Causes And Recovery Of Nerve Injuries

Nerves are the ones that sense what is happening and passes that information to our brain where it will get processed. They are extremely fragile and can be injured by pressure. A nerve injury will hinder the transmission of information and this can result in devastating effects such as the inability of our body to function properly and even a loss in our sense of touch in that region.

Nerves are essentially the wires that we see in our home. Our body sends electrical pulses as signals to work together and these signals will be passed on as the sense of pain, pressure and temperature.

Degree of injury

Nerve injuries are classified into six different degrees from the first to the sixth.

  1. First-degree nerve injuries are minor and will recover on their own after some time. There will not be any permanent muscle or sensory problems.
  2. Second-degree nerve injuries are also recoverable but as they are slightly more serious, the recovery time is longer.
  3. Third-degree injuries will only yield a partial recovery of nerve function.
  4. From the fourth-degree onwards, recovery of nerve functions is impossible. This is due to the formation of dense scar tissues, which blocks any chances of recovery. There will also be separation of nerves and surgery will be required.

Causes of injuries

Pressure

Pressure is one of the most common causes of nerve injury. When a large enough pressure is placed on the nerve, the nerve may break. Once it breaks, the connection between those parts of the body to the brain is lost and the ability to function is cut off. If the part of the nerve cut off does not involve the severing of the insulation layer, the nerve has the ability to heal on its own after some time. However, if both the nerve and the insulation are damaged, the nerve dies and results in the formation of neuroma.

Surgical treatment

As mentioned above, surgery only works when the insulating layer is still intact. The surgeon will sew both ends of the injured nerve together so that new nerve fibers can grow again and the function can be fully restored.  It will take between three to four weeks for the nerves to start growing post surgery. Nerves grow at an extremely slow rate of 2cm per month. A nerve injury in the fingertips will require a year before the patient is able to regain his feeling.

Symptoms And Treatments For Kienböck’s Disease

Kienböck’s Disease is a medical condition of uncertain etiology. What this means is that the exact cause is unknown. This disease involves the collapse of the lunate bone located is the wrist and is usually unilateral. The blood supply to the lunate will then be hindered and without blood, the bone will die off. This is because blood contains the necessary nutrients and oxygen that the bone cells need to grow, repair and sustain itself. When this supply is cut off, osteonecrosis will occur, leading to painful wrist and the eventual development of arthritis.

Symptoms

Patients who suffer from Kienböck’s Disease have no idea that they have it. This is due to the similarity between it and a normal sprained wrist. There will be pain and swelling will be present at the wrist region. Slowly, the flexibility of the wrist will be reduced and stiffness will start to onset due to the reduced range of motion available. Over time, the strength of the wrist will decrease and it will be difficult to clench the fist together.

Treatment

Despite the advanced medical technological in this era, there is still no complete cure for Kienböck’s Disease. However, there are generally 2 kinds of treatment methods namely the non-surgical ones and the surgical ones. Since there is no cure, the ultimate aim of treatment is simply to relieve the pressure built up on the lunate and allows blood to flow properly.

Non-surgical

Non-surgical treatment is preferred during the initial stages of this disease. Treatment methods include the usage of anti-inflammatory drugs to reduce swelling and pain. Some doctors may also require their patients to use a wrist splint to prevent unwanted movements. In serious cases, a cast may be used instead of a splint. If no noticeable improvements were seen during this period, a progression into a surgical treatment may be on the table.

Surgical

As mentioned above, the main purpose of treatment is to relieve the pressure and reinstate proper blood flow. Revascularisation is a method that is capable of performing that. Revascularisation involves the removal of a bone that has blood vessels attached to it and reattached to the diseased bone. This reattached bone is capable of performing all the tasks that are required. Metal screws may be used to fasten the bone properly while it attaches itself over time.

Each patient will respond differently to the types of treatment administered. Some patients may feel better after a non-surgical treatment while others may require surgical intervention to allow them to get the relief they need.

