 Other
Common Orthopaedic Conditions
Below are listed some common orthopaedic conditions offered within our orthopaedic
surgery department. Please enquire if the surgery you seek is not listed.
Bakers Knee Cyst
What
is a Bakers Knee Cyst?
You notice a bulge behind your knee, and you feel tightness there, too.
The pain gets worse when you fully extend your knee or when you're active. What could be
the cause?
A likely explanation is that you have a Baker's cyst, also called a popliteal cyst. A Baker's
cyst is usually the result of a problem with your knee joint, such as arthritis or a cartilage
tear. Both conditions can cause your knee to produce too much fluid, which can lead to a
Baker's cyst. Treating the probable underlying problem usually relieves the swelling and
discomfort of a Baker's cyst.
These cysts occur most often in adults between 55 and 70 and in children between 4 and 7
years old. Up to one in five people with other knee problems may develop a Baker's cyst.
Signs
& Symptoms
In some cases, a Baker's cyst causes no pain and goes unnoticed. The signs
and symptoms you may notice can include:
- Swelling behind your knee, and sometimes in your leg or foot
- Tightness in the back of your knee
Causes
A door hinge needs oil to swing smoothly, to reduce the friction between
its moving parts and to minimize wear and tear. Similarly, the cartilage and tendons in
your knees rely on a lubricating fluid called synovial (si-NO-vee-ul) fluid. This fluid
helps your legs swing smoothly and reduces friction between the moving parts of your knees.
Synovial fluid circulates throughout your knee and passes in and out of
various tissue pouches (bursae) throughout your knee. A valve-like system exists between
your knee joint and the bursa on the back of your knee (popliteal bursa). This regulates
the amount of synovial fluid going in and out of the bursa.
But sometimes the knee produces too much synovial fluid. Most commonly this is caused by
an inflammation of the knee joint, such as occurs with various types of arthritis or a knee
injury, especially a cartilage tear.
When the popliteal bursa fills with fluid and expands, the result is a bulge called a Baker's
cyst. In texture, it's similar to a balloon filled with water.
When
to seek medical advice
If you're experiencing pain and swelling behind your knee, see your doctor
to determine the cause. Treating the underlying condition, such as arthritis or a cartilage
tear, usually relieves the swelling and discomfort of a Baker's cyst. In rare cases, a bulge
behind your knee may be a tumor or a popliteal artery aneurysm rather than a fluid-filled
cyst.
Screening
& Diagnosis
A noninvasive imaging test, such as an ultrasound or a magnetic resonance
imaging (MRI), scan can help distinguish a simple cyst. If your doctor suspects a blood
clot in your leg (deep vein thrombosis) or an aneurysm, he or she may suggest an ultrasound
of your leg or other tests.
Complications
Rarely, a Baker's cyst bursts and synovial fluid leaks into the calf region,
causing sharp pain in the knee, swelling and sometimes redness of the calf. These signs
and symptoms closely resemble those of a blood clot in your leg. If you have swelling and
redness of your calf, you'll need prompt medical evaluation, because a blood clot may require
urgent treatment.
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Treatment
If the cyst is very large and causes a lot of pain, your doctor may use
the following treatments:
Physical therapy: Applying ice packs, a compression
wrap, and crutches may help reduce pain and swelling. Gentle range of motion and strengthening
exercises for the muscles around your knee may also help to reduce your symptoms and preserve
knee function.
Fluid drainage.
Your doctor may drain the fluid from the knee joint using a needle. This is called needle
aspiration.
Medication.
Your doctor may inject a corticosteroid medication, such as cortisone, into your knee to
reduce the volume of fluid being produced. This may relieve pain, but it doesn't always
prevent recurrence of the cyst.
Typically though, doctors treat the underlying cause rather than the Baker's cyst itself.
If your doctor determines that a cartilage tear is causing the overproduction of synovial
fluid, he or she may recommend surgery to remove or repair the torn cartilage.
In some instances, particularly if you have osteoarthritis, the cyst may not go away even
after your doctor treats the underlying cause. If the cyst doesn't get better, causes pain
and interferes with your ability to bend your knee, or if — in spite of aspirations
— fluid in the cyst hinders knee function, you may need to be evaluated for surgery
to remove the cyst.
