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Physiotherapist Mahfuj Alam, Satmasjid Road, Dhanmondi, Dhaka (2026)

06/01/2026

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05/01/2026

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I got over 1,200 reactions on one of my posts last week! Thanks everyone for your support! 🎉

05/01/2026

A supraspinatus tendon rupture is a at the shoulder, causing pain, weakness, and limited movement, often from trauma (falls, heavy lifting) or age-related degeneration (overuse, bone spurs). Treatment ranges from physical therapy and injections for partial tears to surgery for full tears, aiming to restore function, though smoking and certain health factors can affect healing.

🔷 Causes:

1️⃣ Trauma: Sudden injuries like falling on an outstretched arm or lifting something too heavy.

2️⃣ Overuse: Repetitive overhead motions in sports (tennis, swimming) or work.

3️⃣ Degeneration: Wear and tear over time, often linked to age, bone spurs, smoking, and genetics.

🔷 Symptoms:

1️⃣ Pain, especially when lifting or lowering your arm, or lying on the affected side.

2️⃣ Weakness in the shoulder.

3️⃣ Stiffness or a crackling sensation (crepitus).

4️⃣ Immediate intense pain and weakness with acute tears, or gradual pain with degenerative tears.

🔷 Treatment Options:

💠 Conservative (Non-Surgical): Physical therapy, anti-inflammatory drugs, corticosteroid injections.

💠 Surgical: Arthroscopic or open repair for full-thickness tears or severe partial tears, often requiring advanced techniques.

🔷 Recovery & Factors

1️⃣ Partial vs. Full: Partial tears can sometimes heal with conservative care, while full tears often need surgery.

2️⃣ Risk Factors: Smoking can impair healing, so quitting is recommended.

3️⃣ Prognosis: Depends on tear size, age, activity level, and overall health, but many recover well with proper treatment.

05/01/2026

🔊 CERVICOGENIC SOMATIC TINNITUS (CST)

When neck dysfunction — not the ear — drives ringing, buzzing, and noise in the brain

Many people with tinnitus hear the same frustrating words:

> “Your hearing test is normal.”

Yet the ringing, buzzing, hissing, pressure, or electrical noise never stops.

If this sounds familiar, there is an important and often overlooked explanation supported by growing research:

👉 Your tinnitus may not be coming from your ears at all.
👉 It may be coming from your neck and brainstem integration pathways.

This condition is called Cervicogenic Somatic Tinnitus (CST) — and a recent 2024 review explains exactly how cervical spine dysfunction can drive tinnitus even when hearing tests are normal.

At The Functional Neurology Center (FNC), this concept is central to how we evaluate and treat complex tinnitus cases.

---

🧠 WHAT IS CERVICOGENIC SOMATIC TINNITUS?

CST is a subtype of somatic (body-driven) tinnitus where abnormal sensory input from the cervical spine, neck muscles, joints, and connective tissue alters how the brain processes sound.

This is very different from classic tinnitus caused by:
• hearing loss
• noise exposure
• inner-ear damage

In CST:
✔ the ear may be structurally intact
✔ hearing tests may be normal
✔ the issue lies in brainstem sensory integration, not the ear itself

---

🔁 WHY THE NECK CAN CHANGE WHAT YOU HEAR

The brain does not process hearing in isolation.

Deep in the brainstem are powerful integration hubs where multiple systems converge:
• auditory input
• cervical proprioception (neck position sense)
• trigeminal and pain pathways
• vestibular (balance) signals

One of the most important hubs is the dorsal cochlear nucleus.

When abnormal signals come from the neck — such as:
• chronic muscle tension
• joint restriction or instability
• whiplash injury
• disc degeneration
• postural overload
• connective tissue stress

They can alter firing patterns in auditory brainstem neurons, causing the brain to generate sound internally.

🔔 The tinnitus is real —
🧠 but the driver is sensory mismatch, not ear damage.

---

⚠️ WHY CST IS COMMON AFTER CONCUSSION & WHIPLASH

CST is frequently seen after:
• concussions
• whiplash injuries
• car accidents or falls
• chronic desk or tech posture
• hypermobility or connective tissue disorders

These events disrupt:
• cervical joint proprioception
• deep neck stabilizers
• autonomic regulation
• brainstem sensory filtering

Over time, the nervous system becomes sensitized, amplifying noise and internal signals.

This is why patients often say:
• “My neck hurts and my tinnitus flares together.”
• “When my neck is tight, the ringing is worse.”
• “Turning my head changes the sound.”

These are not coincidences.
They are diagnostic clues.

