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.

 

 

Coronoid Fracture: Cause & Symptoms

Coronoid fractures often happen in the ulna although they are relatively uncommon. However, coronoid fractures can be critical injuries. They usually occur in conjunction with elbow dislocations and will lead to elbow instability. The coronoid is designed to strengthen the elbow, increasing the stability. Therefore, a fracture will lead to unstable elbows and a possible loss of motion.

Traumatic elbow injuries such as a coronoid fracture will usually result in a dislocation of not only the bony structures but also injuries to the soft tissues. Very often, the posterior elbow is dislocated and managing it is extremely difficult. Unlike other fractures, coronoid fractures do not respond well to close reduction or splinting.

Causes

Coronoid fracture usually comes hand in hand with an elbow dislocation as dislocation itself involves a large energy impact onto the surrounding bones and soft tissues, leading to several severe soft tissue injuries. This usually happens during high impact sports such as rugby or accidents. One of the most common cause is a fall from a certain height, landing on an outstretched arm when trying to break the fall. The main mechanism involves a combination of twisting and flexing. When the elbow is loaded axially, it is in its weakest state and will lead to the weakening of the coronoid.

Symptoms

Patients suffering from coronoid fractures often have the following symptoms. Patients will be in tremendous pain with diffuse swelling and tenderness. The level of tenderness can be multifocal and depends of the area of injury. Range of motion including flexing, extension and rotation will be severely limited or totally impossible.

Complications

Coronoid fractures may lead to complications if it is not treated properly. The ends of broken bones are sharp and they can cut and tear surrounding blood vessels, nerves and tendons. Fractures may also lead to excessive bleeding and swelling in the elbow region, causing blood clot formation and the disruption of normal blood flow to the rest of the arm. This will lead to a loss of sensation and even function of the arm, requiring emergency attention.

Management

Patients suffering from coronoid fractures will have unstable elbows and it can be fixed by suturing the bone and anterior capsule to the anterior ulna. Surgery will involve either internal fixation or replacement of the fractured radial heads. The injured ligaments need to be surgically reconstructed and if the elbow is still unstable, hinged external fixation will be required.

Neck Sprain: Cause & Treatments

The cervical vertebrae of the spine consist of seven bones that are connected to each other by strong fibrous tissues such as the ligaments, tendons and muscles. A sprain occurs when one of these tissues are stretched beyond its limit. This can happen during a sudden movement such as a car accident, causing the neck to bend to the extreme.

The neck is an extremely smart structure that is designed to house and protect our backbone – the spinal cord. The spinal cord provides support to our head and consists of millions of nerves that acts as signals and transmitters to relay messages from our brain to the rest of our body. However, it is also one of the weakest component of our body and the extreme flexibility that allows you to bend and touch your toes also leaves it vulnerable to impact.

Causes

There are several possible causes for a neck sprain:

  • Spending too much time in an awkward position such as hunching when using a computer for long periods
  • Sleeping in an awkward position without adequate support from a proper pillow
  • Sudden forceful impact such as during a car accident, causing whiplash
  • Working for long periods in the same position such as painting a ceiling for hours

Treatment

Our ligaments, tendons and muscles are designed to heal itself in a short time if it is minor.

  • Applying a cold pack will help to reduce inflammation, allowing the body time to heal. Ice pack should be applied every hour for the first 24 hours as this is the acute stage
  • Applying a heat pack will enhance blood circulation, allowing efficient blood exchange. Old blood containing dead cells will be drained off while new blood carrying large amounts of nutrients and oxygen will help to speed up the healing process
  • Anti-inflammatory medication will help to bring down the swelling and provide pain relief
  • Massaging the neck area will help to dissipate any blood clots that are formed and promote blood circulation
  • Hydrotherapy is a novel treatment method that uses salt to release muscle sprains. Magnesium which is found in the salt will reduce the rate of calcium binding following a muscle contracting
  • Acupuncture is a TCM technique stimulates specific acupuncture points to manipulate the flow of energy and provide restoration of joint mobility to the neck

Neck sprains are usually causes by activities that requires long periods of prolonged movement of the neck.

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.

Arthritis of the Hand: Symptoms & Treatment

Arthritis is the generic name for inflammation in the joints. It can take many different form and the most common one is osteoarthritis. Osteoarthritis is the medical condition when the protective cushioning known as the cartilage is worn out due to wear and tear. It usually happens in areas such as the hand. In this article, we will look at some of the symptoms and treatment for hand arthritis.

Pain

Pain is the most straightforward symptom for any kind of medical conditions. In the initial stages of hand arthritis, the surrounding area will start to have a burning sensation especially after periods of long usage. This pain can be immediate or delayed. As wear and tear of the cartilage continue to take place, the pain will start to be more intense and the frequency increases. After long periods of rest such as after waking up in the morning, the pain can be quite unbearable and the ability to sense changes in weather also appears. Simple activities such as carrying a grocery bag or opening a can be difficult to accomplish.

Crepitation

After some time, there will be sensations of crepitation. This is due to the damaged cartilage rubbing against each other to create a grinding effect. If the hand arthritis affects the hand ligaments, the ligaments and tendons may start to become loose, creating a sense of instability.