Bunion
Removal
What
is Bunion Removal (Bunionectomy, Hallux Valgus Correction)
Bunion removal is the surgical treatment of a deformity of the bones of
the big toe and foot (bunion).
Description
| A bunion is a painful deformity of the bones and joint between
the foot and the big toe. Long-term irritation (chronic inflammation) caused by poorly
fitting and/or high-heeled shoes, arthritis, or heredity reasons causes the joint
to thicken and enlarge. This causes the big toe to angle in toward and over the second
toe, the foot bone (metatarsal) to angle out toward the other foot, and the skin to
thicken (callus formation).
The initial treatment for a bunion is changing from narrow and/or high-heeled shoes
to wide shoes without a heel. When this does not work, surgery may be recommended. |
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Surgical
Correction
Surgical removal of a bunion is carried
out under general anesthesia. Surgery is recommended to correct the deformity, reconstruct
the bones and joint, and restore normal, pain-free function. An incision is made along the
bones of the big toe into the foot. The deformed joint and bones are repaired, and the bones
are stabilized with a pin and/or cast.
After
surgery
The patient is advised to keep the foot propped up and protected from pressure,
weight, and injury while it heals. Complete recovery may require 3 to 5 weeks. The surgeon
can fit a cast with a hard walking sole attached to enable the patient to walk during the
healing and recovery period.
Carpal
Tunnel Syndrome
What
is Carpal Tunnel Syndrome ?
Carpal tunnel syndrome affects about 1 in 100 people at some point in their
life. Men and women of any age can develop it, but it is most common in women in their 30s,
40s and 50s.
carpal tunnel syndrome may be caused as a result of the patients occupation, it can lead
to the person being unable to work. In Most cases the syndrome can be prevented by stopping
or reducing the activity that stresses the fingers, hand, or wrist, or by changing the way
in which activities are done.
Carpal Tunnel Syndrome is a condition where there is excessive pressure on the median nerve.
This can be caused by swelling in the carpal tunnel and/or thickening of the transverse
carpal ligament, which forms the roof of the carpal tunnel.
Pinching or compression of this nerve by the transverse carpal ligament sets into motion
a progressively crippling disorder which eventually results in wrist pain, numbness and
tingling in the hand, pain combined with a “pins and needles” feeling at night,
loss of grip strength and a loss in the feeling of coordination.
What
are the Symptoms?
Patients with carpal tunnel syndrome initially feel numbness and tingling
of the hand in the distribution of the median nerve (the thumb, index, middle, and part
of the fourth fingers). These sensations are often more pronounced at night and can prevent
sleep. The reason symptoms increase at night are possibly due to fluid accumulating around
the wrist and hand whilst lying flat or in the flexed-wrist sleeping position. Carpal tunnel
syndrome may be a temporary condition that completely resolves or it can persist and progress.
As the disease progresses, patients can develop a burning sensation, cramping and weakness
of the hand. Decreased grip strength can lead to frequently dropping objects. Occasionally,
sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also
lead to wasting (atrophy) of the hand muscles, particularly those near the base of the thumb
in the palm of the hand.
What
are the Causes?
Carpal tunnel syndrome is often the result of a combination of factors that
increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem
with the nerve itself. Most likely the disorder is due to a congenital predisposition -
the carpal tunnel is simply smaller in some people than in others. Other contributing factors
include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity
of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the
wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy
or menopause; or the development of a cyst or tumor in the canal. In some cases no cause
can be identified.
There is little clinical data to prove whether repetitive and forceful movements of the
hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Repeated
motions performed in the course of normal work or other daily activities can result in repetitive
motion disorders such as bursitis and tendonitis. Writer's cramp - a condition in which
a lack of fine motor skill coordination and ache and pressure in the fingers, wrist, or
forearm is brought on by repetitive activity - is not a symptom of carpal tunnel syndrome.
Who
is at Risk of Developing Carpal Tunnel Syndrome?
Women are three times more likely than men to develop carpal tunnel syndrome,
perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant
hand is usually affected first and produces the most severe pain. Persons with diabetes
or other metabolic disorders that directly affect the body's nerves and make them more susceptible
to compression are also at high risk. Carpal tunnel syndrome usually occurs only in adults.
