Floating Elbow: Symptoms & Treatment

Floating elbow is a medical term that was first introduced by Stanitski and Micheli to describe an injury in children that involves concomitant fractures of the forearm axis and supracondylar humerus in the same extremity. This medical term has also been extended to include adult patients who suffers from ipsilateral fractures of the humerus and forearm. Floating elbow is usually associated with an elbow dislocated in patients suffering from high impact injuries following a serious incident such as a car crash. The “floating” term is used when the elbow remains dislocated from the hand and shoulder.

The most likely cause of such injury for children is due to a fall on the outstretched arm with the forearm pronated and wrist hyperextended. Direct trauma can also result in this injury. Adult patients suffer from floating elbow largely due to high speed trauma such as an accident or falls from extreme heights.

The most obvious symptom in patients with floating elbow is tremendous pain and an obvious deformity in the affected elbow. There is also a possibility of injuries to the surrounding soft tissues such as the ligaments and tendons and this will depend on the mechanism of injury and severity of pathology.

The severity of injury varies among patients depending on several factors such as the position of the arm and impact of force. The nature of treatment is likewise affected by such factors. Management of floating elbow differs slightly between children and adults. However, the initial management is ultimately provisional immobilisation of the fracture. The injured extremity will be protected by a cast and supported by an arm sling.

Surgical options include either a rigid plate fixation or locked intramedullary nailing of the fracture. Both options will provide stability and a high chance of union. Rigid plate fixation will decrease the downtime and will promote early regaining of the full range of motion in the affected joint. In children however, a closed reduction surgical technique is preferred as it provides the highest chances of union with the least possibility of deformity. A mixture of surgical options is accompanied by post-surgery complications. In rare cases, neurovascular injuries may be initiated by a floating elbow injury although chances are slim. These neurovascular injuries can be in the form of nerve palsy to branchial plexus lesions. Infection following surgery is also a possible factor especially for patients who have open fractures and immediate internal fixation.

 

 

Lisfranc (Midfoot) Injury: Cause & Treatments

Lisfranc or midfoot injuries are often the results of broken bones in the midfoot or torn ligaments. Lisfranc injuries can vary from complex to simple depending on the number of joints and bones that are involved. Many patients often mistaken their midfoot injury to that of a simple sprain. As a result, many choose to self-medicate with pain relief cream. However, Lisfranc injury is not as simple as it seems and may even require surgery in some cases.

Located in the midfoot are clusters of small bones forming an arch at the top of the foot. There are five long metatarsal bones extending to the tones and ligaments and tendons hold the bones in place. However, there are no connective tissues holding the first metatarsal to the second metatarsal.

Lisfranc injuries can occur due to either direct or indirect trauma. Direct trauma is often result of an external force striking the foot while an indirect trauma occurs due to a force transferring to the stationary foot that deforms the foot. The foot is a smart system that is divided into three different sections namely the hindfoot, midfoot and forefoot. The role of the midfoot is to translate force and provide rotational stability and it is the keystone for plantar flexion and dorsiflexion. Therefore with a lack of dorsal support, the load acting on the foot is sufficient to cause dorsal displacement, leading to broken bones and/or ligaments.

The earlier a Lisfranc joint injury is diagnosed, the better it is for both patient and doctor. An initial clinical evaluation involving radiographs such as x-rays and MRI will be performed to indicate the probability of a mild, moderate or complex sprain. If diastasis is not present, immobilisation will be needed. This will include the usage of an immobilisation cast for a period of four to six weeks followed by limited movements. After six weeks, rehabilitation exercises need to start immediately. This is due to the bone being a piezoelectric material and will resorb after periods of inactivity.

If surgery is needed, it will be performed within 24 hours of the injury or after 10 days to allow for the drainage of bodily fluid due to swelling. Kirshner wires will be used to fix the bones together and bone fragments will be removed. After surgery, patients need to be immobilised in a cast for up to 12 weeks with minimal movements.

Some people will no longer be able to return to pre-injury levels of activity after a midfoot injury despite advancement in medical technology.