---

🔍 A KEY SIGN: SOMATIC MODULATION

One hallmark of CST is somatic modulation — tinnitus that changes with movement or posture.

Symptoms may shift when you:
• rotate or side-bend your neck
• look up or down for prolonged periods
• hold sustained posture
• clench your jaw
• press on neck or shoulder trigger points

Not everyone has dramatic modulation — but when present, it strongly suggests a neck-driven component.

---

🧠 WHY CST IS NOT “ALL IN YOUR HEAD”

CST is not psychological.

It is a neuroplasticity problem, similar to chronic pain or dizziness.

A common pattern:
1️⃣ Neck injury or chronic strain alters sensory input
2️⃣ Brainstem adapts
3️⃣ Auditory gain increases
4️⃣ Tinnitus becomes self-sustaining

Even when imaging looks “normal,” network behavior is not.

That’s why some patients improve partially but then plateau — the system must be retrained, not just rested.

---

🩺 WHY PROPER EVALUATION MATTERS

Before labeling tinnitus as CST, serious causes must be ruled out:
• sudden hearing loss
• inner-ear disease
• vascular causes
• neurological red flags

At FNC, we use a layered evaluation to assess:
• auditory contribution
• cervical contribution
• vestibular involvement
• autonomic load
• visual-vestibular-neck integration

CST is often part of a larger neurological picture.

---

🔧 WHY FUNCTIONAL NEUROLOGY FITS CST

CST lives at the intersection of:
• cervical spine
• brainstem
• vestibular system
• autonomic regulation
• sensory integration

That is exactly where functional neurology operates.

We don’t just ask:
❌ “What’s the diagnosis?”

We ask:
✅ “Which inputs are overwhelming the system?”
✅ “Which outputs are being amplified?”
✅ “Where is sensory integration breaking down?”

---

🧠 HOW CST IS COMMONLY ADDRESSED

There is no single cure for tinnitus.

But research and clinical experience show that neck-driven tinnitus responds best to multimodal care, including:
• cervical mobility and stability
• deep neck proprioception
• vestibular-ocular-cervical reflexes
• autonomic regulation
• sensory gain control

The goal is to:
✔ clean up neck input
✔ calm the brainstem
✔ reduce sensory “noise”
✔ restore integration

When the nervous system feels safer and more organized, tinnitus often becomes quieter, less reactive, and less intrusive.

---

🧪 A SIMPLE SELF-CHECK (NOT A DIAGNOSIS)

You may have a cervicogenic component if:
✔ tinnitus followed neck injury or concussion
✔ neck pain and tinnitus flare together
✔ posture affects symptoms
✔ head movement changes the sound
✔ hearing tests don’t explain severity
✔ dizziness, pressure, headaches, or visual strain coexist

---

🌱 THE FNC MESSAGE

CST does not mean tinnitus is permanent.

It means:
• the driver may be outside the ear
• the brain is adaptable
• the right inputs matter

If you’ve been told:

> “You’ll just have to live with it”

We encourage a deeper look.

🧠 The brain is plastic.
🧠 The neck matters.
🧠 Integration changes perception.

📚 Reference
PMC11346753/

04/01/2026

Baker’s Cyst
(Quick Review ) (Clinical Advisor 2026)

Baker cyst, also known as a popliteal synovial cyst, is a fluid-filled swelling that develops in the popliteal fossa (the hollow space at the back of the knee). It is typically caused by the protrusion of the semimembranosus bursa due to underlying knee joint issues.

🔍 Clinical Presentation
Most Baker cysts are found incidentally and are asymptomatic. However, when symptoms occur, they often include:

Physical Signs: Visible swelling or prominence in the back of the knee, leg edema, and decreased range of motion.

Foucher Sign: A classic clinical finding where the cyst becomes firm when the knee is fully extended and softens when the knee is bent (flexed).

Pain & Sensation: Discomfort in the popliteal space, especially during prolonged standing or hyperflexion. In some cases, it can cause "shooting" (lancinating) pains down the back of the leg.

🛠️ Causes and Mechanism
The cyst is essentially a "safety valve" for the knee. When the knee joint produces too much synovial fluid (often due to inflammation or injury), the fluid is pushed into the bursa at the back of the joint.

Common Underlying Conditions (Adults):

Osteoarthritis (most common)
Meniscal tears
Rheumatoid Arthritis (RA)
Gout or Pseudogout

Note: In children, these cysts are usually "primary," meaning they arise on their own without an underlying joint injury. In adults, they are almost always "secondary" to another pathology.

