What are the Basic Techniques Used in Microsurgery?

The procedure performed on very small structures like the nerves and blood vessels using specialized instruments (under a microscope) is called microsurgery.

Microsurgery makes use of techniques that have been performed since the early twentieth century like organ transplantation and blood vessel repair.

Many surgical specialties use microsurgical techniques.

For instance:

  • Otolaryngologists (ear, nose, and throat doctors) – performs microsurgery on the delicate and small structures of the vocal cords or the inner ear.
  • Ophthalmologists (eye doctors) – performs microsurgery in corneal transplants and cataract removals and when treating eye conditions like glaucoma.
  • Urologists and gynecologists – performs microsurgery to reverse vasectomies (male sterilization) and perform tubal ligations (female sterilization).
  • Plastic surgeons – performs microsurgical techniques to reconstruct disfigured or damaged muscles, skin, and other tissues and transplant tissues from other parts of the body.

Equipment

Equipment used in microsurgical procedures magnify the operating field, provides precise instrumentation for easier maneuvering under high magnification, and makes it possible for the surgeons to be able operate on structures that are barely visible to the naked eye.

Microscope

While operating microscopes can vary, depending on their specific uses, they share similar standard features.

The microscope can be ceiling or floor mounted and it comes with a moveable arm to ensure easier manipulation.

A high-intensity light source and a set of lenses ensures a clear view of the surgical site.

Two (or more) sets of lenses makes it possible for the surgeon and an assistant not just to view the operating field but to also independently zoom in and focus.

The rest of the surgical team can view the operating site on a display screen.

Other features include motorized zoom and focus and mouth or foot switch controls.

A five to forty times magnification (5–40x) is usually required for microsurgical procedures.

A lower magnification is used when identifying and exposing structures while a higher magnification is needed when performing microsurgical repair.

Instruments

Microsurgical instruments have distinct differences compared to conventional instruments.

They are designed to make delicate manipulation of small structures possible and they come with handles large enough to hold securely and comfortably.

Some of the common instruments used in microsurgery include:

  • Forceps
  • Scissors
  • Irrigators
  • Vascular clamps
  • Needle holders
  • Vessel dilators
  • Other standard surgical tools

Suture Materials

Stitching or suturing is done using specialized needles and thread.

The diameter (gauge) of the suture thread can vary in size depending on the tissue that needs suturing and the procedure that will be performed.

Suture threads can be absorbable (broken down in the body after a certain amount of time) or non-absorbable (retains its strength indefinitely).

It can also be natural (made of gut, linen, silk, and other natural materials) or synthetic (made of wire, polyester, nylon, and other man-made materials).

The type of suture thread that will be used will depend on the tissue that will be sutured and the procedure that will be performed.

Suture needles can come in various shapes (curved or straight) and sizes (length and diameter).

It also has different point types (blunt, cutting, or rounded).

Generally, needles that are 0.15 mm in diameter are used in microsurgery.

Techniques

Microsurgical procedures use a set of basic techniques that needs to be mastered by the surgeon.

These techniques include vein grafting, blood vessel repair, and nerve repair and grafting.

Blood Vessel Repair

Connecting two cut or separate blood vessels in order to form a continuous channel is called blood vessel repair or vascular anastomosis.

Anastomoses may be end-to-side (connecting one cut end to the wall of another vessel) or end-to-end (between two cut ends).

Vein Grafting

If the cut ends of a blood vessel cannot be attached without any tension, vein grafting is performed. It is an alternative procedure to end-to-end anastomosis.

Nonessential veins that are same in diameter to the recipient blood vessel can be taken from the foot, arm, or hand.

Nerve Repair

When two cut ends of the nerve are connected, the process is referred to as neurorrhaphy or nerve anastomosis.

Nerve repair may involve suturing of the perineurium only, epineurium only, or through both layers.

Nerve Grafting

If a large gap is present between the end of the nerves that are cut, neurorrhaphy cannot be performed without creating any tension in the nerve.

Any tension created can end up interfering with the patient’s postsurgical function.

A piece of the nerve (from another part of the body) may be utilized to create a nerve graft.

It is then stitched into place using anastomosis techniques.

Training

Before a surgeon performs microsurgery in a clinical setting, extensive practice and training will be required.

In addition, basic knowledge of surgical techniques and anatomy will also be needed.

After comprehensive introduction to microsurgical equipment and the operating microscope, basic techniques will be introduced.

Specifically, surgeons must also learn the following basic skills:

  • How to maintain correct posture during the procedure
  • How to maintain constant visual contact with the microscope
  • How to properly hold the instruments
  • How to minimize hand tremors
  • How to perform basic techniques

Once proficiency in the abovementioned skills has been attained, more advanced techniques will be introduced including procedures when treating specific conditions.

