Q: I am a 37 years old man. I am a teetotaller. Since birth I have been living in Chennai (coastal area)- where the climate is pretty warm; the night temperature is min 22 degree Celsius. When I shifted to Delhi I developed swelling and pain in my right big toe joint during winters. I was examined by an orthopaedic doctor who suspected a gout attack. X-ray and blood tests ruled out gout and I was given pain killers and was asked to wear woollen socks and the swelling and pain reduced in a week's time. After nearly one and a half years I was transferred back to Chennai. Last year suddenly my right shoulder froze and I was unable to move my right hand and was in severe pain. I then went to an orthopaedic doctor who took an X-ray which ruled out any dislocation or fracture. He diagnosed the problem as Periarthritis attack and I was given Dolonex-DT injection and tablets for a week. My right hand was also put on an arm sling to prevent frequent movement. I recovered from that also. For the past 4 months I am having a pain in the left index finger joint. I visited the same orthopaedician who then advised me to take a blood test to rule out diabetes and to check rheumatoid factor. Blood test results were normal and I was advised pain killers. But I have no relief. I have now come to Malaysia on a project and I will be here for next 3 months. Now from last week I am having pain in the right hand index finger joint. Please let me know whether I am developing any rheumatoid arthritis problem or osteoporosis. I also suffer from cervical spondylitis and was advised traction. I underwent traction for a week after which my neck pain greatly reduced and I was advised to do few neck exercises which I keep doing regularly. I have also avoided using pillows during sleep. Is this pain related to this cervical spondylitis? If so, what should I do to avoid further aggravation? I go on a walk on weekends. When I do brisk walking I develop pain in my left calf muscle and when I reduce the speed the pain gradually reduces. I do not feel any chest pain. When I had neck pain due to cervical spondylosis I had drilling pain in my left hand with partial numbness in little finger in the left hand. Do advise a neck collar support. If so should I go for a soft or hard one and how to use it?

A:I am glad you have taken your problem seriously. Medically, I would say you have localised cervical facet joint restriction and the nerve root involvement is of C6 C7 AND C8 which give you the pain in the index and little finger. You have done the right thing by taking traction and exercises. I suggest: 1. Continue with the neck exercises regularly. 2. Follow the ergonomic principles at work and rest. 3. Avoid shaving with your neck extended. 4. Do not watch T.V. while lying down. 5. Do not carry weights. 6. While driving use your mirror to reverse the car. Adjust your seat height so that you do not need to strain your neck while driving. 7. While using the computer too sit at the right height so that you do not strain your eyes and neck. 8. Take frequent breaks at work. 9. I would not suggest a cervical collar. If it is very painful, keep a soft cervical collar to use it while driving. Basically, a collar will make you exert your neck a little more as you will comfortable and your muscles are not ready to take the strain and would aggravate your condition. So, I usually suggest exercises, rest, postural advice, and gradual getting back to routine. 10. It should take you 4-6 weeks to get back to normal and by then the ergonomic principles and exercises should become a part of your daily routine and should be followed.