What is Chondromalacia Patella?

Patella commonly known as knee cap or kneepan, is a disc-shaped, triangular bone that is connected to the tendons of the femur and covers the front area of the knee joint. Its key function is to extend and protect the knee joint, especially during bending.

The patella is controlled by quadriceps muscles. If the muscle strength is not balanced in each direction, the patella  can be pulled toward the edge of the groove instead of being centered, causing irritation and chondromalacia patella (CMP). The word “chondromalacia” is derived from the original Greek meaning “softening of the cartilage.”

CMP is a painful disorder which involves degeneration and softening of the articular cartilage between the patella and the outer layer of the femur. The patellar cartilage becomes impaired and develops fissures, causing poor alignment and irritation in the kneecap.

Normally, the patella has a protective smooth cartilage on the underside which allows effortless gliding and bending of joints across the knee and effortless sliding in the groove of the femur. But in the CMP situation the kneecap rubs over one part of the knee joint, resulting in injury and blisters on the surface of the patella. Due to this, continuous irritation and pain in the knee will occur.

Chondromalacia patella image

Image source: eorthopod.com

According to most studies, the cause of CMP is considered idiopathic, but other findings have reported that the degenerative changes are due to the following:

Trauma

Trauma most often occurs when the symptoms have subsided, but the imbalances caused by injury or misuse during recovery have not been corrected.

Repetitive micro-trauma

People with a history of previous trauma to the anterior knee are at a higher risk of developing CMP.

Postural distortion

Pulling or twisting out of shape produces abnormal movement of the patella in the trochlear groove.

First described in 1906, postural distortion occur frequently in adolescents, young adult females, athletes, and overweight people. Runners are more likely to develop CMP due to poor training regimens, rapid rise in duration or intensity of training, hard and uneven running surfaces, and inappropriate shoes.

Chondromalacia Patella Symptoms

Knee pain

Dull pain can be felt beneath or on the side of the patella. Pain is usually of gradual onset and becomes worse with the flexion and extension of the knees from activities such as squatting, climbing or descending stairs, and sitting for a prolonged period of time.

Crepitus

Crepitus is a grating sound or sensation produced by friction between the knee joint and cartilage, commonly heard when compression, active extension, and range of motion are applied.

McMurray sign

MacMurray sign is pain or trapping during circular movement.

Swelling

Redness and edema are also observed. Tenderness can be felt during palpation in the middle part and sides of the patella.

Increased quadriceps or Q angle and valgus posture of the leg may also be noted.

Diagnosis

Physical Examination

The physical examination is the initial examination that is done during consultation with the doctor who will assess the knee for signs and symptoms of CMP like stiffness and crepitus.

In some cases, a diagnostic procedure is necessary to confirm the diagnosis.

Knee X-ray

A Patello-femoral X-ray is done to inspect for any changes in the knee as well as extended cartilages or joints. Among the most helpful views – standing anteroposterior, lateral, and Merchant/sunrise views, the merchant/sunrise view can visualize the articulation in the patellofemoral part and the degree of narrowing of the joint space.

Computed Tomography (CT) Scan

A CT scan demonstrates subluxation and tilt more accurately from the posterior condyles of the femur.

Magnetic Resonance Imaging (MRI)

MRI is an effective tool that is used to evaluate the frontal area of the patella and abnormalities and defects in the focal cartilage. It can also serve as an accurate, non-invasive method to assess in the patellar cartilage. MRI can detect CMP with a sensitivity of 86 percent and an accuracy of 81 percent.

Grading:

• Grade 1 – Softening of the cartilage due to broken vertical collagenous fibers.
• Grade 2 – Blister formation, positive swelling, and thinning of articular cartilage due to the separation of the superficial layer of the articular cartilage from the deep layer of the articular cartilage.
• Grade 3 – Thickness of cartilage with focal ulceration and surface fissuring (crabmeat cartilage)
• Grade 4 – Ulceration, crater formation, and exposure of the subchondral bone

Arthroscopy

It provides an easy method to view the interior part of the patella and serves as a tool to confirm lesions.