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What are the Most Common Orthopaedic Disorders?

Many conditions affect the body’s musculoskeletal system.

While mild cases will respond to home care remedies, others will require the help and expertise of an orthopaedic specialist.

Some of the most prevalent orthopaedic disorders include:

Osteoarthritis

Considered the most common type of arthritis, osteoarthritis is a chronic degenerative joint disease that often affects old and middle-aged individuals.

The condition is characterized by the breaking down of the joint cartilage.

While osteoarthritis can develop in any joint, it usually affects the knees, hands, spine, and hips.

Causes

Osteoarthritis has two classifications—primary and secondary.

The former has no known cause while the latter can be attributed to other factors like infection, deformity, injury, or another disease.

The condition starts with the breakdown of the cartilage.

As it breaks down, the ends of the bone may thicken and bony growths (spurs) can form.

These spurs can interfere with joint movement and bits of bone and cartilage can end up floating in the joint space.

In addition, fluid-filled cysts may also develop in the bone resulting to limited joint movement.

Symptoms

The most prevalent indicator of the condition is pain after joint overuse or inactivity.

Symptoms of osteoarthritis often gradually develop over the years.

Symptoms may vary from one individual to another.

However, it can often include the following:

  • Joint pain
  • Joint stiffness (especially noticeable after inactivity or sleep)
  • Limited joint movement
  • Grinding feeling especially when the joint is moved (more prevalent in the advanced stages)

Treatment

Treatment of the condition will often depend on the patient’s age, symptoms, and general health.

The severity of the condition will also be taken into account.

Treatment goals include reducing joint stiffness and pain and improving joint mobility.

Treatment interventions can include:

  • Exercise – regular exercise (including strengthening and stretching) can help minimize pain and other symptoms.
  • Heat treatment – treating the joint affected with heat may be helpful in alleviating pain.
  • Occupational and physical therapy – these types of therapy may help improve flexibility, minimize joint strain, and reduce joint pain.
  • Assistive devices like splints may also be beneficial.
  • Weight maintenance – maintaining a healthy weight can help minimize symptoms.
  • Medications – this can include anti-inflammatory medications and pain relievers.
  • Joint surgery – surgery might be recommended when there is severe joint damage.

Fractures

A partial or complete break in the bone is called a fracture.

Fractures are classified as open or closed.

Open fractures (compound) occurs when the bone pokes through the skin or when a deep wound exposes the bone.

Closed fractures (simple) occurs when the bone is broken but the skin stays intact.

There are different types of fractures.

Some of the most common include:

  • Greenstick – a bone portion breaks causing the other side to bend
  • Transverse – the break is in a straight line (across the bone)
  • Spiral – break spirals around the bone (usually in twisting injuries)
  • Oblique – break is diagonal across the bone
  • Compression – bone is crushed
  • Segmental – bone is fractured in two places
  • Comminuted – bone is broken into three (or more) pieces, with bone fragments present in the site of the fracture

Causes

Fractures often occur when the force applied to the bone is more than it can handle.

Bone fractures can be attributed to trauma and falls.

It can also be a result of a kick or direct blow to the body.

Repetitive motions and overuse can also tire muscles and put strain and pressure on the bone. This can result to stress fractures—a condition common among athletes.

Fractures can also occur as a result of diseases that weaken the bone, like bone cancer or osteoporosis.

Symptoms

While fracture symptoms can vary, some of the most common include:

  • Sudden pain
  • Difficulty moving or using the affected area or the joints nearby
  • Swelling
  • Noticeable deformity
  • Redness, warmth, and bruising

Treatment

Treatment goals for fracture include putting the broken pieces back in place, preventing complications, controlling the pain, restoring normal function, and giving the affected bone time to heal.

Treatment options can include:

  • Cast or splint – used to immobilize the affected area in order to keep the bone aligned. It also helps ensure the injured area is kept from motion or use while the affected bone is still healing.
  • Medicine – medications are given to control pain.
  • Traction – pulleys, weights, strings, and a metal frame is attached on or over the bed in order to stretch the tendons and the muscles around the broken bone. It will help the affected bone align and heal.
  • Surgery – surgery might be recommended to put the broken bones back in place. Internal or external fixation devices may be used to hold the bone fragments together while healing.

Carpal Tunnel Syndrome

When the median nerve is compressed while it passes through the carpal tunnel, carpal tunnel syndrome occurs.

The median nerve functions by providing motor and sensory functions to the 3 middle fingers and the thumb.

Women are 3 times more prone to developing the condition compared to men.

