Orthopedics Surgery
Soft tissue injuries
Participation in sports activities or simple activities of daily life can cause injuries to tendons, ligaments, muscles, etc.
The most common soft tissue injuries can be:
Sprains, strains, contusions, tendonitis, bursitis.
We will explain the most common with your treatment
Sprains
The joints of the body are maintained and supported by the ligaments. These are strong bands of connective tissue that join bone to bone at a joint. A sprain ranges from a simple stretch to a break.
The most vulnerable areas are the ankles, knees and wrists
Mild sprains improve with ice, rest, compression, elevation, and therapy.
Moderate sprains may require immobilization.
Severe sprains may require surgery to repair the torn ligament.
Strains
Injury to muscles or tendons, mainly in the lower limbs and may correspond to a simple stretching of the muscle or tendon or it may be a partial or complete rupture of any of these.
Treatment is similar to that for sprains.
Tendinitis
Inflammation of a tendon that may be due to the healing process after trauma. It is characterized by edema, heat, and pain. It can also be due to minor cumulative overuse injuries.
Treatment is based on rest, anti-inflammatory, immobilization, physical therapy.
In persistent cases refractory to treatment, surgery may be required.
Bursitis
Bursae are fluid-filled bags located between bones and tendons or muscles. This allows the tendon or muscle to slide smoothly over the bone.
CARPAL TUNNEL SYNDROME
Syndrome characterized by pain and numbness in the hands that makes it difficult to perform simple activities, including sleep. It is more common in women than in men and in those who do repetitive activities.
Anatomy
The Carpal tunnel is made up of the carpal bones on its floor and lateral walls and its roof by the transverse carpal ligament which is a strong band of connective tissue. This makes it a rigid space that any increase in volume in its interior will produce a compression of the structures that pass through it.
In its internal part we find the flexor tendons of the fingers and the Median Nerve, the compression of the latter triggers the syndrome that concerns us today.
Causes
They are many and diverse in nature, generally it occurs when the synovial sheath that surrounds the tendons that pass through it becomes inflamed, reducing the space inside and thus compressing the Median nerve. Other less frequent causes are the presence of masses such as ganglions or as a consequence of poorly reduced distal radius fractures.
Some medical conditions such as diabetes, rheumatoid arthritis, pregnancy and hypothyroidism, in
Surgery
It is the step to follow when conservative treatment fails, it must be done to prevent the disease from progressing to irreversible phases and the decision will be based on the severity of your symptoms and the stage you are in. In severe and severe advanced cases in which axonal damage is found, it may be irreversible but surgery is performed in any case to reduce symptoms and why not, for possible neuronal recovery.
The objective of the surgery is to increase the diameter of the carpal tunnel and thus decompress the Median nerve, this is achieved by sectioning the transverse carpal ligament.
It can be performed with an open or endoscopic technique, both techniques yield the same long-term result and both can be performed with minimal incisions, the choice is left to the surgeon’s discretion. The anesthesia can be local, regional or general, the latter two are preferred since with local anesthesia there is a greater risk of neurological injury. It is a short, outpatient procedure with rapid recovery. In the postoperative period, it is suggested to actively move the fingers, take care of the wound, and keep the limb elevated to avoid inflammation and pain. Some recommend wearing a rigid wrist strap for a couple of weeks while the tissues heal. After several weeks to months there may be discomfort in the wrist, additionally weakness which improves with time.The main objective, which is to reduce the numbness of the fingers, this is achieved quickly, but in advanced cases it can persist as an additional sequel to weakness and atrophy. Depending on the type of work activity of the patient, it will be the disability granted. Most of the time, post-surgical physiotherapy is not required, it is left for special cases of post-operative pain, stiffness or weakness.
Long term recovery
Recovery can take between a couple of months to a year, the more advanced the disease, the slower it is to recover and this may not be complete. On average at 6 months the symptoms have subsided.
Distal radius fractures
It is the longest bone in the forearm, its final part forms the wrist and is an area prone to fractures and they are quite common
Causes
The fracture occurs by falling supported on the hand, it is also frequent in traffic accidents, falls on a bicycle, etc. It can also be accompanied by a fracture in the ulna.
Symptoms
Immediate pain, deformity in many cases, sensation of rupture, functional impotence, edema, pain when moving the hand and fingers.
Diagnosis
Upon examination, the fracture may be suspected, finding edema, pain when palpating the distal radius, deformity and limitation of movements. But this must be confirmed with an X-ray. The fracture is often within 3 cm of the wrist and may extend to the joint. In some cases a fragment can break the skin, known as an open fracture. If it breaks into more than two parts it is known as a comminuted fracture.
Risk factor’s
Osteoporosis (decrease in bone density) is one of the main risk factors in older people. But in healthy bones they can also occur, mainly in people exposed to trauma due to their sports or work activity.
Surgical treatment
Reserved for unstable, highly displaced, many fragmented, open fractures or those that could not be adequately reduced.
In both cases, most of the time it is recommended to do physiotherapy after the treatment.
Care:
Always the first weeks the limb should be kept elevated to reduce edema, pain and reduce complications. The plaster must be kept dry, avoid damaging it or introducing objects
Forecast
In general it is good but it depends on the severity of the injury, sequelae such as stiffness, pain and functional limitation may remain, but fortunately in most cases this does not happen. It is very important that the treatment is carried out by an orthopedist to minimize symptoms and complications.
Osteoporosis
Calcium is a natural mineral necessary for the body for multiple functions including building and maintaining strong bones and teeth.
Since Calcium is not produced in the body, it must be absorbed from the diet. It is eliminated in urine, fecal matter, skin, sweat, hair, and nails.
When not enough calcium is ingested it must be extracted from the bones to supply other functions.
During life, bones undergo the remodeling process which consists of the old bone being removed and new bone replacing it. After 35 years, more bone is removed than is formed, this accelerates after menopause, which weakens the skeleton, making it prone to fractures.
Women are more vulnerable to Osteoporosis (weak bones), this develops slowly over many years. The decrease in female hormones, low Calcium deposits, low Calcium intake throughout life and the absence of exercise, play an important role in the development of this disease.
The idea is, from childhood to have a diet rich in Calcium which will maintain high levels so that when the time of bone loss arrives, it does not reach osteoporosis levels, it is a way to have savings for the age where resorption occurs that is .
The decrease in calcium levels does not manifest itself in a clinical way, it is a silent entity, but with the slightest trauma, a fracture may occur that can be serious if it involves delicate structures such as the spine and the hip.
In Orthopedics, the consequences of the decrease in bone density are important since it produces multiple fractures that can deteriorate the quality of life of patients.