CMP is graded according to degree of damage:

• Grade 1 – Localized swelling and softening of the cartilage with a size of not less than 0.5 cm.
• Grade 2 – Fissuring and fragmentation in an area that is less than 1-3 cm in diameter.
• Grade 3 – Fissuring and fragmentation within an area that is more than 1-3 cm in diameter.
• Grade 4 – Ulceration and erosion of subchondral bone.

Treatment of Chondromalacia Patella

CMP usually does not require treatment if there are no symptoms. If it is symptomatic, pain management and rehabilitative treatment are the primary options.

• Cold Compress – Putting an ice pack over the patella will help reduce the pain and swelling in the area.
• Assistive devices – Immobilization and t use of crutches are sometimes necessary to control the symptoms.
• Anti-inflammatory medications – Non-steroidal anti-inflammatory drugs like ibuprofen, naproxeb, advil, or aspirin are taken to relieve pain and inflammation.
• Stretching and isometric exercises – Strengthening the hamstring muscles and quadriceps will help restore the normal function of the patella. One of these is the quad setting; it is done by contracting the thigh muscles while the legs remain straight.
• Knee support – It can be worn to immobilize the knee and avoid compression and motion of the patella and cartilage.
• Surgery – An operative treatment is suggested to the patient with persistent pain and progression of the affected part after he or she has received the conservative treatment. Surgery is intended to correct the unequal tension of the patella or to remove loose or nonviable cartilage from the posterior patellar surface.

What is a Hangover?

It is a term which describes the unpleasant physiological effects after heavy consumption of alcohol-rich beverages. The symptoms generally vary from mild to severe discomfort.

Since every person is unique, each person will react to alcohol consumption differently. There is no particularly amount of alcohol that leads to a hangover. Generally, when a person has consumed more than he or she can handle, a hangover is experienced. Experts say that a hangover is a term used to describe the body’s reaction to alcohol overconsumption.

Causes of Hangover

When  a single alcoholic beverage is consumed, it will be enough to cause a hangover for some people who have a low tolerance level for alcohol. There have been etiological factors or causes of hangover and below is the list of them:

• It causes irritation in the stomach lining

Alcohol can irritate the stomach lining, causing an increase in stomach acid production, and delayed stomach emptying. Consequently, the person will experience nausea, vomiting, or pain in the abdominal region.

• It expands your blood vessels

When this occurs, the person will experience headaches.

• It leads to sleepiness or drowsiness

When a person overindulges in alcohol consumption, sleepiness occurs, leading to fatigue and grogginess.

• It decreases your blood sugar level

Overconsumption of alcohol can lead to hypoglycemia, which causes symptoms of shakiness, weakness, mood disturbance, seizures, and fatigue.

• It triggers the immune system and its inflammatory response

A person who consumes too much alcohol will experience symptoms like memory problems, decreased appetite, loss of interest in usual activities, and inability to concentrate on any given task.

• It contains congeners which is an ingredient in alcoholic beverages

Congeners are ingredients that give flavor to the alcohol and greatly contribute to a hangover episode. Known to be byproducts of alcoholic fermentation, congners are found in huge amounts in dark wines compared to  lighter ones. Examples of dark wines include red wine, whiskey, and brandy.

• It contains ethanol which causes dehydration

Ethanol has many effects on a person. Besides dehydration, ethanol can leads to the functional impairment of the liver, causing moodiness, decreased attention, weakness, or fatigue.

Symptoms of Hangover

Alcohol is generally known to be a diuretic, and when a person drinks too much of it, he or she will be at high risk of dehydration. The person will experience frequent urination, leading to a loss of body fluids. Alcohol overconsumption may also lead to brain dehydration which results in intense headaches during the hangover period. Other hangover symptoms include the following:

• Decreased concentration
• Palpitations
• Sleep alterations
• Nausea
• Sweating episodes
• Halitosis or bad breath
• Sensitivity to noise and light
• Dysphoria
• Pain in the stomach
• Thirst
• Muscular aches
• Headaches
• Bloodshot eyes
• Shakiness
• Dizziness
• Mood disturbance (irritability, anxiety, and depression)
• Body aches
• Flatulence
• Hypersalivation
• Diarrhea
• Lack of perception

How to Cure a Hangover

How to cure a hangover is typically the number-one question in the back of anybody’s mind. Nobody can escape a hangover when too much alcohol is consumed. The good news is that there is a way to combat a hangover. There are actually twelve ways to cure a hangover.