Causes

Most cases of the condition cannot be attributed to a specific cause.

However, the following are some of the factors that may contribute to the development of the condition:

  • Constant, repetitive, and small movements using the hands (i.e. using a keyboard or typing)
  • Repetitive, frequent, and grasping hand movements (in sports or when doing certain physical activities)
  • Metabolic or hormonal changes (i.e. pregnancy, menopause, or thyroid imbalance)
  • Blood sugar level changes (for instance, in type 2 diabetes)
  • Other wrist injuries or conditions (i.e. sprain, dislocation, break, strain, and inflammation)
  • History of carpal tunnel syndrome in the family

Symptoms

Some of the telltale indicators of carpal tunnel syndrome include:

  • Weakness when gripping objects (either with one or both hands)
  • Numbness or pain (in one or both hands)
  • “Pins and needles” sensation in the fingers
  • Swollen feeling in the affected fingers
  • Tingling or burning in the fingers (especially in the index and middle fingers and the thumb)
  • Numbness and pain that worsens at night and may even interrupt sleep

Treatment

An orthopaedic specialist can recommend the best treatment intervention for the condition based on the following:

  • Patient’s age
  • Patient’s medical history
  • Patient’s overall health
  • Severity of the condition
  • Patient’s tolerance to specific medications, therapies, or procedures
  • Patient opinion or preference

Treatment interventions for carpal tunnel syndrome can include:

  • Hand splinting – helps keep the affected wrist from movement. It can also help ease the nerve compression inside the tunnel.
  • Anti-inflammatory medications – can be taken orally or can be injected into the carpal tunnel space to help minimize the swelling.
  • Exercise – strengthening and stretching exercises can be beneficial for patients whose symptoms have gotten better. The exercises are best recommended and supervised by a competent occupational or physical therapist.
  • Worksite changes – changing the position of the computer keyboard and making other ergonomic changes has been known to help ease some of the symptoms.
  • Carpal tunnel syndrome surgery – eases the nerve compression in the carpal tunnel.

Effective Ways to Prevent Back Pain

Back pain is considered a universal human experience. In other words, it is safe to assume that many people the world over have experienced it at one point or another. The condition is considered a primary cause of disability and is considered one of the primary reasons people miss work or visit a back pain specialist.

Fortunately, certain measures can be observed to help ensure the condition is kept at bay. If prevention fails, simple home care and proper body posture and mechanics can help heal the condition in a few weeks, at least in minor cases.

What are the common causes?

Back pain caused by heavy lifting or falls can occur suddenly and can last less than six weeks (acute). When back pain lingers for more than three months, it is already considered chronic. Back pain can be attributed to numerous causes and can be associated with the following conditions:

  • Ligament or muscle strain – drastic awkward movements and repeated lifting of heavy objects may strain the spinal ligaments and the back muscles. Constant back strain may also result to painful muscle spasms.
  • Ruptured or bulging disks – disks work by providing cushion between the bones found in the spine (vertebrae). The soft material in the disk can rupture and press on a nerve.
  • Arthritis – osteoarthritis can sometimes affect the lower back. In some instances, arthritis in the spine can result to narrowing of the space around the spinal cord (spinal stenosis).
  • Skeletal irregularities – when the spine curves abnormally, back pain can also manifest. Severe cases of scoliosis (a condition characterized by the curving of the spine to the side) may also result to back pain.
  • Osteoporosis – the vertebrae of the spine can develop compression fractures when the bones become brittle and porous.

How do I know I have a back problem?

Common symptoms and signs of back pain can include:

  • Stabbing or shooting pain
  • Radiating pain
  • Limited range of motion and back flexibility
  • Muscle ache

Most cases of back aches will respond well to self-care and home treatment and will get better within two weeks.

When should I see a Doctor or a Back Pain Specialist?

If the back pain persists, or worsens please seek medical attention.

Also seek medical attention if the back pain:

  • Is a result of fall, blow to the back, or other injuries
  • Is accompanied by fever
  • Causes bladder or bowel incontinence (unable to control urine or passing motion)

Seeing a doctor is also considered necessary in the following scenarios:

  • When the back pain is severe and does not improve with rest
  • When the pain spreads to one (or both) legs or extends below the knee
  • When there is tingling, numbness, and weakness in one (or both) legs
  • Is accompanied by drastic and unexplained weight loss

Setting an immediate appointment with the doctor is also suggested for those who experience back pain for the first time past the age of 50 or those who experience back pain and has a history of osteoporosis, steroid use, cancer, or alcohol and drug abuse. By seeing a doctor early, early tests and investigations can be ordered(eg.Lumbar spine X-rays). This can detect spine disorders early for effective treatment.

