This community focuses on musculoskeletal system inclusive of bones, muscles, tendons, ligaments, and soft tissue. The themes covered include conditions, injury, and treatments options with surgical and non-surgical techniques.
<p phdr="Type">The male-to-female ratio for ankle fracture is 2:1. Most patients younger than 50 years are male, while older than 50 years are female. In children, ankle fractures have an incidence of 1 in 1000 per year. 1 As the population ages, ankle fractures are becoming more common. An increase in fall risk and osteoporosis are risk factors. Ankle joint is composed of 2 joints; True ankle joint: between leg bones above (tibia fibula) and ankle bone below (talus). Allow up and down movement of foot (dorsi flexion, plantar flexion respectively). Subtallar joint: means below talus between talus and the heel bone (calcaneus). Allow inversion (sole inward) and eversion (sole outward) of ankle joint. Most common cause of ankle injurie are due to excessive inversion stress it is becasue the joint is more like to invert because of its anatomical build and weak ligaments on the lateral side however when injuries occur because of the eversion stress, they are mostly extensive involving bone and ligament injuries. </p>
<p phdr="Type">Reconstruction surgeries are of two type arthroscopic and open reconstruction depending on orthopedic surgeon’s choice and extent of injury. Time of surgery is debatable topic. Surgery immediately after injury has been associated with increased fibrous tissue leading to loss of motion (arthofibrosis) after surgery (1). According to some surgeon surgery should be delayed until swelling goes down, gain range of motion in knee and can strongly contract (flex) front of thigh muscle (quadriceps)(1). In adults age is not a factor in surgery though overall condition of body may be. People with medical conditions may consider non surgical treatment option because surgery carries greater risk. These include use of painkillers and anti inflammatory medications and bracing for 1 to 2 weeks with ice, elevation and programmed physiotherapy. A new non surgical treatment option is Platelet rich plasma injection, in this procedure blood of the patient is taken platelets are separated by centrifuge and injected I the injured tissue to augment healing. It is useful in both acute and chronic soft tissues injuries. Choice completely depends upon patient choice and level of activity patient having after surgery (2). Many orthopedic surgeons use arthroscopic surgery rather than open surgery for ACL injuries because: 1. It is easy to see and work on the knee structures. 2. It uses smaller incisions than open surgery. 3. It can be done at the same time as diagnostic arthroscopy (using arthroscopy to find out about the injury or damage to the knee). 4. It may have fewer risks than open surgery (3). During arthroscopic ACL reconstruction, the surgeon makes several small incisions—usually two or three—around the knee. Sterile saline (salt) solution is pumped into the knee through one incision to expand it and to wash blood from the area. This allows the doctor to see the knee structures more clearly. The surgeon inserts an arthroscope into one of the other incisions. A camera at the end of the arthroscope transmits pictures from inside the knee to a TV monitor in the operating room. Surgical drills are inserted through other small incisions. The surgeon drills small holes into the upper and lower leg bones where these bones come close together at the knee joint. The holes form tunnels through which the graft will be anchored. If you are using your own tissue, the surgeon will make another incision in the knee and take the graft (replacement tissue). The graft is pulled through the tunnels that were drilled in the upper and lower leg bones. The surgeon secures the graft with hardware such as screws or staples and will close the incisions with stitches or tape. The knee is bandaged, and you are taken to the recovery room for 2 to 3 hours.3 Physical rehabilitation after ACL surgery may take several months to a year. The length of time until you can return to normal activities or sports is different for every person. It takes most people at least 6 months to return to activity after surgery (4). ACL reconstructive surgery remains the gold standard for repairing this common knee injury. The AAOS reports that about 82 to 90 percent of ACL reconstruction surgeries yield excellent results and full knee stability. ACL reconstruction surgery is generally safe. Complications that may arise from surgery or during rehabilitation (rehab) and recovery include following (6, 7). 0.75% (104) of the consecutive patient cohort had a wound complication recorded (5). • Problems related to the surgery itself. These are uncommon but may include: Numbness in the surgical scar area. Infection in the surgical incisions. 0.25% (35) underwent a further procedure to wash out the infected knee joint (5). Damage to structures, nerves, or blood vessels around and in the knee. Blood clots in the leg. DVT and PTE rates were 0.30% (42) and 0.18% (25) respectively with on 90 days(5) The usual risks of anesthesia. There were no in-hospital deaths(5) • Problems with the graft tendon (loosening, stretching, re-injury, or scar tissue). The screws that attach the graft to the leg bones may cause problems and require removal. • Limited range of motion, usually at the extremes. For example, you may not be able to completely straighten or bend your leg as far as the other leg. This is uncommon, and sometimes another surgery or manipulation under anesthesia can help. Rehab attempts to restore a range of motion between 0 degrees (straight) and 130 degrees (bent or flexion). It's important to be able to get your knee straight so you can walk normally. • Grating of the kneecap (crepitus) as it moves against the lower end of the thigh bone (femur), this may develop in people who did not have it before surgery. This may be painful and may limit your athletic performance. In rare cases, the kneecap may be fractured while the graft is being taken during surgery or from a fall onto the knee soon after surgery. • Pain, when kneeling, at the site where the tendon graft was taken from the patellar tendon or at the site on the lower leg bone (tibia) where a hamstring or patellar tendon graft is attached. • Repeat injury to the graft (just like the original ligament). Repeat surgery is more complicated and less successful than the first surgery. 1.36% (190) were readmitted to an orthopedic ward within 30 days (5) </p>
