An irritation of the tissue connecting the forearm muscle to the elbow .Tennis elbow can be caused by respective wrist and arm motions

CAUSES

Tennis elbow usually develops over time. Repetitive motions like gripping a racket during a swing can strain the muscles and put too much stress on the tendons .That constant tugging can eventually cause microscopic tears in the tissue. Tennis elbow might result from

• Tennis
• Racquet ball
• Squash
• Fencing
• Weight lifting

It can also affect people with jobs or hobbies that require repetitive arm movements or gripping such as

• Carpentry
• Typing
• Carpentry
• Raking
• Knitting

SYMPTOMS

Symptoms include pain and tiredness in the bony knob on the outside of your elbow .This knob is where the injured tendons connect to the bone. The pain may also radiate into the upper or lower arm. Although the damage is in the elbow you are likely to hurt when doing things with  your hands

Tennis elbow may cause the most pain when you

• Lift something
• Make a fist or grip an object such as a tennis racket
• Open a door or shake hands
• Raise your hand or straighten your wrist
• Tennis elbow is similar to another condition called golfers elbow which affects  the tendons on the inside of elbow

TREATMENT

The good news about treatment is that usually tennis elbow will heal on its own. Types of treatment that help are

• Icing the elbow to reduce pain and swelling.
• Using an elbow strap to protect the injured tendon from further strain
• Taking internal medicines
• Performing range of motion exercises to reduce stiffness and increase flexibility
• Getting physical therapy to strengthen and stretch the muscles

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INTRODUCTION

Laparoscopic surgery is a surgical technique in which short, narrow tubes ( trocars)  are inserted into the abdomen through small ( less than one centimeter ) incisions . Through these trochars long narrow instruments to manipulate, cut and see tissue

ADVANTAGE

In patients terms, laparoscopic surgery has the advantages of avoiding large open wounds or incisions and thus of decreasing blood loss , pain and discomfort . Patients have fewer  unwanted effects from analgesia because less analgesia is required .The fine instruments are less apt to cause tissue trauma and blood loss. Also it has better quality of life outcomes than open surgery for cholecystectomy, splenectomy and esophageal surgery. However open hernioplasty has at least as good if not better , health status outcomes than laparoscopic repair

DISADVANTAGES

It can take longer to perform than open surgery ( if not performed with right technique) . The  longer time under anesthesia may increase the risk of complication. Sometimes complications do not appear right away but occurs few days to few weeks after surgery

SIDE EFFECTS

• Fever or chills
• Abdominal pain that becomes more intense over time
• Redness , swelling , bleeding or drainage at the incision sites
• continuous nausea or vomiting
• Persistent cough
• Shortness of breath
• Inability to urinate
• Lightheadness

HOW IS LAPAROSCOPY PERFORMED ?

It is usually done as an outpatient procedure. General anesthesia is given as intravenous line in one of your veins. In some cases  local anesthesia is also used. During laparoscopy, the surgeon makes an incision below your belly button and then inserts a small tube called a cannula. The cannula is used to inflate your abdomen with carbon dioxide gas. This gas allows your doctor to see your   abdominal organs more clearly. Once abdomen is inflated , the surgeon inserts the laparoscope through the incision. The camera attached to the laparoscope displays the images on a screen, allowing your organs to be viewed in real time. Generally you get from one to four  incisions  that are each between 1 and 2 centimeters in length. These incisions allow other instruments to be inserted . After the procedure is done , the instruments are removed. Your incisions are  then closed with stitches or surgical staples

 

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Knee replacement surgery also known as knee arthroplasty can help relive pain and restore function  in  severely diseased knee joints. The procedure involves cutting away damaged bone and cartilage from your thigh bone , shin bone and knee cap and replacing it with an artificial joint( prosthesis) made of metal alloys high grade plastics and polymers

SIGNS OF NEEDING A KNEE REPLACEMENT

Knee replacement surgery is usually   necessary when the knee joint is worn out or damaged so that your mobility is reduced and you are  in pain even while resting . The most common reason for knee replacement surgery is osteoarthritis. Other health conditions that cause knee damage include rheumatoid arthritis