Risk Factors of Back Pain

The following are some of the risk factors that put one at a greater risk of developing pain in the back:

  • Lack of exercise – weak and unused muscles in the back may result to back pain.
  • Age – back pain becomes more prevalent as one ages and has the tendency to occur more often once the person turns 30 or 40.
  • Excess weight – carrying around those extra pounds can put stress and strain on the back.
  • Diseases – certain types of cancer and arthritis may contribute to back pain.
  • Psychological conditions – those who are prone to anxiety and depression appear to be more susceptible to pain in the back.
  • Smoking – this has been believed to hinder the delivery of enough nutrients to the disks in the back.
  • Improper lifting – using the back as opposed to the legs may result to back pain.

How can I prevent back problems?

Back pain may be avoided by improving one’s physical condition and practicing the right body mechanics. To ensure the back stays strong and healthy:

  • Build muscle flexibility and strength – back muscle and abdominal exercises (core strengthening exercises) can help condition the muscles so they can effectively function like a natural corset for the back. A physical therapist can suggest exercises that can help achieve said objectives.
  • Exercise – doing low-impact aerobic activities on a consistent basis has been known to help increase both the endurance and strength of the back. It also helps the muscles function better. Swimming and walking are considered good choices.
  • Maintain a healthy weight – carrying around excess weight may strain the muscles of the back. Losing the extra pounds can do wonders for the back.

Observe proper body posture and mechanics:

  • Stand smart – observing a neutral pelvic position as all times is considered ideal. When standing for long periods, placing one foot on a stool (and alternating) can help take some load off from the lower back. Observing proper posture can also help minimize stress placed on the back muscles.
  • Sit smart – at all times, opt for a seat that offers good lower back support, has an arm rest, and a swivel base. To ensure normal curve is maintained, consider placing a rolled pillow or towel in the small of the back. The knees and hips should also be kept level. Changing positions (ideally, every 30 minutes) is also considered ideal.
  • Lift smart – whenever possible, refrain from lifting anything heavy. However, if you really need to lift something heavy, ensure you let your legs do all the work. The back should also be kept straight with the bending done only at the knees. If the object is too heavy, it would be best to get a lifting partner so the back is not strained.

Sore Back? It Might Be Ankylosing Spondylitis

Ankylosing spondylitis (SA) is a type of chronic inflammation of the sacroiliac joints and the spine. Chronic inflammation in those areas can result to stiffness in and around the spine including the middle and lower back, the neck, and the buttocks.

Over time, spondylitis (chronic inflammation of the spine) can result in fusion of the vertebrae. This fusion is referred to as ankylosis. In some cases, ankylosis may lead to spine mobility loss. Ankylosing spondylitis is a systemic disease. In other words, it not only affects the spine but also other tissues throughout the body.

The condition shares several features with other arthritic conditions like reactive and psoriatic arthritis. The condition is more common among men than in women. It also affects all age groups, even children. In children, the condition is referred to as juvenile ankylosing spondylitis. The condition is also known as Bechterew’s disease.

What are the Causes?

Ankylosing spondylitis is believed to be genetically inherited. Nearly 90 percent of SA patients are born with the HLA-B27 gene. Studies indicate that the gene can increase one’s risk of developing the condition. Other genes like ARTS1 and IL23R have also been linked to the development of ankylosing spondylitis. Both genes are believed to influence immune system function.

What are the Symptoms?

Symptoms of SA are often associated with inflammation of the joints, spine, and other body parts. Spine inflammation results in stiffness and pain in the neck, lower back, upper buttock area, and the remainder of the spine. Fatigue is also a prevalent symptom that comes with active inflammation.

Onset of stiffness and pain is often gradual and worsens with loss of motion. Pain and stiffness also become more noticeable after hours of inactivity and in the mornings. Since ankylosing spondylitis is common among adolescents, onset of low back pain is sometimes incorrectly attributed to athletic injuries.

Patients with chronic and severe spine inflammation can develop ankylosis (complete bony fusion of the spine). When this happens, spine pain disappears but patient will experience complete loss of spine mobility. The fused spines are often brittle and are more prone to breakage or fracture. Among patients, sudden onset of pain in the spinal area often signals bone breakage. Ankylosing spondylitis patients can also have arthritis in other joints aside from the spine.

In some cases, patients will experience stiffness, swelling, redness, and pain in the joints found in the knees, hips, and ankles. Occasionally, small joints of the toes can also swell and become “sausage” shaped. In addition, the condition can also cause scarring and inflammation of the lungs and can result to shortness of breath and coughing. Therefore, breathing difficulty can be a complication for those who are suffering from the condition.