<p phdr="Type here.." style="margin-top: 0px">The <b>Anterior Cruciate Ligament (ACL)</b> is one of two crossing ligaments, along with the <b>Posterior Cruciate Ligament (PCL)</b>, found inside the knee which connect the <b>femur (thighbone)</b> and the <b>tibia (shinbone)</b>. These cruciate ligaments control <b>back and forth movement of the lower leg</b> and act to hold the bones together as well as stabilise the whole knee.</p><p phdr="Type here.." style="margin-top: 0px"><img class="irc_mi" src="https://www.theholly.com/files/2018/08/OS04-ACL-Reconstruction.jpg" width="386" height="362" alt="Image result for acl diagram" style="caret-color: rgb(0, 0, 0); color: rgb(0, 0, 0); font-family: -webkit-standard; white-space: normal; margin-top: 0px;" size="m"></p><p><span style="white-space: pre-wrap;">Ligament injuries are considered "sprains" and can be graded by severity; <b>grade 1 sprains </b>- the ligament has been slightly stretched and becomes mildly damaged but can still keep the knee joint stable, <b>grade 2 sprains </b>(sometimes referred to as a partial tear) - the ligament is stretched until it becomes loose, and<b> grade 3 sprains </b>(often referred to as a <b>complete tear</b>) - the ligament has been stretched until it splits into two pieces. </span></p><p phdr="Type here.." style="margin-top: 0px">The ACL can be injured in multiple ways, usually through <b>sudden powerful movements</b> which put too much stress on the knee. These include <b>changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision on the knee which can overextend the lower leg</b>. These injuries can be prevented by strengthening of the leg muscles which support the load of the ligaments, strengthening of the core muscles, and training for correct technique in movements that place stress on the knee. </p><p phdr="Type here.." style="margin-top: 0px">Before treatment is discussed, a physical exam is used to assess for swelling and tenderness as well as the range of motion and overall function of the knee. Further techniques such as X-rays, to check for a bone fracture, and MRI or Ultrasound scans, to check for signs of damage in the tissues of the knee, are used to clarify the severity and location of the damage. </p><p phdr="Type here.." style="margin-top: 0px">Treatment for ACL injuries <b>depends on the severity</b>. Slight sprains or partial tears can be treated conservatively with rest, ice application, compression, and elevation (as known as the <b>RICE steps</b>) as well as potentially a brace and physiotherapy to strengthen the supporting leg and core muscles. Complete tear treatment depends on the patient; if they are elderly or have a very low activity level then surgery may not be needed and the previous treatments can be used. However, if the patient wants to return to sports or activities that involve movements particularly stressful to the knee, such as basketball, football or rugby, then <b>surgery is the only option remaining</b>. </p><p></p>
<p style="color: rgba(0, 0, 0, 0.701961);">The carpal tunnel is a narrow passage inside the wrist formed by bone at the bottom and the transverse carpal ligament on top. The median nerve and adjacent tendons run from the forearm into the palm to control the thumb and first three fingers. Carpal tunnel syndrome, or median nerve entrapment, occurs when the median nerve is pinched at the wrist where the carpal tunnel is found. Repetitive strain of the carpal ligament causes inflammation or swelling. This swelling then presses on the carpal tunnel and compresses the median nerve causing carpal tunnel symptoms.</p><img class="irc_mi" src="https://my.clevelandclinic.org/health/diseases/-/scassets/3d01a7d759f2483ba6c37b31ed2c1669.ashx" alt="Related image" width="292" height="362" style="caret-color: rgb(0, 0, 0); color: rgb(0, 0, 0); font-family: -webkit-standard; margin-top: 0px;" size="m" pos="left"><span style="color: rgba(0, 0, 0, 0.701961); white-space: pre-wrap;"> </span><p><span style="color: rgba(0, 0, 0, 0.701961); white-space: pre-wrap;">Typical symptoms include pain, tingling, or numbness in the hand and fingers.</span><span style="color: rgba(0, 0, 0, 0.701961); white-space: pre-wrap;"> Other relevant symptoms include waking at night with pain, shooting pain in the wrist and/or forearm, or a weakened grip. Dropping things, having difficulty buttoning clothes, feeling like the fingers are swollen (even if they're not), and having trouble making a fist are all symptoms patients have presented with as well. </span></p><p>Not all cases of pain are due to carpal tunnel syndrome so some techniques will be used to establish the specific cause of symptoms. A tapping test, where the doctor will tap on the inside of the wrist, or a wrist flexion test, where the doctor will ask the patient to place the backs of the hands together with the fingers pointing down, may be used in diagnosis. If either or both <span style="color: rgba(0, 0, 0, 0.701961);">cause pain and shock-like tingling then carpal tunnel syndrome is highly suspected.</span> This diagnosis can be confirmed using a nerve conduction study on the median nerve; the speed of transmissions along the median nerve will be slower in cases of carpal tunnel syndrome. </p><p style="color: rgba(0, 0, 0, 0.701961);">Most of the time, conservative treatment of carpal tunnel syndrome is successful. These include resting the affected wrist, stretching and strengthening the wrist and forearm, reducing the swelling using ice or anti-inflammatory medications, and, in more advanced cases, steroid injections of cortisone aimed at reducing swelling and pain. However, in some cases, the pain persists and t<span style="color: rgba(0, 0, 0, 0.701961);">he symptoms continue to affect daily life and simple </span>despite all other attempts at treatment. Additionally, electromyographs (EMG) showing muscle weakness and nerve conduction studies indicating nerve damage increase the urgency with which the carpal tunnel syndrome must be treated. At this point, surgery to cut the carpal ligament to release the median nerve is the final treatment. Once the procedure is done, the ligament heals back but now with enough space for the median nerve which relieves the symptoms. </p><p></p><p></p>