 

Home Treatments – Wrist Sprains

A sprain is the result of a ligament injury. Ligaments are thick connective tissues that connects our bones to the joint. In our wrist alone, there are as many as 15 different bones. As a result, a simple twist to the wrist may result in a sprain when it is moved to beyond its usual range.

For immediate self-care of a sprain or strain at home, the R.I.C.E. approach is the most relevant. R.I.C.E. stands for Rest, Ice, Compression, and Elevation.

Rest

All activities that are responsible for the pain and swelling needs to be stopped immediately. However, this does not mean that all physical activities must stop likewise. For example, you may be suffering from a sprained wrist but you still can use the exercise bicycle in the gym. Do not use this injury as an excuse to stop exercising.

Ice

Ice is one of the most effective and cost efficient way of treating a sprain. The injured wrist needs to be iced regularly throughout the day until the swelling goes down. At several intervals during the day, an iced pack should be placed on the wrist for around 15 minutes. Ice will bring down the swelling and reduce bleeding. As a result of the drastic change in temperature, the body will respond by rushing more blood to the wrist and this will speed up the healing process.

Compression

Compression will help to keep the injured wrist nice and warm. It will also help to promote blood circulation if done correctly. There are a lot of compression bandages available in the market today and this should be worn during the day. By promoting blood circulation, more oxygen can then be brought to the wrist and speed up the healing process.

Elevation

To further reduce swelling, the injured wrist should be elevated above the level of your heart. Through gravity, the excess fluid will then flow away from the wrist and reduce swelling.

Turmeric

Turmeric is a spice that is commonly used in Indian cuisine. It is also an excellent pain reliever due to its anti-inflammatory properties. Not only that, turmeric will also reduce spasm and relax the muscles and tissues. This will in turn reduce swelling. To prepare a home-made turmeric pain reliever, mix one tablespoon of turmeric powder with one tablespoon of lime juice. Apply this paste directly onto the wrist and wrap it with a bandage. Leave it on overnight and you will be able to feel the difference the following day.

Bennett Fracture: Cause & Treatments

A Bennett fracture happens when the bone located at the base of the thumb dislocates and breaks. It can be due to a sudden trauma during high impact sports or accidents. A Bennett fracture will result in swelling of the thumb, pain and the inability to use the thumb. In this article, we will look at the causes and treatments for Bennett fractures.

Causes

The causes of a Bennett’s fracture can differ. However, it happens when the metacarpal bone located in the arm fractures and breaks. This can be due to any kind of forces that will result in a huge impact sufficient to break it.

Treatments

Treatment is classified into non-surgical and surgical. For minor cases where the bones are not misaligned, non-surgical will be more than sufficient. The initial stages of treatment will involve the famous RICE therapy – Rest, Ice, Compression and Elevation. Resting involves immobilising the injured hand and preventing any stresses on it. During this period, the patient is not allowed to participate in any activities. Several times a day, the injured thumb will need to be iced in order to bring down the swelling. To prevent swelling and loss of blood, compression finger sleeves may be worn. This will also help to retain body heat and enhance blood circulation. Lastly, the injured thumb needs to be elevated above the heart to drain away excess blood. Bracing and casting may be required depending on the activity level of individual patients.

Surgical treatment is also classified into invasive and minimally invasive. In minimally invasive surgery, a surgical wire will be inserted through a small incision aided by cameras. However, this method is highly dependent on the stability of the injury and the alignment of the metacarpal bone. If the bones fragments are scattered, an invasive surgery will need to be carried out in order to remove these bone fragments. A small screw will be used to hold the fragments together until they heal on their own. One popular surgical treatment is the Kirschner wire fixation. The K-wires are made up of surgical grade stainless steel and are temporary fixation tools. The pins are drilled into the bones and act as an anchor point for skeletal traction.

Unlike other injuries, Bennett’s fracture cannot really be prevented due to the various uses of the hand and the fingers. However, this fracture can be avoided to a certain extent using medical tapes to tape the thumb and index finger together.