The risk of developing carpal tunnel syndrome is not confined to people in a single industry
or job, but is especially common in those performing assembly line work - manufacturing,
sewing, finishing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel
syndrome is three times more common among assemblers than among data-entry personnel.
During 1998, an estimated three of every 10,000 workers lost time from work because of carpal
tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime
cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated
to be about $30,000 for each injured worker.
How
is Carpal Tunnel Syndrome Diagnosed?
Early diagnosis and treatment are important to avoid permanent damage to
the median nerve. A physical examination of the hands, arms, shoulders, and neck can help
determine if the patient's complaints are related to daily activities or to an underlying
disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome. The
wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should
be tested for sensation, and the muscles at the base of the hand should be examined for
strength and signs of atrophy. Routine laboratory tests and X-rays can reveal diabetes,
arthritis, and fractures.
Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome.
In the Tinel test, the doctor taps on or presses on the median nerve in the patient's wrist.
The test is positive when tingling in the fingers or a resultant shock-like sensation occurs.
The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms
upright by pointing the fingers down and pressing the backs of the hands together. The presence
of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing
numbness, is felt in the fingers within 1 minute. Doctors may also ask patients to try to
make a movement that brings on symptoms.
How
is Carpal Tunnel Syndrome Treated?
Carpal tunnel syndrome treatment usually begins conservatively, and moves
to more aggressive and invasive techniques if the symptoms of carpal tunnel syndrome persist.
The initial carpal tunnel syndrome treatment steps include some medications and splints
Your doctor may ask you to rest your wrist or change how you use your hand and may also
ask you to wear a splint on your wrist. The splint keeps your wrist from moving but lets
your hand do most of what it normally does. A splint can help ease the pain of carpal tunnel
syndrome, especially at night.
Putting ice on your wrist, massaging the area and doing stretching exercises may also help.
Cortisone injections decrease inflammation around the nerve providing temporary relief to
the affected area.
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Surgical
treatment
Surgical correction known as the carpal tunnel release is effective in
the treatment of carpal tunnel syndrome. This procedure involves making an incision in the
fibrous sheath around the carpal tunnel. By releasing tension in the carpal tunnel, the
pressure is removed from the nerve.
Open release surgery, the traditional procedure used to correct carpal tunnel syndrome,
consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament
to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on
an outpatient basis, unless there are unusual medical considerations. Endoscopic surgery
may allow faster functional recovery and less postoperative discomfort than traditional
open release surgery. The surgeon makes two small incisions (about ½" each)
in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen,
and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic
surgery, generally performed under local anesthesia, is effective and minimizes scarring
and scar tenderness, if any. One-portal endoscopic surgery for carpal tunnel syndrome is
also available.
After
Surgery
Although symptoms may be relieved immediately after surgery, full recovery
from carpal tunnel surgery can take months. Some patients may need to adjust job duties
or even change jobs after recovery from surgery.
Recurrence of carpal tunnel syndrome following treatment is rare.
The majority of patients recover completely.
Tendonitis - Wrist
What
is Wrist Tendonitis ?
Wrist tendonitis, also called tenosynovitis, is a common condition characterized
by irritation and inflammation of the tendons around the wrist joint. Many tendons surround
the wrist joint. Wrist tendonitis usually affect one of the tendons, but it may also involve
two or more. Often wrist tendonitis occurs at points where the tendons cross eachother or
pass over a bony prominence.
The wrist tendons slide through smooth sheaths as they pass by the wrist joint. These tendon
sheaths, called the tenosynovium, allow the tendons to glide smoothly in a low-friction
manner.
When wrist tendonitis becomes a problem, the tendon sheath or tenosynovium,
becomes thickened and constricts the gliding motion of the tendons. The inflammation also
makes movements of the tendon painful and difficult.
What
are the Symptoms of Wrist Tendonitis?
The most common and consistent complaint of patients diagnosed with wrist
tendonitis is pain over the area of inflammation. Swelling of the surrounding soft-tissues
is also quite common.
How
is the Diagnosis of Wrist Tendonitis Made ?
