 Normal blood test
01:23 Anemia
02:13 Homocysteine test
02:33 Recommended daily intake
02:54 Dietary sources
03:19 Malabsorption
03:35 Pernicious anemia
04:20 Pain
04:54 Severe deficiency
05:17 Interaction with other medications

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=============================================
ALERT: This video is not intended to replace medical
advice. If you think you have a condition that is
causing you pain, please consult with your doctor
to get a diagnosis and a treatment plan for you.
The intent of this video is only for educational
purposes.
=============================================
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Vitamin B12 deficiency can occur in all kinds of individuals. It may be of particular concern if you are following a vegan or vegetarian diet, or taking medications that reduce your absorption ability of vitamins. This video looks at what exactly a vitamin B12 deficiency can lead to and the ways in which you can obtain vitamin B12 through your diet or by taking B12 supplements.

This video was created by Demystifying Medicine students Dhruvika Joshi, Prabhjot Khabra, Minahil Jabeen and Vanessa Lombardo.

Copyright McMaster University 2017

References:

1. Bruins Slot, W., Merkus, F. W., Deventer, S. J. H. V., & Tytgat, G. N. (1997). Normalization of plasma vitamin B12 concentration by intranasal hydroxocobalamin in vitamin B12-deficient patients. Gastroenterology, 113, 430-433.

2. Daily Intake. (2017). Canadian Food Inspection Agency. Retrieved 30 October 2017, from http://www.inspection.gc.ca.libaccess.lib.mcmaster.ca/food/labelling/food-labelling-for-industry/nutrition-labelling/information-within-the-nutrition-facts-table/eng/1389198568400/1389198597278?chap=6

3. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B b6 s, folate, vitamin B b12 s, pantothenic acid, biotin, and choline. (1998) (pp. 306-356). Washington, D.C.

4. Ermens, A., Vlasveld, L., & Lindemans, J. (2003). Significance of elevated cobalamin (vitamin B12) levels in blood. Clinical Biochemistry,36(8), 585-590. doi:10.1016/j.clinbiochem.2003.08.004

5. Ganeson, S., Thanawala, N., & Hussain, N. (2013). Vitamin B12 deficiency: a treatable cause of developmental delay in infancy. J Paediatric Child Health, 49(4): E348-349. doi: 10.1111/jpc.12158

6. Gropper SS, Smith JL, Groff JL. Advanced Nutrition and Human Metabolism: Fourth Edition. Boston, MA: Wadsworth (2004).

7. Hashim, O. H., & Adnan, N. A. (1994). Coenzyme, cofactor and prosthetic group — Ambiguous biochemical jargon. Biochemical Education,22(2), 93-94. doi:10.1016/0307-4412(94)90088-4

8. Hvas, A., & Nexo, E. (2006). Diagnosis and treatment of vitamin B12 deficiency. An update. Haematologica, 91(11), 1506-1512.

9. Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. (1998). Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. National Academies Press (US).

10. Kwong, J. C., Carr, D., Dhalla, I. A., Tom-Kun, D., & Upshur, R. E. (2005). Oral vitamin B 12 therapy in the primary care setting: a qualitative and quantitative study of patient perspectives. BMC family practice, 6(1), 8.

11. . Langan, R. C., & Goodbred, A. J. (2017). Vitamin B 12 Deficiency: Recognition and Management. American Family Physician, 96(6).

12.. Miller, A., Korem, M., Almog, R., & Galboiz, Y. (2005). Vitamin B12, demyelination, remyelination and repair in multiple sclerosis. Journal of the Neurological Sciences,233(1-2), 93-97. doi:10.1016/j.jns.2005.03.009

13. Møllehave, L. T., Skaaby, T., Simonsen, K. S., Thuesen, B. H., Mortensen, E. L., Sandholt, C. H., … & Linneberg, A. (2017). Association studies of genetic scores of serum vitamin B12 and folate levels with symptoms of depression and anxiety in two danish population studies. European Journal of Clinical Nutrition, 71(9), 1054-1060.

14. National Heart, Lung, and Blood Institute (2011). What are the signs and symptoms of pernicious anemia? Retrieved from https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/signs

15. Niculescu, M., & Zeisel, S. (2002). Diet, Methyl Donors and DNA Methylation: Interactions between Dietary Folate, Methionine and Choline. The Journal of Nutrition,132, 2333-2335.

16. Oh, R., & Brown, D. (2003). Vitamin B12 Deficiency. American Family Physician, 67(5), 979-986. Retrieved from http://www.aafp.org.libaccess.lib.mcmaster.ca/afp/2003/0301/p979.html

17. Osimani, A., Berger, A., Friedman, J., Porat-Katz, B. S., & Abarbanel, J. M. (2005). Neuropsychology of vitamin B₁₂ deficiency in elderly dementia patients and control subjects. Journal of geriatric psychiatry and neurology, 18(1), 33-38.