 

 

 

Hamstring Muscle Injuries: Cause & Treatments

Hamstring injuries are a common occurrence in athletes. They are usually known as “pulled hamstring”. Sports requiring frequent sprinting such as soccer, rugby and basketball poses a higher risk of a hamstring injury. Hamstring injuries happen when the muscle location at the back of the thigh is injured in the form of a strain. Fortunately, this type of injury respond well to nonsurgical treatment. In this article, we will look at the causes and treatment methods for a pulled hamstring.

The main cause of a hamstring injury is due to overloading of the hamstring muscle. The hamstring is a tendon which is essentially a thick bundle of fibers. During a normal scenario, the tendon contracts and shortens and expands and extends. In unusual situations, this tendon contracts and extend due to the presence of an additional load or strain. When this situation happens, the hamstring is pulled, resulting in a hamstring muscle injury.

Treatment will vary depending on the severity of the injury. Most hamstring injuries can recover with nonsurgical treatment. The first treatment administered will be the RICE protocol – Rest, Ice, Compression and Elevation. Resting involves the usage of walking aids such as crutches to avoid placing weight on the injured leg. During this period, the patient is not allowed to participate in any activities. Several times a day, the injured leg needs to be iced in order to bring down the swelling. To prevent swelling and loss of blood, compression garments will need to be worn. This will also help to retain body heat and enhance blood circulation. Lastly, the injured leg needs to be elevated above the heart to drain away excess blood. Once pain and swelling has subsided, a series of physical therapy sessions will be planned for in order to regain strength and range of motion to slowly help return back to sports.

If nonsurgical treatment does not help, surgery will be required. This is usually for cases where the hamstring tendon has been completely torn from the bone. To repair the torn tendon, the hamstring muscle must be located and placed back to its original location. Due to this injury, the body naturally forms scar tissues at the injury site and this must be removed as well. After that, the tendon will be reattached back using biodegradable sutures. This is followed by an intense rehabilitation period lasting at least 3 months.

Patients with hamstring injuries are able to fully recover after completing their rehabilitation plan. Most are able to return back to their pre-injury level and enjoy their favorite sport.

 

SLAP Tears: Cause & Symptoms

A slap tear is an injury to the shoulder. SLAP stands for “superior labrum, anterior to posterior”.  This means that the top portion of the labrum is injured from the front to the back. The labrum is a ring of tissue located around the shoulder socket and it is there to stabilize the shoulder due to the extensive amount of movement associated with it. So what exactly causes a SLAP tear and what are the symptoms? This article will help to answer some of these questions.

Our shoulder is made of a ball and socket joint consisting of three different bones. The bones are the upper arm bone, the shoulder blade and the collarbone. The head of the upper arm bone is designed to fit nicely into the socket in the shoulder blade. Each person’s ball and socket joint is unique to him only. The labrum is a thick and strong fibrous tissue that helps to deepen the socket and promote stability to the shoulder joint. It also helps to attach the ligaments and tendons in the area.

A SLAP tear will occur from the area just in front or behind the biceps tendon. SLAP injuries were first observed in baseball players due to the nature of the game. SLAP tears are often due to repeated usage of the shoulder joint. It can also be due to sudden trauma to the shoulder such as a traction force or a pull on the arm. An attempt to break a fall using the shoulder can also be responsible.

The most accurate symptom of a SLAP tear is pain. However, almost everything can cause pain! Almost every movement associated with the shoulder joint will result in pain for the patient. There will also be a decrease in shoulder strength and a feeling of instability. The range of motion will also be significantly decreased. Baseball players may also observe a decrease in the velocity of their throw after pitching.

A trained medical specialist should only diagnose SLAP tears. There are several tests such as the O’Brien’s test, Apprehension Sign and Jobe Relocation Test that are highly reliable when used together as a whole package. This can be aided by a MRI scan which will help to identify the presence of a SLAP tear and the exact location.

A SLAP tear is a challenging medical injury and the treatment must be done in a timely manner due to the many ptifalls in the diagnosis and management of such injury.