Swelling

Swelling occurs due to an excess of body fluid accumulated in the hand. This is due to the body’s natural defence mechanism sensing that something is wrong. As a result, the white blood cells start to destroy the damaged cartilage, secreting a lot of fluid as a result. This will result in pain and tenderness in the hand.

 

Treatment is classified into non-surgical and surgical methods. In non-surgical treatment, the doctor will prescribe medication to stop the inflammation such as acetaminophen and ibuprofen. These medication can only treat the symptom but cannot repair the damaged cartilage. To counter this, glucosamine and chondroitin may also be prescribed as supplements.

If non-surgical treatment fails to produce good results, surgery will be necessary. The most common form of surgery is finger joint replacement. The replacement materials are biocompatiable and possesses weightbearing capabilities such as ceramics. This will help to restore function to the hand and improve the quality of life.

Cartilage do not self-regenerate and this is why joint replacement is the most viable option up to date.

Shoulder Joint Tear (Glenoid Labrum Tear): Symptoms & Prevention

The shoulder joint is composed of three different types of bones: the shoulder blade, upper arm bone and collarbone. This type of joint is a ball and socket joint, allowing for extreme flexibility and wide range of motion. The upper arm bone acts like a ball and is securely inside the shoulder blade socket. For stabilization purposes, the upper arm bone is slightly larger than the socket, ensuring that the fit is tight. To further enhance the stability, there is a layer of soft tissue called the labrum. Injuries to the labrum is the cause of a shoulder joint tear. In this article, we will look at some of the symptoms and preventive measures.

Symptoms of Glenoid Labrum tears are difficult to be diagnosed. The pain is unable to be localized to the exact location and pain is severely increased when actions involving the injured shoulder is attempted. Such actions can include stretching the arm or raising a hand. As time passes, the shoulder will be weaker and instability will start to set in.

Shoulder joint tears are often caused by a sudden trauma to the shoulder blade. These can include falling on an outstretched arm or a direct blow to the shoulder. In order to prevent this, protective measures should be taken:

Warm-ups and stretching

Have you ever taken a rubber band and pulled it suddenly? The rubber band will end up breaking immediately. This is the same for our muscles and it is the reason why warm ups and stretching are extremely important. Warming up will loosen the muscles and enable the tendons and ligaments to stretch. This will allow them to function properly and hold the shoulder joint together.

Protective gears

Shoulder joint tears are also much more common in players engaging in high impact sports such as rugby and baseball. Players often wear protective paddings designed for the shoulder. These cushioning pads are able to cushion and absorb shocks to a certain extent. Some are even able to prevent fractures and dislocations.

Build strong muscles

Building up strength in the shoulders will increase the ability of tendons, ligaments and muscles to withstand the impact experienced by the shoulder. Strong muscles will hold the shoulder together and prevent any muscular tears during an impact.

Shoulder joint tears are extremely painful and affects our daily lifestyle. Players who participate in high impact or repetitive sports shoulder consider investing in good protective gears and ensure that proper warm ups are performed prior to the start of their activity.

Ligament Tear: Symptoms & Treatments

Our knee is supported by 4 main ligaments – anterior ruciate ligament (ACL), medial collateral ligament (MCL), lateral collateral ligament (LCL) and the posterior cruciate ligament (PCL). Each of the ligament plays a different role in ensuring the stability of the knee. However, due to various reasons, the ligaments can be torn. Rupture of the ligament can be a partial one or a full one and this will affect the treatment administered. A ligament tear will also bring about instability in the knee and the inability for it to bear weight, causing problems when walking. In this article, we will look at some of the symptoms and treatments for ligament tears.

The role of each ligament differs:

The role of the ACL is to stabilise the knee joint by restriciting forward back backwards movement of the knee. It is designed to prevent the tibia bone from moving in front of the femur. The role of the MCL is to protect the knee against any sudden and/or unwanted forces that is directed at the side of the knee. It restricts the sideway movement of the knee. The LCL works in conjunction with the MCL to restrict sideway movement and it protects against sudden forces that is directed at the inside of the knee. Lastly, the PCL works together with the ACL to control forward and backward movements of the knee.

An injured ligament will bring about symtoms that are similar to each other:

·As a general rule of thumb, a partially torn ligament will not bring about a pop sound while a fully ruptured one will produce a pop sound. A fully torn one will also create instant instability and the knee will give way.

·Swelling will occur and the injured knee may start to turn purple due to the lack of proper blood flow to the area. Swelling occurs due to a build up of blood from the injured ligament.

·The knee will be unable to function properly and you may feel that you are unable to control it.

·Tenderness will onset when you touch the knee.

The first step in treatment is to pay the PRICE:

·Protect the knee from further movements

·Resting the knee immediately following injury for at least 48 hours. If you need to move around, consider using crutches or walkers to prevent bearing weight on the injured knee.

·Ice will bring down swelling and reduce inflammation. Always try to ice the area every hour by using a cold compress or simply by wrapping knee in a towel and applying it locally.

·Compress the knee with a bandage to reduce swelling and prevent excessive movements.

·Elevate the knee to above your heart level to reduce swelling. This will cause excessive blood to flow away due to gravity towards your heart.

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.

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.