1. Hydrate with lots of water

The first tip is the need to hydrate.  As mentioned earlier, alcoholic consumption will lead to dehydration episodes. Hence, drink water between alcoholic consumption and before hitting the bunk.

2. Eat first before drinking alcohol

By eating a high fat meal which lets the body slowly digest the fat will protect the stomach lining from irritation.

3. Sleep

When alcoholic beverages are consumed, the body needs to recover from the toxicities of the alcohol. Hence, sleep as well as rest are needed for the body and mind.

4. Take multivitamins

The number-four tip is to take multivitamins, especially vitamin B6 which will help during hangover days. As mentioned, alcohol, which is a diuretic, has a tendency to excrete not only water but essential vitamins. Hence, multivitamins are needed to replenish what was excreted.

5. Engage in exercise or physical activity

Studies show that when a person engages in any form of physical activity or exercise, his or her body produces endorphins which effectively boost mood. It is important to remember to hydrate with water during any physical activity or exercise after alcohol consumption.

6. Drink juice rich in vitamin C

The number-six tip is the consumption of juices that are rich in vitamin C such as orange juice. Such beverages will help increase the energy level, which is needed to combat fatigue caused by hangover episodes.

7. Consume egg after a hangover

Consuming eggs is one of the best treatments to cure a hangover. Eggs are the known to have albumin, which is a natural protein. Furthermore, eggs are osmotic, so consuming eggs can help rehydration in cases of dehydration during a hangover.

8. Drink caffeinated beverages

Another thing to consider is to drink caffeine-rich beverages.  Caffeine is a noted vasoconstrictor, which can help people who suffer from a hangover, and it also relieves headaches.

9. Take pain relievers with care

If headaches and other body aches occur, then medications for pain can be taken. However, it should be stressed that not all pain relievers are good especially when intoxicated with alcohol. Acetaminophen like Tylenol should be avoided as much as possible.

10. Eat toast or crackers with honey

Another tip is to eat crackers with honey.  This is an effective food which flushes the alcohol out of the body. Honey contains fructose which helps expel the alcohol from the body.

11. Take a cool shower

Alcohol, which is a diuretic, is also known to cause vasodilation. Hence, taking a cool shower will lead to vasoconstriction.

12. Adding sugar and salt to water

As mentioned earlier, there is a need to hydrate with water. In the case of the twelfth tip, the body needs to replenish electrolytes that were expelled during vomiting. Hence, electrolytes can be replaced by consuming water with added salt and sugar (which are key electrolytes).

Through doing such tips mentioned under how to cure a hangover, you will prevent, as much as possible, the experience of undergoing hangover.

What is Twisted Bowel?

In the medical community twisted bowel is known as volvulus, which means twisting of the bowels around one’s mesentery attachment. This kind of condition is a rare and affects the small intestines, large intestines and stomach. It is commonly seen in children or infants and may be seen in adults.

Twisted Bowel

When a person has a twisted bowel, his or her intestine’s shape changes. It may lead to the obstruction of the person’s bowel. When the twisted bowel affects the small intestine, it is called small bowel volvulus. While, if it affects the large intestines, it is known as colonic volvulus. Despite the fact that this condition is rare, it is a serious medical condition that warrants special medical attention. Thus, early diagnosis and treatment is important. According to statistics, the morbidity rate of the persons suffering from twisted bowel is about 37 percent. Most  inflicted with twisted bowel who do not go through recuperation will eventually lead to death.