How is the Diagnosis confirmed?

Diagnosis of ankylosing spondylitis is done through physical examination and evaluating symptoms, blood tests, and X-ray findings (radiographs). Pain, stiffness, and decreased motion range of the spine are some of the most prevalent symptoms of ankylosing spondylitis.

However, early symptoms of the condition can be deceptive as stiffness and pain in the lower back can also be seen in several other conditions. Physical examination of patients with SA will often show signs of joint inflammation and decreased motion range, particularly in the spine. Low back and neck flexibility will also decrease.

Additional clues that can help with the diagnosis can be apparent by X-ray abnormalities of the spine and the presence of HLA-B27 genetic marker in the blood.

What is the Treatment?

Treatment intervention for SA typically involves the use of medications to minimize inflammation, suppressing immunity to keep the disease from progressing, exercise, and physical therapy. Medications can reduce inflammation in the spine and other joints and organs. Exercise and physical therapy can also help improve spine mobility, lung capacity, and posture. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed to decrease stiffness and pain in the spine and other joints.

In some patients, inflammation of joints aside from the spine (i.e. knees, hips, ankles, etc.) can be a concern since inflammation in those areas may not respond to NSAIDs alone. In line with this, additional medications that will suppress the body’s immune system may be introduced.

Injectable or oral corticosteroids (cortisone) are powerful anti-inflammatory agents and may be given to effectively control spondylitis and other body inflammations. Unfortunately, it can only be used for short periods as long-term use can have serious side effects.

Physical therapy for patients with SA will involve instruction and exercises to maintain proper posture. It also includes stretching exercises and deep breathing (for lung expansion) to enhance joint and spine mobility. Since spine ankylosis may cause kyphosis (forward curvature), patients are advised to do back-extension exercises and maintain proper posture as often as possible. Physical therapists will also design tailored exercise programs for each individual.

Swimming is often recommended as it helps avoid any jarring impact on the spine. Aerobic exercises are also encouraged as it helps open the lung’s airways and promote total expansion of the breathing muscles.

In cases where severe disease of the spine and the hip joint has occurred or trauma has happened, orthopedic surgery may be needed. Newer treatment techniques enable a good quality of life for patients to be achieved.

Prevalent Symptoms of Ingrown Toenail

Ingrown toenail is a common condition characterized by the corner (or side) of the toenail growing into the soft flesh.

The condition often affects the big toe and can result to redness, swelling, pain, and in some cases, an infection.

While minor cases will respond to homecare treatments, others might result to complications that will require medical intervention.

Complication risk is higher for those individuals who have diabetes or other conditions that causes poor blood circulation to the legs and feet.

Causes

Ingrown toenail can be attributed to some of the following causes:

  • Incorrect cutting of the toenails (should be straight across so the sides of the nail will not grow into the skin)
  • Curved and irregular nails
  • Shoes that are too narrow, flat, or tight
  • Toenail injuries
  • Genetic predisposition
  • Improper foot hygiene

Excessive use of the feet during athletic activities can also make one susceptible to ingrown toenail.

Athletic activities that increase one’s risk for ingrown toenail include:

  • Football
  • Soccer
  • Ballet
  • Kickboxing

Symptoms

Ingrown toenails can be very painful and can worsen over time.

In its early stage, some of the prevalent symptoms of the condition can include:

  • Tenderness
  • Swelling
  • Pain (especially when pressure is placed on the affected toe)
  • Fluid build-up

When infection has set in, other symptoms can manifest including:

  • Redness and swelling
  • Bleeding
  • Pain
  • Skin overgrowth (around the affected toe)
  • Pus

When left undetected or untreated, the condition can infect the underlying bone and may result to serious bone infection.

Complications can be especially severe in patients that are diabetic or any other conditions that causes poor blood flow.

Appointment

A doctor or a podiatrist (foot doctor) can easily diagnose an ingrown toenail.

To accurately diagnose the condition, the doctor will likely ask relevant questions aside from physically examining the affected toe.

Some of the possible questions can include:

  • When did the symptoms begin?
  • Are the symptoms experienced all the time?
  • What are some of the homecare treatments that have been tried?
  • Do you have diabetes or other conditions that may cause poor blood flow to the legs and feet?

To make the most out of your scheduled appointment, it is ideal that you also prepare a list of questions you may have about the condition.

Some of the questions that should make it to your list should include:

  • Is the condition long-term or just temporary?
  • What are the possible treatment options for my case?
  • What are the pros and cons of each?
  • What results can I look forward to?
  • Is it advisable to just wait until the condition heals on its own?
  • What nail care regimen would be recommended while the affected toe is healing?

