DOC I HAVE TENNIS ELBOW
Tennis Elbow (also known as epicondylitis) is the inflammation and swelling of the tendon sheaths (called the synovium) and the enclosed tendons at the origin of the flexor muscles at the medial epicondyle or extensor muscles at the lateral epicondyle of the elbow.
The lateral epicondyle of the elbow is more commonly affected.
The cause of Tennis Elbow is unknown.
Some possible causes are:
1.Injury or trauma to the tendon-minor tears in the tendon attachment of these muscles are always present
2.Repetitive usage of extensor or flexor muscles of the forearm
3.Arthritis of the elbow joints may predispose to Tennis Elbow
4.Systemic diseases such as multiple sclerosis ,amyloidosis, rheumatoid arthritis
The symptoms and signs of Tennis Elbow are:
Onset is usually gradual.
Symptoms:
1.Pain on movement of the tendon of the muscles of elbow
2.Swelling of part of the tendon affected at the elbow joint
3.Stiffness of the tendon of the elbow - inability to stretch
4.Pain often radiates into the forearm
Signs:
1.swelling and pain localized at the epicodyle of the elbow
2.Rotation and grasping such as using a screwdriver or opening a jar aggravates the pain
3.There may be local tenderness of the inflammed tendon.
4.Extension or flexion of the hand against resistance can cause pain at the affected epicondyle of the elbow
5. X-ray s are usually normal although a traction spur may be present.
The complications of Tennis Elbow are:
Fibrosis and rupture of the inflammed tendon of the muscles of the elbow may occur leading to loss of function of the elbow.
The Treatment of Tennis Elbow is:
Conservative treatment:
1.rest of the tendon
2.Cold or ice may help reduce inflammation
3.Splints over the hand, wrist and elbow may help to rest the tendons
4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
5.Muscle relaxant to relax muscles
6.injection of local anesthetic and long acting steroid into the affected area may help to reduce inflammation
7.Avoid overusage of the tendons and muscles of the elbow
Surgery :
Surgical reattachment of torn muscles of the elbow may be necessary if conservative treatment does not work.
The prognosis of Tennis Elbow is:
Prognosis is usually good although recurrence may occur after cortisone injection.
Surgery usually give excellent results.
The prevention of Tennis Elbow is:
1. Avoid any physical exercises such as tennis or golf which causes repetitative usages of the tendons and muscles of the elbow.
2.Avoid rotation or twisting movement of the muscles of the forearm which can cause minor tears of the tendons or muscles of the elbow.
Monday, September 26, 2011
Saturday, September 24, 2011
A Family Doctor's Tale - DISLOCATION OF ELBOW
DOC I HAVE DISLOCATION OF THE ELBOW
Dislocation of the Elbow is a common injury of the elbow.
It is usually posterior in direction and results from a fall on the outstretched hand with the elbow extended.
It is more likely to occur in people who do strenuous physical activities.
The cause of Dislocation of Elbow is:
1.Injury or trauma to the elbow bones from a fall resulting in the humerus end sliding out of the olecranon socket.
2.Somtimes when a child is lifted by the hand or wrist, subluxation of the elbow bones may occur
The symptoms and signs of Dislocation of Elbow are:Symptoms:
Symptoms:
1.Pain and deformity of the affected elbow
2.Swelling of the affected elbow joint
3.Pain often radiates into the forearm
Signs:
1.swelling and difficulty in movement of the elbow
2.typically the other arm is holding on to the affected arm
3. X-rays show usually normal bones with displacement of the locations of the humerus and radius at the elbow joint.
No fractures are seen
The complications of Dislocation of Elbow is:
Deformity and loss of function of the elbow if left untreated.
The Treatment of Dislocation of Elbow is:
Conservative treatment:
1.reduction of the dislocation is done under local anesthesia
2.Use a gentle steady traction on the wrist with counter action on the shoulder.
3.Extend the elbow to unlock the olecranon
4.Bend the elbow slowly and keep it immobilized at 90 degree of flexion in plaster of paris or bandage for at least 3 weeks to allow for ligaments and capsular healing.
5.Do another x-ray to check the position of the elbow joint and exclude fracture during reduction.