📋 Diagnosis & Differential
The most critical part of the diagnosis is distinguishing a Baker cyst from more serious conditions, particularly Deep Vein Thrombosis (DVT). This is often called "pseudothrombophlebitis" because a ruptured cyst can mimic the pain and swelling of a blood pull.

Imaging Options:
Ultrasound: The first-line tool. It is cost-effective and can easily distinguish a fluid-filled cyst from a solid tumor or a blood clot (DVT).

MRI: Used if the doctor suspects internal damage (like a meniscus tear) or if surgery is being planned.

💊 Treatment Options
Treatment is usually focused on the underlying cause of the fluid buildup rather than the cyst itself.

1. Conservative Management
Observation: Asymptomatic cysts require no treatment.

RICE: Rest, Ice, Compression, and Elevation.

Medication: NSAIDs (like ibuprofen) to reduce inflammation.

2. Procedures
Aspiration/Injection: A doctor may use ultrasound to guide a needle into the cyst to drain the fluid and inject a corticosteroid to reduce swelling.

Surgery: If the cyst is persistent and painful, arthroscopic surgery may be performed to repair a meniscal tear or remove the cyst sac.

⚠️ Potential Complications
Rupture: The cyst can "pop," causing fluid to leak into the calf muscle, leading to intense pain and redness.

Compression: A large cyst can press on the popliteal artery or nerves, leading to numbness or compartment syndrome

04/01/2026

🧠🦴 CERVICAL MYELOPATHY
A Serious Neck Condition You Shouldn’t Ignore

Cervical myelopathy is a condition where the spinal cord is compressed in the neck (cervical spine).
It is one of the most serious causes of neck-related neurological problems and often gets missed in early stages.

🔍 What Causes Cervical Myelopathy?

✔️ Age-related disc degeneration
✔️ Disc bulge or herniation
✔️ Cervical spondylosis (arthritis of the neck)
✔️ Thickened ligaments
✔️ Narrow spinal canal
✔️ Previous neck injury or trauma

All of these can reduce space for the spinal cord, leading to compression.

⚠️ Common Symptoms

🖐️ Hand Symptoms
• Weak grip
• Clumsiness (dropping objects)
• Difficulty with fine movements (buttons, writing)

🚶‍♂️ Walking & Balance
• Unsteady gait
• Frequent stumbling
• Feeling of heaviness in legs

🧠 Neck & Body
• Neck stiffness or pain
• Numbness or tingling in arms or legs
• Electric shock-like sensation while bending the neck (Lhermitte’s sign)

🚨 In advanced cases:
• Bowel or bladder problems

❗ Why Cervical Myelopathy Is Serious

👉 Unlike simple neck pain, spinal cord compression can cause permanent damage
👉 Symptoms usually progress over time
👉 Early diagnosis is crucial to prevent disability

🧪 How Is It Diagnosed?

✔️ Clinical neurological examination
✔️ MRI of the cervical spine (most important test)
✔️ Sometimes X-ray or CT scan

🛠️ Treatment Options

🟢 Early / Mild Cases
• Careful monitoring
• Physiotherapy (only under guidance)
• Posture correction
• Activity modification

🔴 Moderate to Severe Cases
• Surgical decompression may be required
• Goal: relieve pressure on the spinal cord and prevent further damage

⚠️ Delay in treatment can lead to irreversible weakness

Early action can protect function, mobility, and quality of life.

02/01/2026

.

The Vital Map of the Neck: Where the Pulse and Life Meet

This image reveals the deep anatomy of the human neck, displaying with impressive precision the network of arteries, veins, and nerves that sustain essential life functions. What normally remains hidden beneath the skin is shown here with a clarity that invites awe.
The man, with a serene face and closed eyes, contrasts with the complex network unfolding in his neck. The main vessels immediately draw attention:

⚫ Common carotid artery and its branches, rising firmly toward the head to supply precious oxygenated blood to the brain, face, and surrounding tissues.

⚫ Internal jugular vein, the major return channel that carries deoxygenated blood back to the heart.

Both vessels are essential pathways: without their constant flow, the brain—center of every thought, emotion, and movement—would simply cease to function.

Surrounding them spreads a landscape of delicate nerves, pale fibers that carry motor and sensory signals with remarkable precision. Among them stand out branches of the vagus nerve, cervical nerves, and branches of the cervical plexus, each with vital roles in speech, breathing, posture, and neck sensation.

The deep muscles of the neck, visible in reddish and beige tones, support the head and allow movements such as rotation, tilting, and lifting the chin. Their firm and symmetrical presence demonstrates the silent strength this region exerts every day.

The image merges science and humanity: the inner body exposed, working tirelessly, and a calm face unaware of all this constant activity. It is a powerful reminder of the precision with which our organism manages life.