Treatment Options

Home Treatment

In mild cases (with no infection), the condition will often respond very well to home care remedies.

Treat ingrown toenail at home by:

  • Soaking feet in warm water three to four times a day (at least 15 to 20 minutes each time)
  • Pushing skin away from the toenail’s edge (use a cotton ball soaked in olive oil)
  • Using over-the-counter medications such as acetaminophen (Tylenol) to relieve the pain
  • Applying topical antibiotic like neomycin and polymyxin (or a steroid cream) to prevent the affected toenail from getting infected

If the condition does not respond to homecare treatments or when an infection develops, ingrown toenail surgery might be required.

Surgical Treatment

Partial Nail Removal – this involves removal of only the portion of the nail that digs into the skin. A piece of cotton is placed under the remaining portion to keep the condition from recurring. A compound called phenol may also be used to keep the nails from growing back. This procedure is considered 98 percent effective in preventing future ingrown toenails.

Total Nail Removal – may be recommended when the condition is caused by thickening. A local pain injection will be given and the entire nail is removed. The procedure is also called matricectomy.

After the procedure, patients will be sent home with a bandaged toe.

Keeping the affected foot raised for a day or two may also be recommended.

Wearing special footwear to help the toe heal properly may also be suggested.

Usually, the bandage is removed two days after the procedure.

Wearing open-toed shoes and doing salt water soaks daily will also be recommended until the toe heals completely.

Pain relief medications and antibiotics will also be prescribed to prevent infection.

Prevention

To help ensure ingrown toenail is prevented, the following beneficial tips should be kept in mind:

  • Toenails should be trimmed straight across – when trimming, do not match the shape of the toe. If you will have your toenails done at a salon, advice the pedicurist to trim straight across.
  • For patients who have diabetes or other conditions that can cause poor blood flow, having a podiatrist trim the nails is recommended.
  • Ensure toenail length is moderate – trimming too short can prove counterproductive as shoe pressure may cause the nails to directly grow into the tissue.
  • Wear proper-fitting footwear – shoes that put too much pressure on the feet may also cause ingrown toenail to develop.
  • Wear protective footwear – if your job puts you at risk of injuring your toes, wearing protective footwear (i.e. steel-toed shoes) is recommended.

What Symptoms Point to Carpal Tunnel Syndrome?

The carpal tunnel is a narrow (about an inch wide) passageway in the wrist.

The tunnel’s floor and sides are formed by small bones wrist bones known as the carpal bones.

The tunnel’s roof is the transverse carpal ligament—a robust band of connective tissue.

Since the boundaries are very rigid, there is little capacity for the carpal tunnel to increase in size or “stretch.”

One of the primary nerves in the hand is called the median nerve.

It goes down the forearm and the arm, passes through the carpal tunnel, and into the hand.

The median nerve not only controls the muscles situated around the base of the thumb, it also provides the feeling in the middle, ring, and index fingers as well as the thumb.

Nine tendons that bend the thumb and the fingers also pass through the carpal tunnel.

These tendons are known as flexor tendons.

When the tunnel narrows down or when the tissues that surround the flexor tendons swell, pressure is placed on the median nerve.

When the median nerve is compressed or squeezed, carpal tunnel syndrome occurs.

Risk Factors

Many carpal tunnel syndrome cases are attributed to a combination of factors.

Studies indicate that older people and women are more prone to developing the condition.

Risk factors for carpal tunnel syndrome include:

  • Repetitive use of the hand – repetition of wrist and hand activities or motions for prolonged periods may irritate the tendons in the wrist. The irritation may cause it to swell and put pressure on the median nerve.
  • Heredity – there might be anatomic differences that can affect the amount of space for the nerve and these are often genetic.
  • Wrist and hand position – activities that involve extreme flexion or extension of the wrist and hand for prolonged periods may cause nerve pressure.
  • Pregnancy – hormonal changes that occur during pregnancy may cause swelling.
  • Health conditions – conditions that are often associated with carpal tunnel syndrome can include thyroid gland imbalance, rheumatoid arthritis, and diabetes.

Symptoms

Telltale symptoms that point to carpal tunnel syndrome can include:

  • Pain, tingling, burning, and numbness in the thumb and the middle, index, and ring fingers
  • Tingling or pain that travels to the forearm and extends to the shoulder
  • Occasional shock-like sensations that are felt in the middle, index, and ring fingers as well as the thumb
  • Hand clumsiness and weakness
  • Loss of proprioception (awareness of where the hand is in space)

Symptoms of carpal tunnel syndrome often manifest gradually.

Many patients report the symptoms come and go at first.