5.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) may be given for pain
6.Gentle range of movement exercises are instituted after removal of bandage or plaster of paris
7.Temporary stiffness may be present and recovery may take several months. Motion should never be forced
8.There should be a gradual return of the elbow to normal movement
and weight bearing.
Surgery :
surgery is never necessary
The prognosis of Dislocation of Elbow is:
Prognosis is usually good with proper treatment.
The prevention of Dislocation of Elbow is:
1. Avoid any traumatic injury to elbow.
2.Avoid pulled elbow in children
Dislocation of the Elbow is a common injury of the elbow.
It is usually posterior in direction and results from a fall on the outstretched hand with the elbow extended.
It is more likely to occur in people who do strenuous physical activities.
The cause of Dislocation of Elbow is:
1.Injury or trauma to the elbow bones from a fall resulting in the humerus end sliding out of the olecranon socket.
2.Somtimes when a child is lifted by the hand or wrist, subluxation of the elbow bones may occur
The symptoms and signs of Dislocation of Elbow are:Symptoms:
Symptoms:
1.Pain and deformity of the affected elbow
2.Swelling of the affected elbow joint
3.Pain often radiates into the forearm
Signs:
1.swelling and difficulty in movement of the elbow
2.typically the other arm is holding on to the affected arm
3. X-rays show usually normal bones with displacement of the locations of the humerus and radius at the elbow joint.
No fractures are seen
The complications of Dislocation of Elbow is:
Deformity and loss of function of the elbow if left untreated.
The Treatment of Dislocation of Elbow is:
Conservative treatment:
1.reduction of the dislocation is done under local anesthesia
2.Use a gentle steady traction on the wrist with counter action on the shoulder.
3.Extend the elbow to unlock the olecranon
4.Bend the elbow slowly and keep it immobilized at 90 degree of flexion in plaster of paris or bandage for at least 3 weeks to allow for ligaments and capsular healing.
5.Do another x-ray to check the position of the elbow joint and exclude fracture during reduction.
5.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) may be given for pain
6.Gentle range of movement exercises are instituted after removal of bandage or plaster of paris
7.Temporary stiffness may be present and recovery may take several months. Motion should never be forced
8.There should be a gradual return of the elbow to normal movement
and weight bearing.
Surgery :
surgery is never necessary
The prognosis of Dislocation of Elbow is:
Prognosis is usually good with proper treatment.
The prevention of Dislocation of Elbow is:
1. Avoid any traumatic injury to elbow.
2.Avoid pulled elbow in children
Thursday, September 22, 2011
A Family Doctor's Tale -DISLOCATION OF SHOULDER
DOC I HAVE DISLOCATION OF THE SHOULDER
Dislocation of Shoulder is a common injury of the Shoulder.
It is usually anterior in direction and results from a fall on the externally rotated abducted arm.
This forces the humerus out of the glenoid cavity of the shoulder blade into its anterior position.
Posterior dislocation is less common and may results from a force directed against the internally rotated arm.
It may occur during a seizure in patients with convulsive orders.
The cause of anterior Dislocation of Shoulder is:
Injury or trauma to the Shoulder bones from an anterior force directed on the externally rotated abducted arm.
The symptoms and signs of Dislocation of Shoulder are:
Symptoms:
1.Pain and deformity of the Shoulder
2.Acromial protrusion of the Shoulder joint
3.Absense of the normal fullness of the humeral head beneath the deltoid and acromial process
Signs:
1.Little and painful movement of the Shoulder
2.typically the other arm is holding on to the affected arm
3.With anterior dislocations the arn is held externally rotated, the shoulder is full and internal rotation is painful.
4. X-rays should be taken at different angles and will show usually dislocations of the humerus ball from its socket of the shoulder blade.
No fractures are seen if it is a pure dislocation
The complications of Dislocation of Shoulder are:
Deformity and loss of function of the Shoulder if left untreated.
The Treatment of Dislocation of Shoulder is:
Conservative treatment:
1.reduction of the dislocation is done under local anesthesia
No general anesthesia is needed.
2.Use a gentle steady straight traction on the arm with counter action on the shoulder.
3.Extend the Shoulder under traction to loosen the muscles
4.Flex the Shoulder slowly forward and keep it immobilized at 90 degree of flexion in a sling for 1 to 2 weeks to allow for ligaments and capsular healing.
