Bell's Palsy: Cause, Symptoms, and Treatment

Bell's palsy is a type of facial paralysis that involve the cranial nerve VII (Facial nerve) resulting in loss of control of facial muscles on the affected side or ,rarely, both sides resulting in total facial paralysis. The paralysis is of the infranuclear/lower motor neuron type. The nerve that controls muscles on one side of the face damaged by inflammation or compression. This facial condition is common to occur in people between 15 and 60 years of age, but people outside this age group can also have Bell's palsy. They can affect men and women equally. Facial nerve
Facial nerve's nuclei are from the brainstem. Inflammation of the facial nerve within its bony canal (fallopian canal) will block in transmitting neural signals or even damage the nerve. The interruption in the messages the brain sends to the facial muscles results in facial weakness or paralysis. Because of that interruption, one may lose the ability to control over eye blinking, closing of the eyes, frowning, raising eyebrows, smiling, salivation, and lacrimation (production of tears). Facial nerve also supply the taste sensation in the anterior two-thirds of the tongue, via the chorda tympani nerve. Again, damage to this nerve will affect the taste sensation in the anterior two-third of the tongue on the affected side. Additionally, the facial nerve carries nerve impulses to the lacrimal glands, the saliva glands, and the muscles of a small bone in the middle of the ear called the stapes.


Causes


Like many other diseases, the exact cause of Bell's palsy is unknown. Studies suggest that this medical condition could be triggered by:

• Herpes Simplex that causes cold sores and genital herpes.
• Herpes zoster virus that causes chickenpox and shingles. They are less common cause of Bell's palsy compared to herpes simplex.
• Epstein-Barr virus that causes mononshingles.
• Brain tumors. An abnormal tissue growth.
• Meningitis that causes meninges inflammation.
• Sarcoidosis that causes organ inflammation.
• HIV that attack the immune system.
• Stroke.
• Diabetes mellitus.
• Ramsay Hunt syndrome from varicella-zoster virus.
• Lyme disease. A bacterial infection caused by ticks.
• Head trauma from an accident.
• An accident from surgery.
• Congenital facial palsy.

Symptoms Symptoms can vary from mild to severe and typically come on over 48 hours. They usually appear abruptly, and you will just notice drooping of your face on the affected side or when you have difficulty eating or drinking. In most cases of Bell's palsy, improvement seen within two to three weeks and full recovery expected within nine months. Common symptoms include:

• Headache.
• Sudden weakness or total paralysis of the facial muscles that causes your face to droop
• Drooping of the eyelid which causes difficulty in closing the eyelid.
• Drooling from the mouth on the affected side.
• Loss of ability to taste.
• Difficulty in eating and drinking.
• Inability to make facial expressions.
• Impaired speech.
• Pain around the ear on the affected side.
• Dry eye from inability to blink the eye.
• Increased tear production.
• Increased sensitivity to sound (hyperacusis).
• Numbness on the affected side of the face.

Risk factors

• More likely to occur in pregnant women than in nonpregnant women.
• More likely to occur in diabetic people.
• Familial inheritance.
• Recent upper respiratory tract infection.
• Viral infection that results in swelling.

Differential diagnosis

Here are some medical conditions that produce facial paralysis and are mistaken as Bell's palsy.

• Stroke. They are accompanied by weakness in the arms and legs. Also has control in the upper part of the face, like wrinkling of the forehead.
• Infection with herpes zoster virus. Presence of small blisters on the external ear and hearing disturbance.
• Lyme disease, caused by ticks, produce facial paralysis.

Diagnosis

There is no routine laboratory or imaging tests required to make the diagnosis of Bell's palsy. Diagnosis is usually done by eliminating the other reasonable possibilities.

• A physical examination conducted by your doctor to include all questions about the symptoms.
• A neurologic examination to check the facial nerve integrity.
• Imaging test like CT scan or MRI to check the facial nerve.
• Blood test can check the presence of bacterial or viral infection.
• Electromyography (EMG) can confirm the presence of nerve damage and to determine the severity and extent of nerve involvement.
• The degree of nerve damage assessment, using the House-Brackmann Facial Nerve Grading System.

Treatment

Usually, the condition gets better by itself with normal or near-normal function. Signs of improvement will show within two weeks, with complete recovery within six to nine months.

Corticosteroids medicines, such prednisone, have been found to improve outcomes and are thus recommended. They work best if taken within 3 days after symptoms start. Corticosteroid works on reducing inflammation.