What Are Risks Of Delaying My Hip Replacement Surgery?

Your rights as a patient permit you to decide when to undergo your hip replacement surgery. Your doctor can only provide professional advices from their many years of experience. A high chance is that your surgeon will recommend you to undergo hip replacement as soon as possible in order to reduce pain and prevent aggravating the injury. However, it all depends on you to make the ultimate call as you may have concerns such as your finances, pre-planned overseas trip and many more. So what are some risks of delaying your hip replacement surgery?

Deterioration of joint tissues

The most serious risk when you delay surgery is the possible deterioration of joint tissues as well as further injuries to the hip joint. This is especially so in patients suffering from degenerative diseases such as osteoarthritis. As osteoarthritis progress, the diseased joint wears out more. It will ultimately lead to a deformed joint. When the diseased joint is at its infancy stage, hip resurfacing is one of the possible treatment methods. However, a delay of surgery will render this option impossible.

Sedentary lifestyle

Patients who delay surgery may also become sedentary after a certain period and daily simple activities and task will soon become hard to carry out. As pain and discomfort set in, patients will find it difficult to walk around. This will then lead to muscle atrophy.

Revision surgery has its limit

One important thing you need to know is that your implant has a finite lifespan. The wear and tear rate varies among patients due to the different activity levels but most will be able to last for at least a decade. Revision surgery is much more complex than the first surgery as there are lesser bones and tissues to work with. Ageing will also cause a reduction in flexibility in joints. Therefore, the longer you delay your first surgery, the harder it is for you to undergo a revision surgery in future.

One common consensus of many patients arrived at the conclusion: most wish they had performed hip replacement surgery earlier instead of waiting for even a few months. Hip replacement surgery had allowed them to return to pre-injury activity level and provide a better quality of life to them and their loved ones. Deciding on when is the best time to undergo surgery depends on you and your immediate concerns. You need to fully understand the surgery risks and weigh them against whatever concerns you have at the moment before arriving at the best solution yourself.

Prevention of Sports Injuries in Children

Keeping our kids safe and sound is the most important thing ever. However, we also need to help them realise their full potential in whatever they do and thus, we should not hinder them. As a result, we should learn how to prevent sports injuries in children in order to progress further. In order to promote an active and healthy lifestyle, sports are an integral part of their lives. With an increase in sports activities come an increase in injury risks and in this article, we will learn how some preventive measures against sports injuries in children.

Wearing safety equipment

Safety equipments are heavy and bulky and they can hinder movement. However, they are mandatory in most contact sports in order to protect the player. For example, helmets are a must while playing baseball and shin guards are compulsory for soccer. Not only are that, wearing the right size is crucial. Only when safety equipments are used correctly can they fully protect the user.

Ensuring that the playing surface is in good condition

The playing surface is very important in preventing injuries. There is a reason why football and rugby are played on soft turf and running events are done on rubberised surfaces. These soft surfaces help to absorb any shocks and impacts due to jumps and provide a soft cushioning when kids fall. However, if soccer is played on a field that has hardly much grass left, injuries risk are greatly increased. Children can easily suffer abrasions when they fall and can even twist their ankles when running at high speeds.

Ensure that kids have proper knowledge

You cannot expect a kid to know how to swim or play soccer without teaching them the basic skills. Therefore, you should always ensure that the children have had sufficient skills prior to letting them play own their own. This way, they can minimise the risk of injuries and still keep their body fit and healthy.

Warming up and cooling down is enforced

We all know the benefits of a proper warm up and cool down session. A warm up session helps to loosen the muscles and warm it up, allowing it to be more flexible and reduce the chance of injury. A cool down session reduces muscle stiffness, helps prep the muscles for repair and lowers the heart rate gradually. However, kids are not interested in spending time to perform warm ups and cool downs. Therefore, we must always strictly enforce it on them.