Diagnosis of wrist tendonitis is a made by looking for the characteristic
signs of this problem. In addition, depending on the tendon that is inflamed, the physician
can perform tests that stretch the area of concern to locate the precise source of inflammation.
For example, one type of wrist tendonitis is called DeQuervain's tenosynovitis.
This is inflammation of the tendon at the base of the thumb. Often seen in new mothers,
DeQuervain's tenosynovitis is diagnosed by a specific test called 'Finkelstein's test' where
the patient makes a fist and the wrist is pulled away from the thumb. Pain from this maneuver
is diagnostic of this type of wrist tendonitis.
Rehabilitation
Exercises
The exercises below will help to strengthen the wrist. Please note that
these should only be attempted when the initial tendonitis has subsided and you wish to
strengthen the wrist. If any pain is initiated from these exercises then you should immediately
cease the exercises.
Tennis
- Elbow Repair
Tennis Elbow
Tennis elbow (medical term lateral epicondylitisis) is where the outer part
of the elbow becomes painful and tender, usually as a result of a specific strain or overuse.
Although it is called "tennis elbow", it is not restricted to tennis players.
Anyone who does a lot of work involving lifting at the elbow or repetitive
movements at the wrist is susceptible to tennis elbow particularly with heavy vibration
such as constant use of road drills, plumbers, painters, gardeners, carpenters, motorcyclists
etc.
Symptoms
- Pain on the outer part of elbow.
- Gripping and movements of the wrist hurt, especially wrist extension
and lifting movements.
- Tenderness to touch, and elbow pain on simple actions such as
lifting a cup of coffee or throwing a ball.
- Pain radiating down the forearm.
- Pain usually subsides overnight.
Non Surgical
Treatments
- Rest, ice, and cold compression therapy are the first initial
treatments.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain,
and inflammation.
- Applying heat and cold (ice packs) in combination works extremely
well, as ice controls swelling and heat heals and promotes blood flow and also relieves
the tightness and pain.
- Anti-inflammatory pain-killers, such as ibuprofen can help
- A brace might also be recommended by a doctor to reduce the range
of movement in the elbow and thus reduce the use and pain.
- Stretches and strengthening exercises help prevent re-irritation
of the tendon
- Sports players may be advised to strengthen shoulder and abdominal
muscles to reduce overcompensation in the wrist during shoulder and arm movements.
- Local steroid injections can relieve symptoms sometimes for several
months, but there is a risk of later recurrence. Following an injection, the patient may
experience pain for a while before the steroid starts to act. Most doctors will limit
treatment to two injections. Steroid injections have little impact in the chronic stages
of the condition.
- ultrasound can be used to reduce the inflammation and promote collagen
production.
Without early treatment this condition can become chronic and more difficult
to eradicate.
Surgical Treatments
Where the Tennis elbow condition has not responded to conservative treatment
surgery is then deemed necessary.
The surgeon will conduct a physical examination and may take X-rays or CT Scans to determine
the exact cause of the problem.
Surgery is usually carried out under general anaesthesia.
The surgeon will make a 3cm incision after which there are several possible surgical treatments
that the surgeon may adopt, including removing a portion of the damaged tendon or releasing
the attachment of the affected tendon. A repair of the healthy portion of tendon is sometimes
carried out as well.
Surgery to release the damaged tendon is usually successful.
The patient will normally stay overnight as a precautionary measure and leave the next day.
Rehabilitation
after Tennis Elbow Surgery?
Within several weeks of surgery, patients should begin light exercises and
begin strengthening their muscles after about six weeks. Patients who wish to return to
athletic activities can begin to do so about 12 weeks after surgery.
Trigger
finger
A trigger finger occurs when the motion of the tendon that opens
and closes the finger is limited, causing the finger to lock or catch as the finger is extended.
The tendons that control the movements of the fingers and thumb slide through a snug tunnel
of tissue, created by a series of pulleys which keep the tendons in place. The tendon can
become irritated as it slips through the tunnel. As it becomes more and more irritated,
the tendon may thicken, making its passage through the tunnel more difficult. The tissues
that hold the tendon in place may thicken, causing the opening of the tunnel to become smaller.
