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Amyotrophic Lateral Sclerosis

Amyotrophic Lateral Sclerosis or ALS is also referred to as Lou Gehrig's disease. This condition is characterized by progressive neuromuscular weakness. Amyotrophic lateral sclerosis affects nerve cells controlling voluntary muscles. Men are more likely to be affected by myotrophic Lateral Sclerosis than women. ALS does not affect involuntary muscles and senses.


Patients suffering from Amyotrophic lateral sclerosis notice problems in dexterity and gait. There might be cramps in the muscles, twitching in the limbs and clumsiness. Patients suffering from myotrophic Lateral Sclerosis face difficulties in chewing and swallowing. Symptoms of Amyotrophic Lateral Sclerosis are often mistaken for other neurological diseases. Gradually the patient faces muscular weakness and loss of function. The muscles may then get paralyzed. This may lead to respiratory failure.


MRI of the brain is done to determine the exact cause of the muscle weakness. Spinal tap can also throw light on the levels of proteins and sugar and white blood cells. Electromyogram (EMG) helps in understanding the electrical activity of the muscles. Riluzole is the only FDA approved medication for controlling Amyotrophic lateral sclerosis. Physical therapy helps in maintaining muscle strength.

Tennis Elbow

When there is inflammation of the tendons on the outside of the elbow at the lateral epicondyle of the upper arm, the condition is known as tennis elbow. This condition is caused by certain repetitive movements of the wrist Tennis players are not the only people who are affected by this condition, which is also known as lateral epicondylitis. Activities like hedge clipping, tennis, excessive use of a screwdriver or hammer, painting or any such activity that involves repetitive motion of the wrist which also requires constant gripping may lead to tennis elbow. Though, the real cause of tennis elbow is not clearly defined, it is due to tears of the tendons that attach the forearm muscles to the bone of the arm at the elbow joint.

Symptoms of tennis elbow

  • Pain over the outside (lateral) of the elbow
  • Pain while lifting or carrying objects or gripping even light objects such as a coffee cup.
  • Pain radiates down the forearm.
  • Tenderness is felt on or below the joint's bony prominence.
  • Pain due to tennis elbow may last for about 6 to 12 weeks.
  • The discomfort may be for a short duration or it may last for several years.

Normally the pain due to tennis elbow sets in gradually, though at times it may also occur suddenly. Most patients complain of pain in the dominant arm. Manual workers like painters, plumbers, carpenters and gardeners who use their hands face the risk of developing this symptom. Many sports participants like racquet sports players, golfers, fencers are also prone to tennis elbow syndrome.

Tennis elbow is not simply caused by inflammation of the tendons alone, consider experts. The degenerative process either due to aging, or repetitive use of the forearm may also be responsible. If there is poor blood flow in that area, it does not heal completely and accessing nutrition and oxygen necessary for healing becomes difficult. This condition will lead to small tears in the tendon because of its degeneration and is revealed as symptoms of tennis elbow.

X-rays help to diagnose tennis elbow for patients who have the usual symptoms near their forearm. If the doctor has any confusion, an EMG is sometimes obtained to confirm the diagnosis of a tennis elbow. Pain over the outside of the elbow may sometimes occur due to instability of the joint, elbow arthritis and radial tunnel syndrome. Though the symptoms of these conditions are normally distinct, they can be confusing at times.

Even after the initial injury is healed, these areas tend to tear again. Hemorrhage will result because of this condition and there will be formation of rough, granulated tissue and calcium deposits within the surrounding tissues. Inflammation is caused due to leakage of collagen. The blood flow in this area is cut off because of the pressure developed due to inflammation. It can also squeeze the radial nerve that controls muscle in the arm and hand.

When your elbow is involved in any activity, always take care to warm up your arm for a few minutes before starting. Apply a pack of ice over the arm for 15 or 20 minutes, if you experience severe pain in that area after use. If the usual measures like rest, anti-inflammatory medications and stretching routine do not yield good results, then in rare cases surgery is considered. Tennis elbow can be prevented by:

  • Lifting objects with the palm facing your body.
  • Using hand weights, you can do strengthening exercises.
  • Before starting any stressful activity, stretch the relevant muscles by grasping the tips of your fingers.
  • Be cautious to avoid a relapse. Try to modify or just discontinue the action that caused the strain. Frequent breaks during the activity will help prevent this condition.
  • Strapping a band around your forearm just below the elbow will help as a support. Using bands can cut off blood circulation and thus delay healing and so it is best to use these bands only after tennis elbow has healed completely.

Haglund's Deformity

Haglund's deformity is a bony growth along the posterior lateral border of the calcaneus or the heel bone surrounded by a tender tissue. Haglund's deformity primarily springs from bone enlargement at the back of the heel bone in the area where Achilles tendon attaches to the bone. Hence it is also called pump bump. It is also called as 'retro ocular bursitis and 'calcaneal exotosis'. Bursitis is an inflammation of the sacs (bursae) that contain small amounts of lubricating fluid to help the joints move smoothly. The syndrome is usually found to occur in females in their teens who often use high heels causing irritation of the rigid heel counter of the shoe rubbing up and down on the back of the heel bone. However, the deformity can also occur among runners and athletes. Common symptoms include red painful area in the back of the heel and swollen area at the back of the heel bone. There is irritation in the Achilles tendon. Repeated blistering on the back of the heel leads to callous formation.


Haglund's deformity is identified by physical examination and x rays. The doctor correlates the physical symptoms of redness and pain in the area with findings in x-ray studies, bone scans and MRI. Haglund's deformity can be present at birth or may be acquired by injury over the patient's lifetime. Shoe gear is the primary reason for Haglund deformity. Haglund's deformity can be caused by bursitis or pressure against the shoe.


The treatment for Haglund's deformity depends upon the severity and cause of the disease. During the initial stages when the disease is mild, applying ice followed by moist heat and compression will help ease discomfort from pump dump. Changing the type of shoes can stop the injury and consequent redness and swelling from developing. The pain can also be alleviated to some extent by placing a heel lift inside the shoe so as to lift the Haglund bump above the part of the heel counter of the shoe that rubs it. A doctor may also prescribe anti-inflammatory drugs to reduce pain. Soaking the foot may also soothe the area. In mild cases, a doctor may also recommend padding of the area. Normally corticosteroid injections are given to relieve the pain but for long term complication this injection cannot be recommended as it can weaken and cause rupture to the Achilles tendon. In severe cases of deformity, surgery may be necessary to remove or reduce the bony growth.

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Bibliography / Reference

Collection of Pages - Last revised Date: November 19, 2019