Hairline Fractures and Their Causes

Hairline fractures, otherwise known as stress fractures are caused by repetitive forces acting on the bones usually in places such as the foot and lower limb. Due to an imbalance between the resorption and growth of new bone tissues and cells, bones are unable to regenerate and timely replacement cannot happen. Due to this fatigue, micro cracks in the form of hairline fractures are ultimately formed. What are some causes of hairline fractures?

High impact sports

High impact sports such as soccer, basketball and rugby are at a higher risk of developing stress fractures. This is due to the stressful nature of the game and the forces involved. The 3 sports require constant jumping and running throughout the duration of the game. Over time, fatigue will kick in due to insufficient rest and micro cracks will happen as a result.

Increase in intensity of activities

Fractures can happen to people who have a sudden change in the intensity of their activities. For someone who is used to sitting in the office for prolonged periods of time, a change in lifestyle can lead to a rapid increase in intensity of activities and cause hairline fractures. This is especially so in people who are trying to lose weight or increase muscle mass. A sudden increase in physical activities will place tremendous pressure on the body and lead to a higher risk of injury.

Menopause

Menopause in women will result in the thinning of bones and studies have concluded that an average woman loses 10% of her bone mass within the first 5 years. Menopause will cause a drop in oestrogen levels which is responsible for maintaining bone strength in women. Due to this decrease in bone mass, it is at a higher risk of fractures, especially stress fractures.

Ballet dancers

Ballet dancers are often required to be using the ball of their foot and this adds a lot of stress to the bones there as the entire body weight is acting on this. Coupled with requirements to turn and jump around, the intensity is amplified, placing the foot to be at an extremely high risk of hairline fractures.

Causes of hairline fractures are plenty and they are quite painful. However, due to their tiny nature, they often heal themselves within a few months if proper care is administered. They can be caused by daily routines as well as sports. Be mindful of restraining yourself from strenuous activities when you are a patient of hairline fractures and you will soon be on your way to pre-injury status.

Treatment and Prevention of Tennis Elbow

Tennis elbow is a painful medical condition due to overuse of the tendons in the elbow. Contrary to its name, tennis elbow does not happen to people who are active in playing tennis. Pain is usually felt in the muscles that are attached to the piece of bone that is bumped up at the elbow region. The intensity of pain depends on the severity of the injury and it can be treated using pain relievers for minor cases to surgery for major ones. What are some treatment methods and ways to prevent tennis elbow?

As mentioned above, tennis elbow is an overuse injury that can be caused by various reasons such as sports, gardening and even simple tasks such as lifting a plastic bag filled with groceries. This pain is caused by wear and tear of the common extensor tendon, leading to inflammation and swelling.

The most important treatment that can be administered is rest. Careful attempts to reduce repetitive motions in order to prevent further aggravation of the tendon are crucial and this can be kept in check by using an elbow brace. An effective elbow brace will wrap snugly around the forearm below the elbow and prevent unwanted movements that can hinder recovery efforts. Another type of common treatment method is the oral consumption of nonsteroidal anti-inflammatory drugs or NSAIDs. NSAIDs help to reduce inflammation and bring down selling, but they do not heal the injury. They simply make the injury feel much more bearable to the patient. Applying a nice cold ice pack at home or in the office can also help to bring down the inflammation and reduce swelling. Cold packs will constrict the blood vessels and reduce blood flow, resulting in lesser movements in the elbow region. To tackle the problem at its roots, you can choose either to perform physical therapy or undergo surgery. Physical therapy will help to strengthen the muscles and soft tissues around the elbow to help better support your injured elbow. It takes place under the supervision of a trained physical therapist that will provide quality advices. For serious cases, surgery is often required to stitch up the injured tendon and snip off the loose parts which are causing irritation to the nearby tissues.

The best prevention tips for tennis elbow are strengthening exercises and reducing chances of overusing the elbow. Stretching and strengthening the muscles will ensure that you have the physical strength to perform out activities without increasing the chances of injuries. Do not overuse your elbow joint by constantly alternating your hands when you are performing strenuous activities and if they are to be done for a long period of time, use an elbow brace.