Sciatica pain can be mild to intense. Many with lumbar herniated disc and sciatica often wonder whether or not they require a surgery. Needless to say, it is never an easy decision. But the good news is that micro discectomy surgery has a higher rate of success when it comes to relieving sciatica pain. When compared to many other options, this one is relatively minimally invasive. It doesn t alter the structure of the spine permanently since it works by removing a small portion of the disc, which has herniated or extruded out of the disc.

When your sciatica pain stems from lumbar disc herniation, a small open surgery with the help of magnification is the prevalently opted surgical approach. On the other hand, a laminectomy is done when the bone or disc pinching the nerve root is required to be removed.

When should you consider undergoing surgery for sciatica?
Typically, neurosurgeons recommend considering surgery for sciatica in a host of situations which include the following:

Severe pain in the leg lingering for more than six weeks, which mainly affects one side of the leg or buttock
Intense pain in the low back and buttock, which continues through the course of the sciatic nerve andextends to the lower leg and even foot. This pain can be described as sharp and searing rather than a dull thud.
When pain has not alleviated even after non-surgical treatments that may include non-steroidal anti-inflammatory drugs (NSAIDs),oral steroids, injections, manual manipulations, and physical therapy
When the patient is not able to take part in the day to day activities due to intense lower back pain and the symptoms tend to become severe during movements like sneeze and cough.
When the symptoms are continuing to worsen, thereby indicating nerve damage, particularly when the progressive signs have their root in neurological issues
It is important to note here that surgical intervention may only be needed when the patient experiences progressive weakness in the lower portion of the body or sudden loss of bladder or bowel movement, which may stem from cauda equina syndrome. Two surgeries, namely lumbar laminectomy and microdiscectomy are performed on the basis of the cause as well as the duration of the sciatica pain.
In some cases, the symptoms are unique on the basis of the underlying causes of sciatica. For instance, trying to bend the body backward or walking a longer distance than normal may trigger unbearable symptoms. On the other hand, when the affected individual tries to bend the body forward, it can lead to symptoms stemming from the lumbar herniated disc.
In case sciatica occurs after an accident, injury or trauma, or if it happens in tandem with other symptoms, then it requires an immediate medical attention.
Thus, choosing to go for a surgery depends on several factors that only your doctor can assess and decide upon.

Sciatica - When Do You Have To Go For Surgery?

Cubital Tunnel Syndrome is also known as Ulnar Neuropathy, a nerve compression syndrome where the Ulnar nerve, also known as the funny bone nerve, gets compressed due to heightened pressure or stretching. It can lead to numbness or a tingling sensation in little and ring fingers, sometimes pain in forearm and an overall weakness in the hand. Ulnar nerve is one of the three main nerves in the arm. It runs in a groove on the inner side of the elbow. Since it travels through a narrow space and has very little protective tissue, the nerve is quite vulnerable to compression.

Symptoms
The symptoms of this condition may range from mild to severe. Some of the mild symptoms include:

Numbness in little and ring finger as the fingers fall asleep
A tingling sensation, usually like the pinch of pins and needles in ring and little finger
Pain in forearm
Weakness in the hand
Some of the severe symptoms include:
Reduction in overall hand grip
A claw like deformity in hand
Wasting of muscles of the hand
Bending elbow over a long period of time like while using cell phone or during sleep can cause ulnar nerve compression. Resting the elbow for a long period over a hard surface can also cause an irritation of the nerve, leading to such symptoms. In some cases, the nerve snaps back and forth over a bony bump, resulting in an irritated nerve. People who undertake intense physical activity, especially using their arms, are more likely to develop this problem. Eg. baseball pitchers. Apart from this, people who have suffered from a dislocated elbow or have arthritis are also at risk.

Generally, doctors diagnose this condition through the symptoms. However, nerve tests are also conducted to check the level of nerve compression. Electromyography is a procedure in which electrodes are placed on the skin and muscles to measure muscle health. Determining muscle health and level of compression helps decide the mode of treatment. Generally, the symptoms of cubital tunnel syndrome are managed through a conservative treatment. However, in cases of severe compression, surgery can be considered as an option to relieve pressure, moving nerve to the front of the elbow or removing a part of the bone.