All About Wrist Arthroscopy

Wrist arthroscopy is a minimally invasive surgical technique performed with the aim of diagnosing and treating existing problems with the wrist. You may be familiar with traditional surgery where the intended area is cut open, treated and stitched back. On the contrary, arthroscopy uses small fiber optic instruments that allows the surgeon to look inside the body and treat it with robotic arms. This will reduce the chance of infection and shorten the recovery time.

Why is it needed?

Following a wrist injury, the wrist may be unable to perform to its full ability. There may be the presence of a clicking sound when you rotate it and swelling will be present. Unlike the rest of the body, the wrist is rather small in comparison. In order to properly assess and treat it, the ligaments, cartilage and bones will need to be observed in detailed.

How is it performed?

A small high definition camera will be fixed to a tiny fiber optic tube by the surgeon. Small incisions will be made at the affected site and the camera will be inserted into the back of the wrist joint. The real time images captured will be projected onto a TV screen where the surgeon is able to see magnified pictures. Different robotic arms will also be inserted through other incisions and they will be controlled by the surgeon who will then repair the injured parts accordingly.

What happens after arthroscopy?

After the surgery, your wrist will be wrapped in a protective bandage and a splint to provided support and prevent unwanted movement. Since the incisions are tiny, they will close up on their own after some time and infection risks are significantly lowered. However, there are still certain risks involved. Despite the reduced risk of infection, 1% of the patients still suffer infection due to various reasons. Some patients also reported numbness which is due to the damage to the nerves. However, this will go away after some time.

Recovery

The next few days following the surgery, the wrist should be kept elevated in order to prevent swelling and blood clot formation. The surgery site should also be kept clean and dry to prevent any infection. Ice may be used to bring down the swelling. Recovery time will differ among patients and one way to shorten it is through the aid of physical therapy sessions. Your doctor will prescribe you simple exercises that can be performed at home in order to help regain the full range of motion and flexibility.

Causes and Symptoms of Flexor Tendon Injuries

Flexor tendon injuries as the name suggest are injuries affecting the tendons. Tendons are thick, elastic fibrous cord like structures that connects the muscles to the bones. The ability for our fingers to bend and flex is due to the flexor muscles. Flexor muscles start from our elbow down to the forearms and finally the tendons which are finally attached to the fingers. Each of our finger has two flexor tendons and that includes the thumb. The usual culprit for a flexor tendon injury is due to a deep cut in the fingers or hands which injures the flexor tendons. In this article, we will look at some of the causes and symptoms of flexor tendon injuries.

Flexor tendon injuries are challenging as they cannot heal without surgical treatment. Unlike other forms of injuries, tendons need to be brought together and stitched back surgically in order for healing to occur. Secondly, careful postoperative management needs to be planned in detail as immobilisation can cause rupture of the tendon. Lastly, the bulkiness of the tendon needs to be reduced but scarring will make it almost impossible.

Causes

Sports activities are the main culprit of flexor tendon injuries. The most popular sports are soccer, rugby and wrestling. In fact, there is a term “jersey finger” that is used by athletes due to their repeated occurrence with jersey wearing activities. Jersey finger occurs when a player is grabbing another player’s jersey and finger and a sudden change in direction is initiated, pulling the tendon off the bone. Other activities include rock climbing which requires a lot of finger strength.

Some medical conditions may also lead to a decrease of strength in the flexor tendons, making them more prone to tearing. Patients who are suffering from rheumatoid arthritis will have weak tendons and in serious cases, the tendon can tear without any prior notice. The patient will only realise it when he cannot bend his finger anymore.

Symptoms

Symptoms will vary among patients but the most common signs include:

  • A visible open injury at the joint area
  • The inability to bend one or more finger(s)
  • Pain and tenderness when a finger is bent
  • Numbness in the fingertip

Flexor tendon injuries are difficult to manage due to its complex nature. Therefore, it is important to seek medical advice immediately when you suspect your might have suffered a jersey finger injury. If surgery is really required, do not worry. Surgery often brings in good return of finger functions.