The neck is not just an anatomical area; it is a vital corridor, a bridge between the heart and the brain, between what we feel and what we think.

Clarifying Note:
This content is for informational and academic purposes only. It does not replace direct clinical evaluation nor is it intended as a self-diagnosis guide. If you experience any signs or symptoms, seek qualified medical attention.

01/01/2026

Neurologic Examination of the upper and lower extremities 🧠☤

A neurologic exam of the upper and lower extremities assesses motor function (strength, tone, coordination), sensation (light touch, pain, vibration, proprioception), and reflexes, using observation (gait, posture, muscle wasting, fasciculations) and specific maneuvers like pronator drift (upper limb) or Romberg's test (lower limb/balance) to check for upper (UMN) or lower (LMN) motor neuron issues, helping localize neurological lesions systemhyporeflexia .

🔷 Upper Extremity Examination:

1️⃣ Inspection: Look for muscle wasting, asymmetry, abnormal posture (e.g., clawing), or involuntary movements (tremors, fasciculations).
2️⃣ Tone: Ask the patient to relax; move their arm passively at the shoulder, elbow, and wrist, feeling for rigidity (UMN) or floppiness (LMN).
3️⃣ Power: Test strength (e.g., grip, shoulder abduction) against resistance, comparing sides.
4️⃣ Reflexes: Test deep tendon reflexes (biceps, triceps, supinator/brachioradialis) with a hammer, checking for hypo/hyperreflexia.
5️⃣ Sensation: Test light touch, sharp/dull (pain), vibration (tuning fork), and proprioception (joint position sense) across dermatomes.
6️⃣ Coordination: Finger-to-nose test, rapid alternating movements (e.g., hand flips).
7️⃣ Special Tests: Pronator Drift: Patient holds arms out, palms up; look for involuntary pronation (UMN sign).

🔷 Lower Extremity Examination & Gait :

1️⃣ Gait & Observation: Observe walking (normal, heel walking, toe walking, tandem walk) for foot-drop, asymmetry, and arm swing. Check for posture.
2️⃣ Tone: Move legs passively at the hip, knee, and ankle, checking for spasticity or rigidity.
3️⃣ Power: Test strength (hip flexion, knee extension/flexion, ankle dorsiflexion/plantarflexion) against resistance.
4️⃣ Reflexes: Test deep tendon reflexes (knee jerk, ankle jerk) with a hammer, also checking for clonus if indicated.
5️⃣ Sensation: Test light touch, pain, vibration, and proprioception on the legs and feet.
6️⃣ Coordination: Finger-to-nose (if patient can sit), heel-to-shin.
7️⃣ Special Tests: Romberg's Test: Stand with feet together, eyes closed; assess balance (positive in proprioceptive/vestibular issues).

🔷 Key Findings to Note:

💠 UMN Lesions: Spasticity, hyperreflexia, positive Babinski sign (not detailed but key), pronator drift.

💠 LMN Lesions: Muscle wasting, fasciculations, hypotonia, hyporeflexia.

31/12/2025

:
Where Precision Becomes Movement.

This image reveals, in extraordinary detail, the deep anatomy of the hand and wrist—one of the most complex and precise structures of the human body. Beneath the skin unfolds a true work of biological engineering designed to provide strength, delicacy, and absolute control.

The tendons can be clearly seen—long and firm—acting like living cables that connect the forearm muscles to the fingers. Thanks to them, you can make a fist, write, hold a fragile object, or apply force when necessary. Each tendon follows an exact path, leaving no room for error.

Among these whitish cords appear the intrinsic muscles of the hand, responsible for fine and precise movements. They enable deeply human gestures such as pointing, caressing, drawing, and performing coordinated actions that distinguish the human hand from any other limb in the animal kingdom.

An organized network of blood vessels and nerves is also visible, responsible for transporting precious blood and carrying sensory information and motor commands. Through this network you can feel temperature, texture, pain, and pressure, and respond immediately to your surroundings.

The wrist acts as a true transition point: delicate structures converge there and must glide smoothly within very narrow spaces. Any alteration in this area can significantly affect the function of the entire hand, underscoring its clinical importance.

To look at this image is to understand that the hand is not just a tool.
It is an extension of thought, an interpreter of intention, and a direct expression of the human mind.
Every movement you take for granted is the result of this complex and silent anatomical symphony.

Disclaimer: This content is for informational and academic purposes only. It does not replace direct clinical evaluation nor is it intended as a self-diagnosis guide. If you experience any signs or symptoms, seek qualified medical care.