As a result, the tendon becomes momentarily stuck at the mouth of the tunnel as the finger
is extended. A pop may be felt as the tendon slips past the tight area. This why pain and
catching may be felt as the finger is moved.
The goal of surgery is to widen the opening of the tunnel so that the tendon can slide through
it more easily. The surgery is performed through a small incision in the palm. Usually,
the fingers can be moved immediately after surgery. Some soreness in the palm is common,
but elevating the hand after surgery can help reduce swelling and pain. Recovery is usually
complete within 6 - 8 weeks.
ANKLE
FUSION:
An ankle fusion is a surgical procedure that is usually done when an ankle
joint becomes worn out and painful, a condition called degenerative arthritis.
An ankle fusion actually removes the surfaces of the ankle joint and allows the tibia to
grow together, or fuse, with the talus. For the ankle, a fusion is a very good operation
for treating a worn-out joint. This is especially true if the patient is young and very
active. An ankle fusion, if successful, is not in danger of wearing out like an artificial
ankle. A fusion keeps the ankle joint from moving during walking and other activities, so
the other foot joints will need good mobility.
You can expect a great deal of swelling in your ankle, and will need to keep your foot elevated
to help reduce the swelling. Once the swelling goes down and the incisions on your foot
are healing, you will be put in a plaster cast from your knee to your toes. You will need
to wear the cast until the ankle has fused — usually 3-4 months. For the first 6 weeks
you should not put any weight on your foot as it may disturb the healing joint. While in
the hospital, a physical therapist will teach you how to walk with crutches without putting
weight on your foot.
Over the next few weeks, you will have x-rays taken to monitor the healing of your fused
ankle joint. When the x-rays show that the joint is fused enough to take your weight, the
cast will be removed and you will be given a brace to wear that will support you as you
begin walking with weight on your foot again. The brace is usually worn for about a month.
Ankle
Arthroscopy
WHAT IS AN ANKLE ARTHROSCOPY?
Ankle Arthroscopy is a minimally invasive surgical procedure used to investigate, diagnose
and treat an ankle disorder that fails to respond to physiotherapy, medication or other
non-surgical treatments. This procedure involves using very small incisions to enables the
Surgeon have a quick easy and clear view of the inside of the ankle through a pencil slim
camera known as an Arthroscope Each incision is less than 1cm and usually two incisions
are required. There are two types of Ankle Arthroscopy a) Diagnostic Arthroscopy (investigation
to find out what is wrong with an ankle joint) b) Therapeutic Arthroscopy (correction of
an injury or fault within the ankle joint). It is most common for these procedures to be
provided at the same time.
Ankle Arthroscopy is usually performed in order to investigate and relieve persistent ankle
pain, swelling, clicking, catching, instability or 'giving way' of the joint. This is an
increasingly more common orthopaedic procedures today than it has ever been because the
ankle joint is so easily injured through sport injuries, work related injury, arthritis
or general inflammation or 'wear and tear'. The majority of Ankle Arthroscopies are performed
on patients between the age range of 20 and 60 years, although much younger and older patients
can also benefit from this procedure.
The very small incisions used result in minimal soft tissue disruption and trauma. This
in turn results in:
- Significantly lower pain levels than an open approach
- The ankle is comfortable to weight bear through on the day of
surgery
- Most cases can be performed as day cases
- Lower infection rates than open surgery
- Earlier return to work/function/sports
- Little scarring
- Minimal effect if further surgery to the ankle is required
Once back on the ward the physiotherapist will get the patient
up. The patient may put as much weight through the ankle as is comfortable. Crutches maybe
needed for a day or so.
The affected limb will need to be elevated when not weight bearing for the first 48 hours.
Dupuytren’s
Fasciectomy
The layer of tissue just under the skin in your palm, the fascia,
has become abnormal. The fascia has formed a band which is thicker than normal and is
shortened. The band prevents you fully straightening your finger. This is known as Dupuytren's
contracture.
Surgery is the most common treatment of Dupuytren's disease. Surgery is usually considered
at a relatively late stage of the disease, typically when fingers are already bent by
more than 15 to 20 degrees and the use of the hand has become restricted. In a much progressed
stage, when the hand is already bent inwards, surgery is the only proven therapy that
we know of that can make your hand straight again.