Fingertip Injuries Treatment

Fingertip injuries are a common form of injury at various places such as home, office and outdoors. They can occur due to different reasons with the most common being a sudden trauma, during food preparation and cleaning. There are many different forms of fingertip injuries and they can exist as tearing, crushing or even amputating in nature. Due to the importance of our fingertip to our daily lives, even a minor injury can be disruptive to our activities. Extreme pain is often felt due to the rich amount of nerves present. In this article, we will look at the treatment for fingertip injuries.

The treatment methods for fingertip injuries differ from the type of injury sustained.

Mild cases

In mild cases where only part of the tissue is removed, a simple dressing is all that is required. The wound needs to be properly rinsed with water and cleaned with an antiseptic agent to kill off all the bacteria that are present. A gauze needs to be placed over the wound to prevent direct contact with the atmosphere and promote healing.

Minor cases

For minor cases where part of the bone is exposed, the dangling flesh needs to be trimmed and sanitized. The process will be largely similar to the mild case except for the fact that stitches may be required if the wound is unable to close on its own after a couple of days.

Serious cases

In serious cases where a large chunk of flesh is chipped off or the fingertip severed, grafts and reattachment will be required when possible. Large grafts are available for harvesting at the groin region. The patient will need to undergo surgery for the grafting process. In situations involving a severed finger, reattachment is the first option provided that the severed finger can be found and is deemed to be still able to function when reattached. The severed part of the finger needs to be placed in an ice box but not in direct contact with the ice to prevent frostbite from damaging the tissues.

Fractures

There are also cases of bone injuries in the form of a fracture. These broken fingers are usually at the tip of the fingers and do not affect the function of the finger but they can cause pain and tenderness. Broken finger treatment methods will usually involve the realignment of bone fragments through the use of a splint or metal implants.

The fingertip sensation may be lost for a few months following a fingertip injury. Deformities may be present but these will go away when the finger is fully healed. Injuries are classified into 2 types; those that involves the flesh and those that involves the bone.

How Can I Manage Pain After My Total Hip Replacement Surgery?

Patients who are scheduled for a total hip replacement surgery will often have many questions about the procedure, and the most common being pain management. Most patients want to know how to overcome the initial pain barrier and how to live with it during the recovery period. They want to be able to sleep well and not be woken up in the middle of the night drenched in cold sweat from the pain. In this article, we will look at ways to manage pain after hip replacement surgery.

Pain is essentially a chemical reaction occurring in the body. Different people have different pain tolerance levels so it is very subjective. Therefore, pain management usually requires a certain level of expectations on the patient’s part. Hip replacement surgery will definitely bring about significant inconvenience of the need for prolonged periods of immobility and rest in order to allow the body to kick start the healing process. Our body repairs the muscles and tissues when we are at rest.

In the initial stages of post surgery, minimal motion is recommended. Often by the 10th day, the pain level will be bearable without the need for oral medications to suppress it. Patients during this stage will start to use walking aids such as crutches and walkers to aid them in their movements. Whenever feasible, you should always try to use ice to help relief the swelling and bring down the pain. With advances in technology, reusable gel packs that are capable of staying cold for long periods of time are available and this offers a much better option for patients.

Pain relief medications are a must. Otherwise, the pain may get so unbearable that you cannot do anything. However, always remember to use medication in conjunction with ice packs in order to reduce the dependency on drugs.

Elevating the legs will also help to bring down swelling. This can be done almost everywhere. Regular elevation of the leg coupled with icing and medication will help bring down the pain to a new low. Physical therapy will also be required by the patient for up to a year depending on the recovery level. Physical therapy helps the patient to regain range of motion, build up muscles and strengthen the injured area in order to prevent re-injury.

Pain management after hip replacement surgery is fairly straight forward. Lots of rest is needed followed by regular consumption of pain relief medication, icing, elevation and physical therapy. The initial stages may be difficult at first but persevere on and the results will be all worthwhile.

2 Exercises to Prevent ACL Injuries

There are a total of four major ligaments in our knee whose function is to provide stability to the knee joint. One of the most important one is the Anterior Cruciate Ligament (ACL). There are numerous fibrous bands attaching the ACL to the bones and that helps to keep motion in check and prevent excessive ones. It also prevents the lower leg from going into hyper extension. Due to the many types of forces experienced by the ACL, it is much easier to be injured compared to the other 3 ligaments. In this article, we will look at some exercises that can help to prevent ACL injuries.