31/12/2025

is a key diagnostic method in physical exams where a healthcare provider uses their hands and fingers to feel the body to assess size, shape, consistency, texture, tenderness, and location of organs or masses, helping detect abnormalities like swelling, pulsations, temperature changes, and masses to aid in diagnosis. Different parts of the hand detect different things, from skin texture (fingertips) to temperature (back of hand) or vibrations (side of hand). It's a crucial tactile skill, often used with other techniques like inspection, auscultation (listening), and percussion (tapping) to get a complete picture of a patient's health.

💠 What it involves

1️⃣ Fingertips: Detecting fine details like texture, pulsations, or subtle swelling.

2️⃣ Finger and thumb: Grasping to assess size, shape, and consistency of a mass or organ.

3️⃣ Back of hands/fingers: Checking skin temperature (warm/cool).

4️⃣ Side of hand (pinky side): Feeling for vibrations.

💠 What it helps find

1️⃣ Swelling, lumps, or masses.

2️⃣ Tenderness or areas of pain.

3️⃣ Changes in temperature or moisture.

4️⃣ Size, shape, and location of organs (like the liver or spleen).

5️⃣ Muscle tone and joint stability.

💠 Importance

1️⃣ It's a fundamental diagnostic tool, allowing providers to "see" beneath the surface.

2️⃣ It helps guide further tests and treatment.

3️⃣ Despite technology, it provides valuable information about a patient's condition, from cancer screening to identifying inflammation.

゚viralシ

31/12/2025

Shout out to my newest followers! Excited to have you onboard! Vũ Minh, คน ไม่อยากป่วย, Honesto Encapas, Prasanth Natarajan ThiruAyiroor, Shaik Irfaan, Adel Rashad, Sofia Araya, Farhad Uzzaman, Asma Abdelaal, Mohamed Salah Abo Hamza, Folkuyan Olena, Thúy Hằng Phạm, Faiza Gahwagi, Mardul Alva, Hans Fizz Jaf, Jun Kurokawa, Naz Zia, Dennise Vivian Frias Rocha, Lando Marco Simão, Lala Taddese Tuli, Basem El-Esway, Manjil Alam Mondal, Muhammad Sarwar, Khaled Alfahd, Samiya Tlm, Parch Chaudhary, Γεωργία Αγγελάκου, Nianas Waba, Md Farhad Hossen, Md Wali Ullah, Farhad Hossain Farhad Hossain, Akshay Gaikwad, Ashadul Al Galif, Shameka Browne - Valadez, AMd Shohel Rana, Gheorghe Tanasov, Sohel Pasha, VenkataChalapathi Mamilla, Akmal Aziz, Masum Khan, Rayhan Kabir, Luigi Chianura, সুমন টেলিকম, Sam Dub, MD Jaynal, Naqeebullah Khaksar, Tomasz Janowicz, Dlshad Samad, Tahire Ferizi Sabedini, محمد كنعان

30/12/2025

A supraspinatus tendon rupture is a at the shoulder, causing pain, weakness, and limited movement, often from trauma (falls, heavy lifting) or age-related degeneration (overuse, bone spurs). Treatment ranges from physical therapy and injections for partial tears to surgery for full tears, aiming to restore function, though smoking and certain health factors can affect healing.

🔷 Causes:

1️⃣ Trauma: Sudden injuries like falling on an outstretched arm or lifting something too heavy.

2️⃣ Overuse: Repetitive overhead motions in sports (tennis, swimming) or work.

3️⃣ Degeneration: Wear and tear over time, often linked to age, bone spurs, smoking, and genetics.

🔷 Symptoms:

1️⃣ Pain, especially when lifting or lowering your arm, or lying on the affected side.

2️⃣ Weakness in the shoulder.

3️⃣ Stiffness or a crackling sensation (crepitus).

4️⃣ Immediate intense pain and weakness with acute tears, or gradual pain with degenerative tears.

🔷 Treatment Options:

💠 Conservative (Non-Surgical): Physical therapy, anti-inflammatory drugs, corticosteroid injections.

💠 Surgical: Arthroscopic or open repair for full-thickness tears or severe partial tears, often requiring advanced techniques.

🔷 Recovery & Factors

1️⃣ Partial vs. Full: Partial tears can sometimes heal with conservative care, while full tears often need surgery.

2️⃣ Risk Factors: Smoking can impair healing, so quitting is recommended.

3️⃣ Prognosis: Depends on tear size, age, activity level, and overall health, but many recover well with proper treatment.

Physiotherapist Mahfuj Alam

06/01/2026

05/01/2026

05/01/2026

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