5.Do another x-ray to check the position of the Shoulder joint and exclude fracture during reduction.
5.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) may be given for pain
6.Gentle range of movement exercises are instituted after symptoms have subsided
7.Temporary stiffness may be present and recovery may take a few months. Movements should never be forced
8.There should be a gradual return to normal movement
Another method of reduction is called the Stimson's method for anterior dislocation:
1.Patient is placed in a prone position on the bed with the affected arm hanging over the side of the bed.
2.A 5kg to 10 kg weight is tied to the wrist for traction.
3.As the shoulder muscle relax, spontaneous reduction frequently occurs.
4.The patient's shoulder is placed in a sling for 1 to 2 weeks to allow for ligaments and capsular healing and the shoulder joint immobilized until it recovers with rehabilitation.
Surgery :
1.Surgery is seldom necessary and requires open reduction under general or regional anesthesia
2.Surgery is also done for correction of recurrent dislocations of the shoulder.
These procedures usually restrict the rotation of the shoulder joint or reinforce the weakened shoulder joint capsule.
The prognosis of Dislocation of Shoulder is:
Prognosis is usually good .
Recurrences of dislocation of the shoulder can occur due to the loosening of the capsule of the shoulder and weakening of its ligaments.
The prevention of Dislocation of Shoulder is:
Avoid any traumatic injury to Shoulder.
Dislocation of Shoulder is a common injury of the Shoulder.
It is usually anterior in direction and results from a fall on the externally rotated abducted arm.
This forces the humerus out of the glenoid cavity of the shoulder blade into its anterior position.
Posterior dislocation is less common and may results from a force directed against the internally rotated arm.
It may occur during a seizure in patients with convulsive orders.
The cause of anterior Dislocation of Shoulder is:
Injury or trauma to the Shoulder bones from an anterior force directed on the externally rotated abducted arm.
The symptoms and signs of Dislocation of Shoulder are:
Symptoms:
1.Pain and deformity of the Shoulder
2.Acromial protrusion of the Shoulder joint
3.Absense of the normal fullness of the humeral head beneath the deltoid and acromial process
Signs:
1.Little and painful movement of the Shoulder
2.typically the other arm is holding on to the affected arm
3.With anterior dislocations the arn is held externally rotated, the shoulder is full and internal rotation is painful.
4. X-rays should be taken at different angles and will show usually dislocations of the humerus ball from its socket of the shoulder blade.
No fractures are seen if it is a pure dislocation
The complications of Dislocation of Shoulder are:
Deformity and loss of function of the Shoulder if left untreated.
The Treatment of Dislocation of Shoulder is:
Conservative treatment:
1.reduction of the dislocation is done under local anesthesia
No general anesthesia is needed.
2.Use a gentle steady straight traction on the arm with counter action on the shoulder.
3.Extend the Shoulder under traction to loosen the muscles
4.Flex the Shoulder slowly forward and keep it immobilized at 90 degree of flexion in a sling for 1 to 2 weeks to allow for ligaments and capsular healing.
5.Do another x-ray to check the position of the Shoulder joint and exclude fracture during reduction.
5.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) may be given for pain
6.Gentle range of movement exercises are instituted after symptoms have subsided
7.Temporary stiffness may be present and recovery may take a few months. Movements should never be forced
8.There should be a gradual return to normal movement
Another method of reduction is called the Stimson's method for anterior dislocation:
1.Patient is placed in a prone position on the bed with the affected arm hanging over the side of the bed.
2.A 5kg to 10 kg weight is tied to the wrist for traction.
3.As the shoulder muscle relax, spontaneous reduction frequently occurs.
4.The patient's shoulder is placed in a sling for 1 to 2 weeks to allow for ligaments and capsular healing and the shoulder joint immobilized until it recovers with rehabilitation.
Surgery :
1.Surgery is seldom necessary and requires open reduction under general or regional anesthesia
2.Surgery is also done for correction of recurrent dislocations of the shoulder.
These procedures usually restrict the rotation of the shoulder joint or reinforce the weakened shoulder joint capsule.
The prognosis of Dislocation of Shoulder is:
Prognosis is usually good .