However, symptoms have been observed to occur more often and linger for longer periods as the condition worsens.

Experiencing symptoms during night time is often very common and may sometimes wake patients up from sleep.

During the day, symptoms become more evident when the wrist is bent backward or forward (i.e. when driving, holding a book, using the phone, etc.) for long periods.

Many patients find relief from the symptoms when moving or shaking their hands.

Diagnosis

Physical Examination

Aside from asking about the patient’s symptoms, medical history, and general health, the doctor will also perform hand and wrist tests to accurately diagnose the condition.

During the physical examination, the doctor will likely perform the following:

  • Tap along (or press down) the median nerve to check for tingling or numbness. This test is called the Tinel’s sign.
  • Hold and bend the wrist in a flexed position. This is done to test for numbness and hand tingling.
  • Check for muscle weakness around the thumb’s base.
  • Test for hand and fingertip sensitivity by lightly touching them while the patient’s eyes are closed.
  • Look for signs of muscle atrophy around the thumb’s base.

Tests

Electrophysiological tests – determines how well the median nerve is working and whether there is too much pressure placed. The tests can also help assess if the patient is suffering from other nerve conditions such as neuropathy. Electrophysiological tests can include electromyogram (EMG) and nerve conduction studies.

Ultrasound – ultrasound of the wrist may be recommended to check for signs of median nerve compression.

X-rays – this is often recommended when the doctor wants to rule out other conditions (ligament injury, fracture, and arthritis) that may exhibit the same symptoms.

Magnetic resonance imaging (MRI) scans – this may be requested to check for other possible causes for the symptoms or to look for abnormal tissues that may have caused median nerve compression.

Treatment Options

While the development of the condition is often gradual, left untreated, the condition can worsen over time.

That being said, it is of prime importance that the condition is diagnosed and evaluated in its early stages.

When diagnosed and treated early, it is often easier to slow down or stop the progression of the condition altogether.

Nonsurgical Interventions

Splinting or bracing – wearing a splint or brace at night can help ensure the wrist is not bent while sleeping. Keeping the wrist in a neutral or straight position can help minimize the pressure on the median nerve. Wearing a splint during the day can also help guarantee some of the symptoms will not worsen.

Nonsteroidal anti-inflammatory drugs (NSAIDs) – medications like naproxen and ibuprofen has been known to help effectively relieve the inflammation and pain.

Nerve gliding exercises – some patients can benefit from exercises designed to help the median nerve move freely within the carpal tunnel. These specific exercises may be taught by a doctor or a physical therapist.

Steroid injections – Corticosteroid (or cortisone) is injected into the carpal tunnel to minimize the inflammation. However, while the injection can minimize symptom flare ups and relieve pain, the effect is sometimes only temporary.

Surgical Interventions

If nonsurgical treatment alternatives will not relieve the symptoms, carpal tunnel syndrome surgery will most likely be recommended.

Surgery recommendation will also depend on the severity of the symptoms.

In cases where patient experiences constant numbness and wasting of the thumb muscles, surgery might be considered to prevent irreversible damage.

Open carpal tunnel release – in this procedure, the doctor will divide the roof of the carpal tunnel (transverse carpal ligament) to increase the size of the tunnel and minimize median nerve pressure.

Endoscopic carpal tunnel release – in this procedure, the doctor will make two very small incisions (also called portals) and uses an endoscope to view the inside of the wrist and hand. A special knife will be used to divide the transverse carpal ligament.

Spine Curvature Disorders: What are the Different Types?

The backbone (or the spine), is comprised of vertebrae (small bones) that are stacked one on top of another.

Viewed from the side, a healthy spine has gentle curves on it.

These curves work by helping the spine absorb stress from gravity and body movement.

Ideally, when viewed from the back, the spine should run straight down the middle of the back.

However, when spine abnormalities occur, the natural curvatures become exaggerated or misaligned in certain areas, as evident in the 3 different types of spine curvature disorders—kyphosis, scoliosis, and lordosis.

Kyphosis

Also referred to as hunchback or roundback, kyphosis is a condition characterized by an excessive curvature of the spine in the upper back.

In elderly women, the condition is called dowager’s hump.

The spine’s thoracic region (or the upper back) typically has a slight natural curve.

The spine in the upper and lower back as well as the neck is naturally curved to help ensure the weight of the head is supported and to absorb shock.

When there is a larger than normal natural arch, kyphosis occurs.

Patients who have kyphosis may have a visible hump on their upper back.

In patients with kyphosis, the upper back may appear protruding and noticeably rounded.

Kyphosis may also cause spine pressure which can result to pain.

When pressure is also placed on the lungs, kyphosis may also cause breathing difficulties.

