Goyal physiotherapy & rehab. Centre, vrindavan

The human hand has multiple bones, tendons, ligaments and muscles which in unison help us to grip things and manipulate other objects to do our work. Within the wrist lies a narrow passageway on the palm side which houses the main nerve for movement of the nine tendons. These tendons help us to move our fingers individually and grip things or accomplish any task we want with our hands.

What is carpal tunnel syndrome??
Carpal tunnel syndrome is a condition where this nerve gets pinched due to a variety of factors and may have adverse effects. Some of the symptoms include tingling, numbness and pain with movements of the arm.

Causes of Carpal Tunnel Syndrome:
The nerve within the wrist which is known as the median nerve can be pinched due to a variety of factors:

1. Movements where the wrists are always higher and in an angle: Repetitive movements of the wrists where the hands are always at a lower angle, can increase the chances of carpal tunnel syndrome. This is usually a workplace related problem and thus be caused by bad hand posture.
2. Medical Conditions: There are certain medical conditions that may also trigger the onset of carpal tunnel syndrome such as diabetes, thyroid, menopause and other problems.
3. Pregnancy: Pregnancy has also known to cause carpal tunnel disorder as it can alter the balance of fluids within your body. However, other factors could also put your fluids in imbalance and cause problems with the median nerve.
4. Conditions that may cause inflammation: Certain conditions such as rheumatoid arthritis can cause the inflammation within the joints which might lead to the median nerve being pinched which in turn might lead to carpal tunnel syndrome.

Some Preventive Measures from Carpal Tunnel Syndrome:

1. Breaks from repetitive work: It is important for your wrists to have a break when you are doing repetitive tasks that might cause carpal tunnel syndrome. Relax and stretch your muscles within the break time
2. Wear wrist splints: These are support devices which can help correct problems for repetitive actions throughout the day while you are sleeping.
3. Take pain reliever if you start having chronic pains: If your wrist pain is not letting you functions normally, take a pain reliever such as ibuprofen or aspirin and go to a doctor as soon as possible for a more thorough treatment.

carpal tunnel syndrome?

Most of us may not be aware, but the knee is the largest joint in the human body and contributes the maximum to a person’s physical movement from one place to another. The knees play a significant role in a variety of movements including squatting, supporting the weight, running, kneeling, sitting, etc.

Whether it is a severe accident, osteoarthritis that set in with age, or other reasons, the result could be stiff, painful knees. The first line of treatment would be exercise, physiotherapy, and medications. However, if these do not work, then surgical treatment is the choice. Though usually it is reserved for people over the age of 50, there could be exceptions.

Given the number of functions it is involved in, when a serious procedure like knee replacement is being considered, the pain that the person would go through and the recovery time are two important parameters to address. It is best that the patient has a detailed discussion with the doctor and gets all doubts clarified. This will help both the patient and the doctor have realistic and practical expectations about what to expect after the surgery.

So, when pain and stiffness make knee replacement inevitable, prepare for it. The following sequence outlines what happens right from surgery to recovery.

1. Under general anesthesia, the damaged portion of the knee is removed, and a prosthesis (metal or plastic) is used to replace the removed portion.

2. Hospital stay can range from 3 to 5 days.

3. In about a month, the patient will have remarkable recovery, with almost no pain.

4. Though not advisable, most patients would be able to stand and do basic movement on the day of surgery.

5. Begin walking with the support of parallel bars and continue using cane/walker/crutches for the first few days to avoid overload on the knees.

6. With proper support, walking is possible in 3 to 5 days. Continue using a cane for the next few weeks to strengthen the knee.

7. Schedule a postoperative visit in the 4th to 6th week after surgery.

8. Draw up an exercise routine with your physiotherapist.

9. Ice pack can be applied to control swelling.

10. Driving should be possible, once you are off pain medications, as these can make you drowsy.

11. Blood clot in the surgical site causing a bruise will disappear in a couple of weeks.

12. Knee replacement is almost magical as in the long run (10 years postoperatively), there is a good 98% chances of success.

Having said this, it is important to remember each person responds differently to the procedure and therefore treatment/rehabilitation is completely personalized.

Knee replacement surgery is a procedure that is used to replace a worn out knee joint with an artificial knee joint. Such a surgery is advised if your knee is causing pain and limiting your daily activities, provided other treatments have failed to cause the desired impact.