Recurrences of dislocation of the shoulder can occur due to the loosening of the capsule of the shoulder and weakening of its ligaments.
The prevention of Dislocation of Shoulder is:
Avoid any traumatic injury to Shoulder.
Tuesday, September 20, 2011
A Simple Guide to Bedwetting (enuresis)
A Simple Guide to Bedwetting (enuresis)
---------------------------------------
What is Bedwetting?
___________________
Bedwetting or functional enuresis is the repeated involuntary voiding of urine during day or night at an age where continence or control of urine is expected.
Bedwetting or functional enuresis is common in children.
Prevalence of bedwetting:
5 years old - 7 per cent for boys and 3 per cent for girls
10 years old -3 per cent for boys and 2 per cent for girls
18 years old -1 per cent for boys and 0 per cent for girls
It usually occurs during non rapid-eye-movement (REM) sleep.
What are the causes of bedwetting?
------------------------------------
1.family history of bedwetting often present
2.prevalence of emotional and mental disorder greater than in general population such as anxiety or rejection
3.slow physical development,
4.an overproduction of urine at night,
5.a lack of ability to recognise bladder filling when asleep
Symptoms
1.day or night involuntary voiding of urine after the age of 5 years at least twice a month or continuously.
2.In older children more than once a month
3.Somtimes a child develops bedwetting in responce to jealousy or reduced attention from parents or caretaker after a new child is born into the family
Complications:
Amount of urinary incontinenc is related to effect on the child's emotional or psychological well being:
1.self esteem is affected
2.social ostracism by peers
3.anger at caretakers
4.rejection by caretakers
Diagnosis and treatment
1.an underlying condition such as urinary tract infection, developmental bladder abnormalities or nervous system disorders must be ruled out by tests conducted.
2.A "wait and see" approach is the preferred course of action. Record the days when the child is dry and give a reward as a form of motivation.
3.Regulate the amount of fluid taken before bedtime
4.Patient and family counseling will take out the anxiety and fear of rejection by the child
5.Use of urine sensitive device that detects wetness and activate auditory stimulus can help the child condition the response of waking up before he loses control of his bladder. This method is called behavioural conditioning.
6.Medicine such as antidressant can help to control bedwetting in children but only as as a short-term measure.
Prognosis:
Fairly good with counseling and motivation
---------------------------------------
What is Bedwetting?
___________________
Bedwetting or functional enuresis is the repeated involuntary voiding of urine during day or night at an age where continence or control of urine is expected.
Bedwetting or functional enuresis is common in children.
Prevalence of bedwetting:
5 years old - 7 per cent for boys and 3 per cent for girls
10 years old -3 per cent for boys and 2 per cent for girls
18 years old -1 per cent for boys and 0 per cent for girls
It usually occurs during non rapid-eye-movement (REM) sleep.
What are the causes of bedwetting?
------------------------------------
1.family history of bedwetting often present
2.prevalence of emotional and mental disorder greater than in general population such as anxiety or rejection
3.slow physical development,
4.an overproduction of urine at night,
5.a lack of ability to recognise bladder filling when asleep
Symptoms
1.day or night involuntary voiding of urine after the age of 5 years at least twice a month or continuously.
2.In older children more than once a month
3.Somtimes a child develops bedwetting in responce to jealousy or reduced attention from parents or caretaker after a new child is born into the family
Complications:
Amount of urinary incontinenc is related to effect on the child's emotional or psychological well being:
1.self esteem is affected
2.social ostracism by peers
3.anger at caretakers
4.rejection by caretakers
Diagnosis and treatment
1.an underlying condition such as urinary tract infection, developmental bladder abnormalities or nervous system disorders must be ruled out by tests conducted.
2.A "wait and see" approach is the preferred course of action. Record the days when the child is dry and give a reward as a form of motivation.
3.Regulate the amount of fluid taken before bedtime
4.Patient and family counseling will take out the anxiety and fear of rejection by the child
5.Use of urine sensitive device that detects wetness and activate auditory stimulus can help the child condition the response of waking up before he loses control of his bladder. This method is called behavioural conditioning.
6.Medicine such as antidressant can help to control bedwetting in children but only as as a short-term measure.
Prognosis:
Fairly good with counseling and motivation
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