ACL injuries are the most common knee injuries. Every year, many people tear or rupture their ACL due to various reasons, with the most common being sports. When the ACL is extended to beyond its maximum capability, it ruptures. Unlike bones that can heal on its own over time, ligaments do not heal on its own and once it is damaged, it will be permanently damaged and will require surgical means to aid in a full recovery. Situations where the ACL can be ruptured usually involve sudden directional changes or deceleration. In soccer, it can be as simple as a sudden change in direction to shield the ball from an opponent, with a hard twist while the studs of the boots are still firmly in the ground, causing the knee to twist and rupturing the ACL.

Lateral hops

Lateral hops simulate jumping and landing actions which are extremely common in almost every sport and is one of the major causes of ACL injuries. The body is designed in a way where the knee will cushion the impact from any jumps and hence it is important to “teach” our knee muscles how to properly absorb shocks. The main idea of lateral hops is to cultivate a good landing technique and thus it is important to land firmly on the ground without any shuffling actions.

Leg balance squats

Leg balance squats as the name suggests help to cultivate balance in the legs. It drives the legs forward and a quick switch to the other, creating a chain reaction. This way, the body can easily drive one leg to the side in order to work the hips and lower extremities to provide balance to the body when faced with any trauma, reducing the chances of an ACL injury.

Since our body is designed as a linkage system where every muscle group contributes to the control of the knee and the ligaments, a total body core muscle strengthening program should be put in place to help prevent ACL injuries.

Preventing Sports Injuries: Stretching Exercises

Medical research has proven that an increase in the flexibility of a muscle unit increases performance and reduces the amount of injuries sustained. Basic stretching exercises include warming up and cooling down sessions. The main mechanism is due to the loosen tendons after stretching which is less prone to tears when used. Stretching also helps to reduce the recovery time in-between sessions and increases the biomechanical efficiency.

There are basically 3 main types of stretching namely static, ballistic and proprioceptive neuromuscular facilitation (PNF). Static stretching is the most common and the safest amongst the 3. Static stretching works by slowly pulling the muscles towards its maximum end range of motion for a duration of 15 seconds. This is done in a painless and controlled environment and during the stretching exercise no sudden jerks should be made. It is performed for usually for 3 sets and after which an increase in flexibility will be observed. Static stretching should also be performed after the exercise to aid in recovery. Studies have shown that stretching can help to dissipate the lactic acid build up in the muscles which are responsible for the soreness experienced post-exercise.

Ballistic stretching on the other hand uses the momentum of a moving body to stretch it beyond the normal range of motion. This is also known as bouncing stretching which pulls your muscles through exercises such as bouncing on a trampoline while stretching the back. Medical studies have concluded that this is not useful and can lead to injuries since it stretches your muscles suddenly instead of progressively as seen in static stretches.

Last but not least is the proprioceptive neuromuscular facilitation (PNF) stretch. It is the fastest and most effective stretching method that combines passive and isometric stretching to obtain maximum flexibility. PNF stretch was originally intended for recovering stroke victims. It works by passively stretching the muscles and then contracting it isometrically and repeating over and over again.

Stretching can be easily performed anywhere regardless of the activity you are about to perform. In fact, stretching should not be considered a warm up exercise. You should perform stretching even before you commence your warming up exercises. Always keep your stretches sport specific so that you work the correct muscle groups. Remember to always exercise caution when doing stretches and do not work muscle groups that are injured or it can be further aggravated.

Preventing Osteoarthritis through Exercise

Osteoarthritis is a significant degenerative disease that affects the joints. It appears most commonly in the lower extremities which includes the knee and ankles. The reason why the lower extremities are favoured is due to the immense amount of stresses experienced each day. Despite the high prevalence of Osteoarthritis, it can be prevented through simple exercises. We will discuss in this article about how best to prevent Osteoarthritis through daily exercises.