Antiviral medications, when added in steroids, is of a small added benefit in the treatment. One review found antivirals alone are ineffective in improving recovery from Bell's palsy. They are usually prescribed if Bell's palsy caused by a virus.

Mild pain relieved by some over-the-counter pain medications, such as ibuprofen or acetaminophen.

Dry eye protection from drying up by using eye drops or an eye patch.

Surgery is generally not recommended, but may improve the outcome for those who have not recovered from severe facial nerve paralysis.

Physical therapy

• A series of facial exercises will promote muscle re-education. These exercises will strengthen your facial muscles and promote faster recovery.
• Applying heat can help reduce pain. An infrared radiation applied to the affected side of the face or a warm, moist towel placed over the face will help relieve pain.
• Electrical stimulation to stimulate the facial nerve, but there is no concrete evidence to support its efficiency.
• Soft tissue mobilization or massaging your face will promote relaxation and increase circulation.

Promote mouth care. Food may stick in the mouth that may cause gum problems or tooth decay. Brushing or using dental floss will help prevent these problems.

Swallowing problems, prevention by eating slowly and chewing your food well. A soft diet will also help you.

Acupuncture is given, but the efficiency of using this alternative medicine remains unknown.



Prognosis

The prognosis is generally very good. Most people with Bell's palsy start to regain normal facial function in as early as 3 weeks, even without treatment. Studies show complete recovery achieved in at least 1 year.



Complications

Most people recover from Bell's palsy without complication. However, complications are possible for severe cases of Bell's palsy. These may include:

• Chronic loss of taste (ageusia).
• Chronic facial spasm.
• Facial pain.
• Persistent facial weakness.
• Reduced sense of taste.
• Incomplete or faulty regeneration of facial nerve, such as synkinesis.
• Difficulties in speech, eating, and drinking.
• Twitching of facial muscles.
• Eye problems, such as corneal infections

Shin Splints: Causes, Symptoms, and Treatment

Shin Splints, medically known as Medial Tibial Stress Syndrome, refers to a pain along  long bone in the lower leg (Tibia). This condition is a physical activity-related problem that is usually common to athletes(runners), dancers, and military recruits. We often experience this pain, even on a simple activity such as morning jog, brisk walking, or even catching a bus to take a ride to work.

Causes:

Shin splints develop after a vigorous, repetitive physical activity, compromising the bones, muscles, and tendons in the lower leg. As a result of overworked, pain and inflammation will soon be experienced. This condition is common to anyone who just started an activity or a sudden change in the level of activity. A sudden change and/or increase in the frequency, duration, and intensity of an activity will likely cause shin splints. 

Symptoms:

The most common complaint is a dull, throbbing pain and tenderness along the border of the tibia. Pain usually occurs during and after exercise. Mild swelling will also occur in the lower leg.

Risk Factors:

Anyone will likely have shin splints if:

• You are wearing an improper or a worn-out shoes during an activity or exercise.
• You have some foot deformities, such as flat feet and high arches.
• You are a new participant in a sports activity.
• You suddenly increase the frequency, duration, or intensity of an activity.
• You are into military training.

Diagnosis:

We often do home remedies to manage shin splints. If the symptoms continue to persist, it would be better to see your doctor. 

The doctor usually does physical examination and patient interview on symptoms and medical history. X-rays will also be done to rule out other problems that cause the pain, such as stress fractures.




Treatment:

We often do home remedies to manage shin splints. If the symptoms continue to persist, it would be better to see your doctor. 

• Rest. If would be best if you take some time off from an activity or exercise that causes the pain. This will promote faster recovery. Instead, try to engage in low-impact activities that don't give too much stress on your lower leg such as swimming.
• Ice. Never apply ice directly over the skin. Wrap around the ice with layers of towelling.
• Apply icing for 20 minutes, four to six times a day for several days. This will help in reducing pain and swelling.
• Ultrasound, iontophoresis, phonophoresis, and electrical stimulation  can help reduce pain and inflammation.
• Elastic compression bandage will help against swelling.
• Take some over-the-counter pain reliever to reduce pain and swelling, such ibuprofen, Aspirin, Naproxen, or Acetaminophen.
• Range of motion and flexibility exercises to the lower leg muscles helps a lot. See your physical therapist to help you with pain management and your return to sports. Here are some exercises you can do at home.
• Wear shoes with good cushioning to reduce stress on the lower leg.
• Orthotic shoe insert provides foot alignment and stability of your foot and ankle.
• Surgical treatment done in very severe cases. 