18. Vogiatzoglou, A., Smith, A. D., Nurk, E., Berstad, P., Drevon, C. A., Ueland, P. M., … & Refsum, H. (2009). Dietary sources of vitamin B-12 and their association with plasma vitamin B-12 concentrations in the general population: the Hordaland Homocysteine Study. The American journal of clinical nutrition, 89(4), 1078-1087.

19. Whitney, E., Rolfes, S., Hammond, G., & Piche, L. (2011). Understanding Nutrition (1st ed., pp. 332-334). Toronto: Nelson Education Ltd.

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Three drug-free remedies for knee pain you may not have heard of.

1. Pulsed electromagnetic frequency (worn)
2. Collagen protein (ingested)
3. Cetylated fatty acid (topical)

Knee pain is one of the most common pains in the body. It can occur from injury, post-surgically, or with repeated stress.

Common knee conditions are sprained ligament, meniscus or cartilage damage, tendonitis, bursitis, or wear and tear related to arthritis. Some people can develop knee pain caused by an irritated nerve in the back. Symptoms can include pain, swelling, stiffness, clicking, and popping. 700,000 meniscus surgeries are performed per year despite 3 randomized controlled trials showing no benefit vs sham surgery or PT. A similar number of knee replacements are performed each year in the U.S. One third of knee replacement patients continue to have pain and one in five is dissatisfied with the results.

The three drug free remedies discussed are:

1. Pulsed electromagnetic frequency
Actipatch- https://www.ncbi.nlm.nih.gov/pubmed/26235410, https://www.ncbi.nlm.nih.gov/pubmed/31140929, LBP https://www.ncbi.nlm.nih.gov/pubmed/27910725
https://www.ncbi.nlm.nih.gov/pubmed/30552258
https://www.ncbi.nlm.nih.gov/pubmed/22504115
https://www.ncbi.nlm.nih.gov/pubmed/26705327
Low levels of electromagnetic radiation, charge the mitochondria, increase cellular energy, reduce inflammatory chemicals.
PEMF could alleviate pain and improve physical function for patients with knee and hand OA

2. Collagen
https://www.ncbi.nlm.nih.gov/pubmed/18416885, https://www.ncbi.nlm.nih.gov/pubmed/17076983
https://www.ncbi.nlm.nih.gov/pubmed/26267777
https://www.ncbi.nlm.nih.gov/pubmed/22500661
Collagen peptides
Hydrolyzed collagen peptides
Source from bones, hide, eggshell membrane, fish collagen
10g-12g/day in coffee, water, or smoothies

3. Cetylated fatty acid cream
https://www.ncbi.nlm.nih.gov/pubmed/15903393,
https://www.ncbi.nlm.nih.gov/pubmed/15705022
https://www.ncbi.nlm.nih.gov/pubmed/30874246
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6409167/
`Reduced pro-inflammatory cytokine levels, changes in membrane fluidity and signal transduction pathways reducing the proteoglycan degrading enzyme activity, and release of leukotriene B4 from neutrophils have been hypothesized.
-it can be safely prescribed as self- and on-demand treatment.
-In conclusion, the administration of topical CFA may mitigate the most common symptoms in knee OA.
-Findings suggest that topical CFA is effective in all knee OA patients with slightly higher evidence for those with advanced disease.
Dose; apply twice a day, 1-2 mos

If not of these help after 1-2 months then it may not be the treatment for you.

Additional resources:
Knee meniscus: https://regenexx.com/search/knee+meniscus/
Knee replacement: https://regenexx.com/search/knee+replacement/
Knee ACL: https://regenexx.com/search/knee+ACL/

If you would like a non-surgical medical intervention that uses your own cells, please see Regenexx.com
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Earn CME for related activities: https://www.naccme.com

In this presentation from the 2017 Mastering Clinical Challenges and Emerging Therapies in IBD, held July 22, 2017 in Chicago, Illinois, Dr. Reem Jan discusses the rheumatologist’s approach to the management of joint pain in patients with inflammatory bowel disease (IBD).

© 2017 Imedex, LLC.
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Chronic joint pain affects millions of people of people across the world every year. Thousands of patients routinely seek medical attention for joint pain, and it is one of the leading causes of disability.

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To give you an estimate of the disease, in 2002, about 10.5 million people in the United States said they experienced severe joint pain, but by 2014 that number had jumped to 14.6 million, said researchers from the U.S. Center for Disease Control and Prevention. Severe Joint pain can limit a person’s ability to perform basic functions and seriously compromise their quality of life.

Luckily with strict precautions, good exercise, proper diet and supplementation joint pain can be managed. In this video we discuss five of the best foods that you should include in your diet if you are suffering from joint pain, and also the science behind it

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Top 5 Signs Your Shoulder, Hip, or Knee Pain Is NOT Arthritis

Bob and Brad discuss signs that your pain is not arthritis for your shoulder, hip, or knee.

This Week’s Giveaway:
We are giving away a suite of Renpho products!

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Pain, swelling and stiffness in your joints. All are symptoms of rheumatoid arthritis. But because these symptoms come and go, the condition can sometimes be tricky to diagnose. And it’s important to get the right diagnosis because starting treatment early can make a difference.

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