Twisted Bowel Symptoms

The affectation of the twisted bowel will produce different symptoms and signs. The severity levels from one person to another also differ. Persons who have milder forms of twisted bowel may not have any serious problems or complications. However, those persons who have a severe or chronic form of the twisted bowel condition may lead to serious problems or complications such as, lack of nutrients, oxygen, and blood blockages. When this happens, it is known as strangulation. When strangulation is untreated, it will lead to bowel necrosis or the cell death in the gastrointestinal system.

Some of the symptoms that are commonly reported when one person has twisted bowel are:

• Nausea

Persons with twisted bowel experiences nausea and its severity may differ in various persons.

• Dehydration

When a person has twisted bowel it will eventually lead to diarrhea. Diarrhea is a medical condition wherein a person passes his or her waste that is watery in consistency. Hence, when this happens the person will be at risk for dehydration.

• Abdominal distention

When there is prolonged twisted bowel, it may lead to the abdominal inflammation or distention. When one has abdominal distention it may be due to constipation or there is a problem with the passage of gas. In addition to that, the person will experience tenderness in his or her abdominal region.

• Pain

One common sign of persons with twisted bowel is pain. The degree of pain felt will vary from one person to another. Once a person experiences pain because of the twisted bowel, they may also experience cramps. When one has pain brought about by twisted bowel, it will lead to a restriction of channeling the person’s stool and a limitation of the blood flow, which leads to vicious and sudden spasms and contraction of the muscles.

• Fever

Persons with twisted bowel also experience fever that rises to about 99 degrees Fahrenheit.

• Changes in the bowel movement

When one is suffering from twisted bowel, the person will experience changes in the bowel movement, as well as suffering from a symptom known as constipation or diarrhea.

• Vomiting

This may be experienced side by side with nausea. The person may experience bile vomiting or non-bile vomiting as the area in the twisted bowel is blocked, making food to regurgitate its way back up.

Lack of appetite – Due to the fact that there is twisted bowel, the person has a tendency to lose his or her appetite.

Malnutrition – When a person has twisted bowel, there will be blockage of food to pass, which can result in malnutrition since food, which is the source of nutrition, can no longer pass and be absorbed by the body.

Twisted Bowel Causes

There is still no clarity as to why twisted bowels occur in some persons. Research shows that the intestines fold upon itself, which results in twisted bowel. However, it can manage to untwist on its own without any medical interventions.

There are actually two etiological reasons for twisted bowel, which are primary and secondary. Primary causes deals with the motility of the gut and its diet. While the secondary etiological reason deals with the aggravation of the twisted bowel due to underlying disease conditions, despite the absence of any abnormalities in the anatomic region. Other causes of twisted bowel are as follows:

• Megacolon
• Diaphragmatic hernia
• Stenosis or atresia
• Meconium ileus
• Cystic fibrosis
• Hirschsprung disease
• Intussusceptions
• Intestinal pseudo obstruction
• Meckel diverticulum
• Colonic volvulus

Twisted Bowel Treatment

Persons with twisted bowel syndrome are given the following options with regards to treatment. Such treatments are suggested:

• Diet Modification

In preventing constipation, there is a need to modify the diet from unhealthy to healthy diet and consuming lots of liquids, such as water. The diet should also be rich in fiber.

• Colon Cleansing

It is otherwise known as colon therapy, colonic irrigation and colon hydrotherapy, which is to remove toxins, like feces, from the intestinal tract and the colon. This may done a few times in a year depending on the warrant of the disease condition.

• Exercise

It is suggested for persons with twisted bowel to have a regular exercise routine. The benefit of having an exercise routine is good for the digestive system as it will reduce the twisted bowel symptoms. In addition to that, it stimulates the flow of blood in the abdominal region by relieving pain and other problems in the gastrointestinal region.

Twisted Bowel Surgery

If for instance, the person with twisted bowel has a very severe form of the disease condition; surgical treatment is the best option. It is through surgery that the bowel is straightened up so that it will return to its normal state. However, if the condition is so severe and surgically straightening the twisted bowel will not give any relief, then excising the affected bowel may be a good treatment.