Here are some exercises you can do at home.

Toe Curls.

• Standing. Spread the towel in front of you. Place your one foot at the edge of the towel. Slowly bring or pull the towel towards you using your toes. Repeat this procedure with the other foot.

Calf Stretching

• Long sitting on the floor. Loop a towel or resistance band at the bottom of your one foot. Gently pull them towards you into dorsiflexion. Hold it for a few seconds and repeat three times on each leg. Do the same stretching on the other leg.

Shin Resistance Exercise

• Sitting on the floor. Loop a resistance band around the front of your one foot while the other end of the resistance band looped around a stationary object like a table. Dorsiflex the foot against the resistance band. Do this with 10 to 15 reps. Progress with heavier band later on.

Prevention:

• Start a new exercise or activity slowly. Gradually increase the frequency, duration, and intensity as you go along with your exercise or activity. Don't rush.
• Start an exercise with warm up and light stretching to prepare your muscles.
• Stop an exercise the moment you feel pain in your shinbone.
• Try to develop strength in your lower leg before going into high-impact activities.
• Cross training is effective in improving fitness and performance. Incorporate low-impact activities such as jogging and swimming, with your main activity or sports.
• Avoid overdoing an exercise or an activity.
• Wear the right shoes that give comfort and safety.

Frozen Shoulder: Causes, Symptoms, Treatments - All About Physical Therapy

Frozen shoulder, otherwise known as adhesive capsulitis, is a condition in the shoulder characterized by stiffness, pain, and limitation of motion. It is typical in frozen shoulder to involve only one, although, few cases affect both shoulders. 

Causes:

Frozen shoulder usually happen after a recent injury or after a medical procedure or from, a medical condition such as stroke, diabetes, or mastectomy. The inability of moving the shoulder into its full range of motion because of pain results in stiffness of the tissues around the joint. Later on, shoulder movement becomes more difficult and painful.

Symptoms:

This shoulder condition usually develops gradually, becomes worse over time and then slowly resolve over the course of 1 year up to 3 years. Persistent pain and limitation of motion from joint stiffness are the most obvious symptoms seen in people with frozen shoulder. This condition develops in 3 stages and each stage can last up to several months.

Freezing Stage 

• The painful stage. More and more pain is experienced when you do any movement of the shoulder. Limitation of motion starts to become limited.

Frozen Stage

• Pain begins to diminish at this stage, but the stiffness still remain making shoulder movement difficult affecting daily activities.

Thawing Stage

• Shoulder movement slowly improves at this stage.

Risk Factors:

• Age. Common to people aged 40 to 70 years
• Gender.More often to women than in men
• After surgical procedure 
• Recent injury such as fracture
• Medical problems such as stroke, hyperthyroidism, hypothyroidism, diabetes, Parkinson's disease, or cardiac disease

Diagnosis and Test:

• Medical History to include a detailed description of the symptoms, present and past medical conditions, and medications and/or supplements taken.
• Physical Examination to include testing the range of motion of both shoulder joints. The affected shoulder will show limited motion, both active and passive.
• Imaging Test
• X-rays, which shows a clear image of the bone, help find other problems in the shoulder.
• Ultrasound and MRI give a better view of the soft tissues to rule out other problems.

Treatment

The aim of treatment for frozen shoulder is to ease pain and keep the mobility and flexibility of the shoulder. Here are some of the recommended treatment approaches of frozen shoulder.

• Medications. Over the counter pain-relieving and antiinflammatory drugs, such as aspirin and ibuprofen to cut pain and swelling.
• Heat application followed by gentle stretching to increase range of motion.
• Range of motion exercises, given by a physical therapist, to recover shoulder joint mobility.
• Ice and corticosteroid injection will help reduce pain and swelling.
• Transcutaneous Electrical Nerve Stimulation (TENS) give pain relief by blocking pain fiber that carries pain impulses.
• Joint Distention. A sterile water is injected into a joint to stretch the tissue so that movement is easier
• Shoulder Manipulation under anesthesia. You will receive general anesthesia and the doctor do manipulation to break adhesion.
• Shoulder Arthroscopy. This procedure is rarely done. The doctor uses a lighted, tubular instrument inserted into a small incision around the joint to remove scar tissue and adhesions.