RISK FACTORS

• Infection
• Blood clots in the leg
• Heart attack
• Stroke
• Nerve damage

PROCEDURE

Before the procedure-

1. Your doctor will explain the procedure to you
2. Consent form is asked to sign
3. Physical examination is done
4. Complete medical history is asked
5. Notify your doctor if you have a history of bleeding disorder
6. You will be asked to fast for eight hours before procedure
7. You may receive a sedative prior to the surgery to help you relax

During the surgery-

Generally knee replacement surgery follows this process

1. You will be asked to remove clothing and will be given a gown to wear
2. An intravenous (IV) line may be started in your arm or hand
3. You will be positioned on the operating table
4. Urinary catheter may be inserted
5. Excessive hair at the surgical site may be clipped off
6. Skin over the  surgical site will be cleaned with an antiseptic solution
7. The doctor will make an incision in the knee area
8. The doctor will remove the damaged surfaces of the knee joint and resurface the knee joint with  the prosthesis . The prosthesis is made up of metal and plastic, A cemented prosthesis  attaches  to the bone with a porous surface onto which the bone grows to attach to the prosthesis. The prosthesis is generally comprised of 3 components-the tibial component, the femoral component and the patellar component
9. The incision will be closed with stitches or surgical staples
10. A sterile bandage or dressing will be applied

After the procedure-

In the hospital -after the surgery you will be taken to the recovery room for observation . Once your blood pressure , pulse and breathing are stable and you are alert you will be taken to your hospital room. Knee replacement  surgery usually requires as in hospital stay of several days

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A hip fracture is a break in  the upper portion of the femur ( thigh bone) . Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis . When a hip fracture occurs in a younger patient it is typically the result of a high energy event such as a fall from a ladder or vehicle collision

SYMPTOMS

• Inability to get up from a fall or to walk
• Severe pain in your hip or groin
• Inability to put weight on your leg on the side of your injured hip
• Bruising and swelling in and around your hip area
• Outward turning of your leg on the side of your injured hip

RISK FACTORS

• Age
• Osteoporosis
• Other chronic medical conditions
• Nutritional problems
• Physical inactivity

COMPLICATIONS

• Blood clots in your legs or lungs
• Bedsore
• Urinary tract infection
• Pneumonia
• Further loss of muscle mass, increasing your risk of falls and injuries
• Death

TREATMENT

Most hip fractures occurs in one of the two locations on the long bone that extends from your pelvis to your knee

• The Femoral neck- This area is situated in the upper portion of your femur, just below the ball part( femoral head ) of the ball and socket joint
• The intertrochanteric region- This region is a little farther down from the hip joint , in the portion of your upper femur that juts outside

Treatment of hip fracture usually involves a combination of surgery , rehabilitation and medication

Surgery- The type of surgery you have generally depends on the the where and how  severe the fracture is , whether the broken bones aren’t properly aligned and your age and underlying health conditions. The options include :

• Internal repair using screws
• Total Hip replacement
• Partial hip  replacement
• Your doctor might suggest total or partial hip replacement if the blood supply to the ball part of the hip joint was damaged during the fracture

Rehabilitation- Physical therapy will initially focus on  range of motion and strengthening exercises.

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DEFINITION

A bone fracture is a medical condition where the continuity of the bone is broken. A significant percentage of bone fractures occurs because of high force impact or stress. Also it may be due to cancers , osteogenesis imperfecta, osteoporosis etc…

TYPES

• Avulsion fracture- a muscle or ligament pulls on the bone, fracturing it
• Comminuted fracture- the bone is shattered into many pieces
• Compression (crush) fracture- generally occurs in the spongy bone in the spine
• Fracture dislocation – a joint becomes dislocated and one of the bones of joint has a fracture
• Greenstick fracture- the bone partly fractures on one side, but does not break completely because the rest of the bone can bend
• Hairline fracture- a partial fracture of the bone .Sometimes this type of fracture is harder to detect with routine x-ray
• Impacted fracture – when  the bone is fractured , one fragment of bone goes into another
• Intra articular fracture- where break is along the length of the bone
• Oblique fracture- a fracture that is diagonal to a bones long axis
• Pathological fracture- when an underlying disease or condition has already weakened the bone, resulting in a fracture
• Spiral fracture- a fracture where at least one part of the bone has been twisted
• Tortus fracture- bone deforms but does not crack
• Transverse fracture- a straight break right across a bone