Once the knee replacement surgery is completed, the focus shifts to the recovery phase.

1. The duration of the recovery depends on the type of surgery and the individual.

2. After the surgery, painkillers are administered to provide relief from the pain.

3. In some cases, oxygen is administered through various tubes if required.

4. A blood transfusion may also be required after a knee replacement surgery.

5. The surgical wound will require a dressing to allow it to heal faster and prevent infection.

6. A drain will be attached to the wound to drain out the blood from it and prevent accumulation of blood in the wound.

7. The dressing of the wound should be changed regularly.

Post- Surgery Care

• Post-surgery, you will need assistance to help you walk. If the surgery that you underwent was minimally invasive, then you should be able to walk on the very same day. Your physiotherapist will prescribe and show you some exercises to strengthen the knee. It is important that you follow his/her instructions to avoid complications.

• A passive motion machine is sometimes prescribed as it helps to restore the movement of the knee. It helps in reducing the swelling by keeping your leg elevated and moving the knee when you are lying down.

Here are some knee replacement recovery tips:

1. Avoid doing any work that puts pressure on the knees.

2. Eat nutritious meals so that the body receives proper nourishment, thus allowing your leg to heal faster.

3. Avoid heavy exercises which can strain your knees.

4. Perform all the exercises prescribed by your physiotherapist to speed up the recovery process.

5. Do not sit with your legs crossed for a few months after the surgery.

You can be diagnosed with a tennis elbow even if you have never been on a tennis court! A tennis elbow refers to tendinitis or swelling of the tendons in the elbows and arms. Tough tissue bands that join the muscles of the arm to the bone are known as tendons. This affliction is one of the most common reasons for elbow pain and can affect men and women at any age. However, it is most commonly seen in patients who are around 40 years old.

Tennis elbow develops gradually and is triggered by repetitive motions that strain the muscles or put too much pressure on the tendons such as sports that involve swinging a racquet, weight lifting or hobbies like carpentry, knitting, typing or painting.

Most cases of tennis elbow resolve themselves with time as long as you rest the elbow and give your tendons a break. Some things you could do to speed up the healing process are:

1. Soak the elbow in an ice bath for half an hour every 3 to 4 hours. This should help relieve the pain and reduce swelling.

2. Use an elbow strap to support the arm and prevent further strain in the injured tendon.

3. Exercising the arm to reduce stiffness and increase the possible range of motions. This will also make your tendons more flexible. However, exercises should be done only under a physiotherapist’s guidance so as to prevent any further damage. Additionally, your doctor may also suggest physiotherapy, to strengthen and stretch the arm muscles.

4. Over the counter, anti-inflammatory medicines such as ibuprofen or aspirin can also help reduce the pain and swelling. These drugs should not be used without a doctor’s guidance as they can cause a number of side effects. In some cases, these side effects can slow down the healing process.

5. Painkiller or steroid injections may also be prescribed to temporarily ease the pain and swelling around the elbow.

In some cases of severe tennis elbow, these forms of treatment may not be effective and if you are still suffering from pain and swelling for over 4 months, you may need to consider surgery. Surgery for tennis elbow involves removing the damaged section of the tendon and repairing the remaining part.

Recovery from a tennis elbow may seem slow but it is essential to be patient and avoid lifting weights or putting any strain on the arm during recovery. Once the swelling has completely gone down and you feel no pain or tenderness in the area, only then should begin using your arm normally.  

Knee pain should not be taken lightly and medical assistance must be sought, if it has been there for a long time. With knee replacement surgery you can resume to a healthy lifestyle.

Knee replacement is a procedure where the weight-carrying surfaces of knee joint are replaced surgically to ease the pain or any disability. People suffering from osteoarthritis, rheumatoid arthritis or psoriatic arthritis undergo knee replacement. All these conditions revolve around stiffness and painful knee. This surgery is usually performed on people aged over 50.

Surgery Types-

Knee replacement is mainly of two main types:

1. Total knee replacement where both the sides of knee joints are replaced
2. Partial knee replacement where only single side of the joint is replaced

Procedure-

In case of partial knee replacement with minimal invasion, a smaller incision, which is 3 to 5 inches, is required. This leads to minimal tissue damage, and the surgeon can work between the fibres of the quadriceps muscles. Here, an incision through the tendon is not required. This may result in less pain, recovery time is reduced, and motion is better as scar tissue formation is less.