Surgical procedures:
There are two main options:
Open fasciectomy.
Fasciectomy simply means cutting the thickened tissue. (Another word for the thickened
tissue is called fascia.)
Open fasciectomy means that to get to the thickened tissue, the overlying skin is cut
open. This allows the surgeon to see the thickened tissue, and then to cut it. The skin
is then stitched back together. It is a relatively minor procedure which can be done
under local anesthetic.
Needle fasciectomy.
This is sometimes called needle aponeurotomy. The Surgeon pushes a fine needle through
the skin over the contracture. He then uses the sharp bevel of the needle to cut the thickened
tissue under the skin. The procedure is done under local anesthetic.
So which is the best option? There are pros and cons of each procedure. For example:
Needle fasciectomy can be a quick procedure and has shorter healing time. However, the
contracture returns in about half of cases within 3-5 years following this procedure.
If you have an open fasciectomy, (removal of the thickened tissue), the chance of the
problem returning is much less than with a needle fasciectomy. However, it is a more extensive
operation and it can take some time for the wound to heal and for you to get full function
of the hand.
Hallux
Rigidus
What is Hallux Rigidus?
Hallux rigidus is a disorder of the joint located at the base of the big
toe. It causes pain and stiffness in the big toe, and with time it gets increasingly harder
to bend the toe. "Hallux" refers to the big toe, while "rigidus" indicates
that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative
arthritis.
Early signs and symptoms include:
- Pain and stiffness in the big toe during use (walking, standing,
bending, etc.)
- Pain and stiffness aggravated by cold, damp weather
- Difficulty with certain activities (running, squatting)
- Swelling and inflammation around the joint
- As the disorder gets more serious, additional symptoms may
develop, including:
- Pain, even during rest
- Difficulty wearing shoes because bone spurs (overgrowths) develop.
Wearing high-heeled shoes can be particularly difficult.
- Dull pain in the hip, knee, or lower back due to changes in
the way you walk
- Limping, in severe cases
What Causes Hallux Rigidus?
Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities
of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis—the
kind that results from "wear and tear"—often develops in people who have
defects that change the way their foot and big toe functions. For example, those with
fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing
hallux rigidus.
In some people, hallux rigidus runs in the family and is a result of inheriting a foot
type that is prone to developing this condition. In other cases, it is associated with
overuse—especially among people engaged in activities or jobs that increase the
stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus
can also result from an injury—even from stubbing your toe. Or it may be caused
by certain inflammatory diseases, such as rheumatoid arthritis or gout. Your foot and
ankle surgeon can determine the cause of your hallux rigidus and recommend the best treatment.
Diagnosis of Hallux Rigidus
The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best
time to see a foot and ankle surgeon is when you first notice that your big toe feels
stiff or hurts when you walk, stand, bend over, or squat. If you wait until bone spurs
develop, your condition is likely to be more difficult to manage.
In diagnosing hallux rigidus, the foot and ankle surgeon will examine your feet and manipulate
the toe to determine its range of motion. X-rays are usually required to determine how
much arthritis is present as well as to evaluate any bone spurs or other abnormalities
that may have formed.
Torn
Achilles Tendon
The Achilles tendon is the tendon that connects the calf muscle
(gastrocnemius) to the heel bone (calcaneus). This is the tendon that is just below the
skin at the back of the ankle. As with most tendon injuries, this tendon may be injured.
FUNCTION
When the gastrocnemius muscle (in the calf) contracts (shortens), the
tendon which is attached from the muscle to the heel bone (calcaneus) moves. As the muscle
shortens, the tendon moves to point the foot downwards. This is the action that allows
a person to stand on one's toes, to run, to jump, to walk normally, and to go up and down
stairs.
TYPES OF INJURIES
Achilles tendonitis is an inflammation of the tendon. It
often results from a small stretch injury that causes the tendon to become swollen, painful
and less flexibility than the normal tendon. Untreated, this injury may fail to heal,
or progress to a chronically painful condition. Of course, in some people, the tear may
progress to a complete rupture of the tendon. A ruptured (or torn) tendon may occur when
the tendon has been structurally weakened by an ongoing tendonitis, or when a completely
healthy tendon is subjected to a sudden, unexpected force. As a result, the tendon tears.