For mild cases, a towel or a protective cover for elbow is recommended. The towel should be wrapped around the elbow loosely. An elbow splint can be worn at night to protect the elbow from being bent for long time.

How can a physical therapist help?
A physiotherapist has an essential role to play in treatment of this syndrome. A therapist can help the patient to learn ways of avoiding pressure to the nerve. After surgery, with restrictions of movement, a therapist can help achieve smooth recovery and movement of the elbow. Your physical therapist will determine the activities that bring on your symptoms. The recommendations at this point will be to avoid those activities for a time. Remember, the nerve is irritated and at times swollen. If the irritation and swelling are reduced, the symptoms should resolve.

Cubital Tunnel Syndrome  - How Physiotherapy Can Help You?

A small piece of bone is known as a fragment and it is very common that an avulsion fracture also tends to damage the protrusions of bone to which the tendons attach. This basically means that the tendon or ligament will come away from the bone and it will take a small piece of bone with it. It is sometimes very hard to find out what type of injury you have and this is why knowing the causes and symptoms of an avulsion fracture are very helpful in determining exactly how severe the injury is. 

Here are the causes of an avulsion fracture:

Explosive landing: Athletes who tend to jump or land with great impact tend to get these most commonly. Therefore, it is crucial for your health that if you participate in such sports, you do follow the correct method of jumping.
Explosive extension: Similar to how an athlete landing ferociously can get an avulsion fracture, someone who is extending the legs very violently and explosively during an exercise can also get an avulsion fracture. This is because the bone getting extended could very well damage the protrusions to which the tendons are attached. 
Symptoms
These are the two main causes of an avulsion fracture. There are not many symptoms of an avulsion fracture. This is because an avulsion fracture can only be determined by an MRI or by an X-ray scan. Therefore it is nearly impossible to diagnose that you have an avulsion fracture without looking at the results of the tests performed on the part of your body. However, the way you got the fracture and especially the details of it are very good indications of whether you have an avulsion fracture or not.

Avulsion Fracture - Common Causes Behind it

The carpal tunnel is the passageway for the median nerve to pass through on the inner side of your hand, when your palms are facing down. For example, while typing, there is a lot of movement of the fingers and this puts a lot of pressure on this tunnel. In fact, people who are involved in a lot of typing are one of the most prone people for carpal tunnel syndrome (CTS). Other causes would include trauma, fractures, etc., where the tunnel is injured.

Conventional measures to treat CTS included a combination of exercise and pain killers in mild to moderate cases. In moderate (sometimes) to severe cases, surgery was also done. However, with advancements in medical technology, endoscopic surgical procedure is gaining popularity.

What is done?
In endoscopic surgery, a small incision is made in the wrist or one each in the palm and the wrist. Through this, a flexible tube with a camera and minute cutting tools are inserted into the wrist. Another ligament known as transverse carpal ligament is cut. This reduces the pressure on the median nerve, which provides relief from the CTS symptoms.

What to expect as benefits?
The intention behind the surgery remains the same in both traditional and endoscopic procedures. The pressure on the median nerve is released, restoring movement and reducing pain in the joints. In addition, the endoscopic procedure has the following benefits.

Less invasive: Needless to say, there are only one or two small incisions done for this procedure, so less surrounding tissue is damaged.
Same day surgery: No hospitalization is required, and unless required, the patient can return home on the same day of surgery.
Reduced recovery time: The recovery period is usually substantially less compared to the traditional surgical approach.
Back to work: Depending on which is your dominant hand, you would be able to return to your regular work earlier than with regular surgery. If your non-dominant hand is involved, a day or two of rest is required. If your dominant hand was involved, give it up to four weeks for complete recovery.
Reduced chances of nerve injury: The area of operation has many nerves and blood vessels, and endoscopic surgery reduces the chances of damaging adjacent nerves.
Anesthesia: This is done under local anesthesia. Therefore, complications arising out of general anesthesia are completely avoided.
Indications
While these sound promising, your doctor will decide if you are a candidate for endoscopic procedure depending on the following:

Nonsurgical treatment including exercise and pain killers have not provided relief, even after several months.
Severe symptoms including those of nerve damage, like loss of sensation, altered coordination, etc., is affecting your normal daily routine.
Person requiring bilateral surgery like severe trauma, wheelchair dependent, etc.