Causes

This condition can affect people of all ages.

Kyphosis that is secondary to poor posture is called postural kyphosis.

Other likely causes of the condition include:

  • Scheuermann’s disease (has no known cause and occurs in children)
  • Arthritis (and other bone degeneration disorders)
  • Spine injury
  • Osteoporosis
  • Aging
  • Muscle weakness (in the upper back)
  • Slipped discs
  • Spine infection
  • Tumors

Treatment Interventions

Seeking the help of an orthopaedic specialist is recommended when the condition is already accompanied by fatigue, breathing difficulties, and pain.

Treatment of kyphosis will depend primarily on two key factors—underlying cause and the condition’s severity.

Depending on the cause, the following treatment interventions are often given:

  • Scheuemann’s disease – corrective surgery, braces, or physical therapy
  • Tumors – tumors are often removed when there is possibility of cord compression
  • Osteoporosis – bone deterioration is often treated to ensure kyphosis will not worsen
  • Infection – antibiotics are often prescribed

Scoliosis

Scoliosis is characterized by an abnormal curvature of the spine.

Normally, the shape of the spine includes a curve at the lower back and at the top of the shoulder.

However, if the spine is curved from side to side in a “C” or “S” shape, there is a huge possibility the patient has scoliosis.

Scoliosis is often categorized into two—structural and nonstructural.

In the former, the curvature of the spine may be caused by injury, disease, or a birth defect. It is also considered permanent.

The latter on the other hand pertains to temporary curves that can still be fixed.

Causes

According to the American Association of Neurological Surgeons (AANS), there is no known cause for at least 80 percent of scoliosis cases.

However, some of the likely causes can include:

  • Cerebral Palsy – a nervous system disorder that can affect learning, seeing, thinking, hearing, and movement
  • Muscular dystrophy – a genetic disorder that often causes muscle weakness
  • Spinal infection or injuries
  • Birth defects that affect an infant’s spinal bones (for instance, spina bifida)

Treatment Interventions

Recommended treatment intervention for scoliosis will depend on several factors.

However, the degree of the spine curvature is considered a primary one.

When identifying the ideal treatment option, other key factors that are taken into account include:

  • Patient’s age
  • Type and degree of curvature
  • Type of the scoliosis

Two of the primary treatment options for scoliosis are bracing and surgery.

Bracing

Bracing is often the recommended option in the following scenarios:

  • The patient is still growing and the curvature is more than 25 to 30 degrees
  • The patient is still growing and the curvature is already between 20 and 29 degrees (and the curvature is worsening)
  • The patient has at least 2 more years to grow and the curvature is between 20 and 29 degrees

Using braces will not straighten the spine.

It is used to prevent the curvature from worsening.

This treatment intervention is effective in cases where the condition has been detected early.

Surgery

Surgery is the recommended treatment intervention for patients who have curves greater than 45 or 50 degrees.

It may also be resorted to when the condition already affects the patient’s way of life and is already causing discomfort.

The standard scoliosis surgery is spinal fusion.

The procedure involves fusing the vertebrae together with the use of bone grafts, screws, and rods.

Lordosis

Normally, the spine is curved a little in the lower and upper back and the neck.

The curves are designed to help the body:

  • Absorb shock
  • Support the head’s weight
  • Align the head over the pelvis
  • Bend and move flexibly

Lordosis occurs when the curves arches too far inward.

The condition is also known as swayback.

Since the condition affects the neck and lower back, it can result to excess pressure on the spine, causing discomfort and pain.

Left untreated, it can also affect the patient’s ability to move.

Causes

While the condition can affect people regardless of age, certain factors and conditions can increase one’s risk.

These factors include:

  • Lower back trauma
  • Poor posture
  • Obesity
  • Discitis (inflammation of the space between the vertebra)
  • Osteoporosis (loss of bone density)
  • Spondylolisthesis (occurs when one vertebra slips forward and does not align)
  • Achondroplasia (a form of dwarfism)

While rare, muscle problems and conditions related to the nervous system may also cause lordosis.

These conditions include:

  • Muscular dystrophy
  • Cerebral palsy
  • Myelomeningocele
  • Anthrogryposis
  • Spinal muscular atrophy

Treatment Interventions

Unless severe, lordosis will not require treatment.

The chosen treatment option will depend on the presence of other symptoms and the severity of the curvature.

Possible treatment interventions include:

  • Medication – to minimize swelling and pain
  • Physiotherapy – to improve motion range and strengthen the muscles
  • Weight loss – to help improve posture
  • Braces – often recommended for teens and children
  • Surgery – often recommended in severe cases (with neurological concerns)