When the tendon tears, people often report hearing a pop at the back of the ankle. If
they are playing doubles in tennis, the person often thinks that his/her partner has hit
them in the back of the ankle. With the injury, pain, swelling, and loss of function occur.
Since the calf muscle is no longer attached to the heel bone, people find it difficult
to walk normally, and have difficulty doing activities that require any type of significant
push off with their toes (such as running, jumping, doing toe raises). Left untreated,
the tendon often fails to heal, thereby resulting in a permanent disability.
DIAGNOSIS
For a tendon rupture, the area of the rupture is often swollen, tender,
bruised (ecchymotic), and may actually have a palpable gap in the tendon. X-rays, although
they do not show the tendon reliably, do show the calcaneus. When doing the x-ray, the
physician is checking to see if the bone to which the Achilles tendon attached (calcaneus)
has been injured. In some cases, the tendon will not tear; but instead, it will literally
pull a piece of calcaneal bone off of the rest of the calcaneus. Although this is repairable,
the technique is different then merely sewing the two ends of a ruptured tendon together.
If the tendon has not ruptured, then the patient may have sustained only a pulling injury
to the tendon. This type of injury results in a stretch injury to the tendon which is
called tendonitis. Although this often heals without surgery, until completely healed,
the tendon is structurally weaker then normal and is at an increased risk for tearing
with continued athletic activity or additional injury producing situations. The most reliable
diagnostic study for a suspected rupture of the Achilles' tendon is the Thompson test.
This is a test performed during the physical exam. When then test is abnormal, the probability
of a ruptured tendon being present is extremely high.
TREATMENT
The treatment options for a complete rupture of the tendon
include surgery followed by casting, or casting alone. There are advantages and disadvantages
to each technique and the options should be discussed with your physician. With surgery,
the tendon is either reattached to the calcaneal bone (if it has been pulled off or avulsed)
or the two ends are sewn together is the tendon has been torn in two. In most people,
a cast is applied after surgery until healing is complete. Each patient must be considered
individually. There are many reasons why a person may not be a suitable candidate for
a surgical repair of the injury. These include, but are not limited to: poor circulation,
presence of skin problems at the site of the injury, age, a sedentary lifestyle, other
medical conditions that make the person a poor candidate for surgery (such as heart or
lung problems). If the injury is treated non-operatively, then a cast is applied until
healing is complete. The length of time required for healing is highly variable. Often
it may take as long as six months for complete healing to occur.
Trapeziectomy
The Trapezium is one of the eight carpal (wrist) bones and lies at
the base of the thumb. Arthritis in the joints is very common and is contributed to by
instability of the joint and a natural vulnerablity to wearing of the joint surface. Its
is a progressive condition that leads to increasing stiffness and deformity of the thumb.
If neglected, the joint tends to stiffen.
Trapeziectomy involves the complete removal of the trapezium bone. It is mandatory if
the joints both above and below the trapezium are arthritic. Some Surgeons fill the gap
but there is no evidence that this improves outcome.
Trapeziectomy with ligaments reconstruction is performed routinely by
many surgeons. There is no evidence that this improves outcome and reserve it for instance
where the base of the thumb appears too slack to sit securely into the new joint created
by removal of the bone
A hammer toe is a deformity of the second, third or fourth toes.
In this condition, the toe is bent at the middle joint, so that it resembles a hammer.
Initially, hammer toes are flexible and can be corrected with simple measures but, if
left untreated, they can become fixed and require surgery.
People with hammer toe may have corns or calluses on the top of the middle joint of the
toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty
finding comfortable shoes.
Hammer toe results from shoes that don't fit properly or a muscle imbalance, usually in
combination with one or more other factors. Muscles work in pairs to straighten and bend
the toes. If the toe is bent and held in one position long enough, the muscles tighten
and cannot stretch out.
Shoes that narrow toward the toe may make your forefoot look smaller. But they also push
the smaller toes into a flexed (bent) position. The toes rub against the shoe, leading
to the formation of corns and calluses, which further aggravate the condition.
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