Carpal Tunnel - How Endoscopic Surgery is Beneficial?

A bone fracture occurs when a strong external force is applied on the bones causing it to break. It is an extremely painful condition that results in days of immobility and rest. There are several reasons which can result in bone fracture, some of them being:

1. Injuries caused in sports
Any sport requires and demands extreme physical exertion and participation. Being involved in any sport therefore automatically increases your risk of incurring injuries. Bone fractures therefore are mostly reported during sports.

2. Osteoporosis
Due to the deficiency of calcium, the bones of both men and women tend to get weak and more susceptible to fracture and breakage. It is one of the primary causes that lead to bone fracture.

3. Osteomalacia
This also refers to a condition wherein the bones become weak and brittle. Much like osteoporosis, osteomalacia too significantly contributes to instances of bone fractures.

4. Osteosarcoma
This is a rare form of bone cancer that most often develops either near the femur or near the shinbone. An instance of this form of bone cancer is most often found in children and weakens the bone, consequently leading to fractures.

Though there may be different causes of broken fractures, its symptoms remain similar. Some of them are-

1. Swelling
One of the most common symptoms of bone fracture is perceptible swelling. If any of your bone is fractured, that particular part will be visibly swollen.

2. Deformity
Bones give your body the shape it has, thereby, any fracture anywhere would inevitably manifest itself as a clear deformity of that particular part.

3. Extreme pain
It goes without saying that a bone fracture would entail excruciating and extreme pain. This pain sharply increases with mobility thereby necessitating complete rest.

4. Temporary loss of function
The part of the body where the bone is broken temporarily becomes dysfunctional. For instance, if the bone in your hand is broken, you will find it extremely difficult to move and do any work with it.

Causes and Symptoms of Bone Fracture

Sports injuries are a common problem, where various types of musculoskeletal injuries can occur during the physical activities. These injuries can either be acute or chronic in nature. In athletes, such injuries can pose as a risk to their careers, which makes it essential for the physicians to provide the most appropriate treatment. It is mandatory to provide a prompt, safe and quick treatment that can restore the athlete s preinjury level of participation in sports.

Various treatment approaches are present for treating sports injuries. The use of intra-lesion blood injection is being made for addressing the musculoskeletal injuries. An easy and minimally invasive method of using concentrated autologous growth factors in treating sports injuries is the use of platelet rich plasma (PRP). It is a fraction of the blood plasma that contains a higher concentration of platelets than normal plasma, along with growth factors.

PRP is used in the treatment of both soft tissue and bone injuries. Growth factors have a positively influencing effect on the healing process of connective tissue components.
There is a huge difference between the anatomy and functions of tendons, ligaments, muscles and joint capsules. Hence, the site of injection of PRP also varies.
The cellular tension in the tissue and the collagen structure is affected after the administration of PRP.
Use of PRP is popular in the treatment of an Achilles tendon. For injecting PRP, an ultrasound scan is done, the site of injection is accurately identified and then PRP is administered.
Proper location of the site of injury and deciding the accurate injection zone prior to the injection of PRP makes it easier to facilitate treatment and eliminate discomfort.
Administration of PRP should be considered secondary to physical therapy and other conservative means of treatment.
Enthesopathy is a discomfort in the area where the attachment of tendons, ligaments and the articular capsule is present. The use of PRP is increasing in the treatment of this condition. It has an inflammatory nature and presents as epicondylitis or capsulitis.
Studies have proved that PRP is an effective alternative to injection of steroids for an anti-inflammatory effect. Steroids majorly provide only symptomatic relief, whereas PRP is more definitive.
PRP has also found an increased use in the area of surgical procedures of knees. It is used to increase the efficiency of the healing grafts placed in the knee during reconstructive surgeries.
For treatment of bone injuries, use of PRP has shown an improved quality and rate of bone healing. Even in cases of an infected injury, PRP aids in healing efficiently.
No known side effects or complications after use of PRP have been observed, which makes it a sought after option in management of sports injuries.


Platelet Rich Plasma In Sports Injuries

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