Studies have concluded that exercises can help to prevent Osteoarthritis. Light exercises such as walking are able to effectively reduce the development of osteoarthritis while heavy ones can lead to an increase. As we age, our cartilage becomes less flexible and more brittle. As a result, it cannot work as effectively as before. Exercising frequently helps to prevent muscle atrophy and this is beneficial for those suffering from degenerative joint problems. Exercising frequently helps to build muscle mass, increase strength and flexibility. Patients who complain of pain while exercising should consider aquatic-based exercises which are pain free due to the buoyancy of water.


Flexibility exercises

The aim of flexibility exercises is to increase mobility in the joints and reduce stiffness. Simple flexibility exercises can help to stretch the surrounding muscles and increase blood flow to the region.


Leg stretch

Sit down on the floor and bend your knees while holding the soles together. Hold your ankles firmly and slowly push your knee down using your elbow. You will be able to feel a stretch on the inner part of your leg. Remember to do this slowly or you risk pulling your quad muscles.

Lower back stretch

Lie flat on a piece of yoga mat whilst extending your legs. Get into a position similar to when you are doing crunches but instead of holding your ankles, hold your knee this time round. Pull your knees towards you at a slow but consistent pace while maintaining proper breathing techniques.

Low impact aerobic exercises

Low impact aerobic exercises such as swimming and cycling are gentle on your joints yet improving your cardiovascular function effectively. While people commonly associate osteoarthritis with aging, it does not seem to be the case now. There is an increasing trend in younger patients suffering from osteoarthritis. Instead of participating in high impact sports such as soccer and running, consider making the switch to low impacts ones.
There is no effective cure for osteoarthritis yet and the only way is to manage it with medication and exercises in an attempt to live with the pain and go on with your life.

3 Common Procedures Performed By Orthopaedic Surgeons

Orthopaedic surgeries are surgeries that involve the musculoskeletal system including our hands, shoulders, foot and knees. It is one of the most established arm of surgery and one of the most important. At one point or another in our lives, we will definitely require orthopaedic surgery to deal with issues such as sports injuries, musculoskeletal injuries or degenerative diseases. What are some common procedures performed by orthopaedic surgeons?

Total joint replacement

Due to ageing or diseases, a healthy joint can be damaged and rendered almost useless. In order to regain the full range of motion of a good quality lifestyle, total joint replacement will need to be performed on patients using man-made materials called biomaterials. These biomaterials are biocompatible and will mimic the actions of the actual joint. However, they cannot fully replicate the functions of the original one to a full extent. Wear and tear over a period of time can cause the cartilage to wear off, causing stiffness and pain due to the lack of synovium which helps to reduce friction.

Rotator cuff repair

Rotator cuff repair is performed to repair injured or torn tendons in the shoulder. There is a group of muscles in the shoulder joint forming a cuff, resulting in the name rotator cuff. Our shoulder offers superb flexibility and range of motion but this causes the shoulder joint to be extremely unstable. A slight impact can cause the shoulder “ball” to pop out of the “socket”, resulting in a dislocation. The presence of the tendons will hold the shoulder muscles to the shoulder, preventing any accidental popping out action. Due to injuries or overuse, the tendons can become weak and will not hold as well. Surgery may be performed either as a traditional open surgery or a more modern arthroscopy depending on the extent of the tear. The surgery will fix back the tendon to the shoulder and it will be held together by self-vanishing sutures.

Anterior Cruciate Ligament reconstruction

There are 4 major ligaments in our knee and one of the most important one is the anterior cruciate ligament (ACL). The ACL is responsible for the overall stability and even surface stress distribution across the knee. It limits the rotational capability of the knee as well as prevents excessive forward motion of the tibia to the femur. The ACL is frequently torn during sporting activities involving high impact and sudden jerks. For example during rugby, the long metal studs from the boots can be still stuck in the soft grass field and an attempt to make a directional change results in the twisting of the knee, instantly tearing the ACL. ACL reconstruction is performed either by open surgery or arthroscopic.  The surgeon will remove a tendon from the hamstring and use it as a replacement for the ACL.

Above are 3 of the most common orthopaedic surgeries performed by orthopaedic surgeons worldwide. No matter what surgery you are about to undergo, we wish you a speedy recovery.