SYMPTOMS

The signs and symptoms of a fracture vary according to which bone is affected , the patients age and general health as well as the severity of injury. Some of the following are

• Pain
• Swelling
• Bruising
• Discolored skin around the affected area
• Angulation- affected area may be bent at an unusual angle
• Patient is unable to put weight on the injured area
• Patient cannot move the affected area

DIAGNOSIS AND TREATMENT

Bone healing is a natural process which in most cases well occur automatically. For the natural healing process to begin , the ends of the broken bone need to be lined up this is known as reducing the fracture. The patient is usually asleep under a general anesthesia when fracture reduction is done. Fracture reduction may be done by manipulation closed reduction or surgery.

Immobilization-as soon as the bones are aligned they must stay aligned while they heal

This may include

• Plaster casts or plastic functional braces- these hold the bone in position until it has healed
• Metal plates and screw – current procedures may use minimally invasive techniques
• Intra medullary nails- internal metal rods are placed down the center of long bone
• External fixators- these may be made of metal or carbon fiber , they have steel pins that go into the bone directly through the skin
• Healing – if a broken bone has been aligned properly and kept immobile , the healing process is usually straight forward
• Physical therapy- after the bone has healed , it may be necessary to restore muscle strength as well as mobility to the affected area

COMPLICATIONS

• Heals in the wrong position
• Disruption of bone growth
• Persistent bone or bone marrow infection
• Avascular necrosis or bone death

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Prepared by Dr Sajna Hamza

 

 

INTRODUCTION

Pneumonia is an infection in one or both lungs, Bacteria , viruses and fungi cause it. The infection causes inflammation in the air sacs in your lungs, which are called alveoli. The alveoli fill with fluid or pus making it difficult to breath

SYMPTOMS

The signs and symptoms vary from mild to severe , depending on factors such as the type of germ causing the infection and your age and overall health. Mild signs and symptoms often are similar to those of a cold or flu but they last longer

Signs and symptoms of Pneumonia may include

• Chest pain when you breath and cough
• Confusion or changes in mental awareness
• Cough may produce phlegm
• Fatigue
• Fever  , sweating and shaking chills
• Lower than normal body temperature
• Nausea , vomiting, or diarrhea
• Shortness of breath

CAUSES

The most common are bacteria and viruses in the air we breath. Your body usually prevents these germs from infecting your lungs . But sometimes these germs can over power your immune system , even if your health id generally good. Pneumonia is classified  according to the types of germs that cause it and where you get the infection

• COMMUNITY ACQUIRED PHEUMONIA- It is the most common type of pneumonia .It occurs outside of hospitals or other health care facilities. It may be caused by  a) Bacteria b)Fungi c) Viruses
• HOSPITAL ACQUIRED PNEUMONIA- From the people catch pneumonia during a hospital stay for another illness.  Hospital acquired pneumonia can be serious because the bacteria causing it may be more resistant to antibiotics and because the people who get it are already sick
• HEALTH CARE ACQUIRED PNEUMONIA- It is a bacterial infection that occurs in people who live in long term care facilities or who receive care in out patient clinics , including kidney dialysis centers
• ASPIRATION PHEUNOMIA- It occurs when you inhale food , drink , vomit or saliva into your lungs . Aspiration is most likely if something disturbs your normal gag reflex such as a brain injury or swallowing problem or excessive use of alcohol or drugs

RISK FACTORS

• Children who are 2 years old or younger
• People who are age 65 or older
• Being hospitalized
• Chronic disease
• Smoking
• Weakened or suppressed immune system

COMPLICATIONS

• Bacteria in the blood stream
• Difficulty breathing
• Fluid accumulation around the lungs
• Lung abscess

TREATMENT

Treatment for pneumonia involves curing the infection and preventing complications. Specific treatments depend on the type and severity of your pneumonia , your age and your overall health. The options include

• Antibiotics
• Cough medicine
• Fever reducers
• Pain relievers

HOSPITALIZATIONS-

• You are older than 65
• You are confused about time , people or places
• Your kidney function has declined
• Your systolic blood pressure is below 90 mm Hg or your diastolic blood pressure is 60 mm Hg below
• Breathing is rapid
• You need breathing assistance
• Your heart rate below 50 or abv 100

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Prepared by: Dr Sajna Hamza