In total knee replacement, four steps are performed:

1. Removal of damaged cartilage surfaces, which is at the ends of the femur and tibia, with a small quantity of underlying bone.
2. Replacement with metal components, which help as a recreated surface of the joint
3. Incision of knee cap with a resurface made of a plastic button, which is optional based on the case
4. Insertion of a medical-grade plastic spacer amid the metal components. This creates an effortless gliding surface.

After general or spinal anaesthesia, an incision of 8-12inches is made in the front part of the knee. Joint part which is damaged is removed from the surface of the bones. The surfaces are then formed in a way to hold a metal or plastic artificial joint. The thigh bone shin as well as knee cap is attached to the artificial joint with either cement or a special material.

After Effects of the Procedure-

After the surgery, patients may stay in a hospital for three to five days. Post surgery, notable improvement can be seen after a month or later. The patient is gradually relieved from pain with the construction of new gliding surface during surgery.

There will be slow progress in the movement. In the beginning, one may walk with a support of parallel bars and then with the help of crutches, walker, or cane. After full recovery in about six weeks, people can enjoy normal activities except running or jumping.

Presently, over 90% of total knee replacements function well even after 15 years of surgery. Hence, knee problem is no problem at all!

A herniated disc also known as a slip disc or prolapsed disc refers to the problem where one of the discs located in between the bones of the vertebrae(backbone) gets damaged and stacks itself upon the nerves. The tender inner portion of the disc gets protruded over the outer ring. Herniated disc causes severe neck pain and back pain. It occurs when the outer ring gets weak and tears down. The most common symptoms include pain and numbness, especially on one side of the body. The pain extends down to the arms and legs. It worsens during nighttime. The muscles become weak. Overweight people are likely to have this disease, as the discs carry extra weight. Old people are vulnerable to a slip disc.

Effects of Herinated Disc:
- An untreated case of herniated disc may cause permanent damage to the nerves.
- In certain cases, a herniated disc is capable of cutting off nerve impulses to the "caudal equine"nerves, present in the lower back and legs. This leads to loss of bladder control or bowel control.
- Saddle anaesthesia is another long-term effect. Nerves are compressed by the slip disc, causing loss of sensation in the inner portions of your thighs, the back of your legs and surrounding the rectum region.
- Symptoms may improve or worsen.

Diagnosis of Herinated Disc:

Treatment or diagnosis of herniated disc or slip disc can be either conservative or surgical in nature. The nature of treatment is determined according to your discomfort level and the kind of pain you are experiencing, or how much the disc has slipped out.
- The pain caused by herniated disc can be relieved by undertaking an exercise schedule which includes stretching and strengthening the spine and its surrounding muscles.
- A physiotherapist should be appointed for recommending the types of exercises.
- Taking pain relievers also soothes the pain.
- Stronger medicines prescribed by doctors include-muscle relaxers, narcotics to deal with the pain, medicines for nerve pain such as "gabapentin"  or "duloxetine".
- In case of the symptoms not subsiding within a span of six weeks, a surgery may be recommended by your doctor. The surgeon may have to remove the damaged part of the disc. This surgery is called a microdiskectomy.

Hip replacement surgery is a method wherein a defective hip joint is removed and replaced with an artificial hip joint. This procedure is only opted for after all the other treatments have failed to yield the desired effects. Hip replacement surgery removes damaged or diseased parts of a hip joint and replaces them with new, man-made parts. The goals of this surgery are to:

• Relieve pain

• Help the hip joint work better

• Improve walking and other movements.

Who Should Have Hip Replacement Surgery?

The most common reason for hip replacement is osteoarthritis in the hip joint. Your doctor might also suggest this surgery if you have:

1. Rheumatoid arthritis (a disease that causes joint pain, stiffness, and swelling)

2. Osteonecrosis (a disease that causes the bone in joints to die)

3. Injury of the hip joint

4. Bone tumors that break down the hip joint.

Your doctor will likely suggest other treatments first, including:

1. Walking aids, such as a cane

2. An exercise program

3. Physical therapy

4. Medications.

These treatments may decrease hip pain and improve function. Sometimes the pain remains and makes daily activities hard to do. In this case, your doctor may order an x ray to look at the damage to the joint. If the x ray shows damage and your hip joint hurts, you may need a hip replacement.

The Procedure-

Hip replacement surgery is a procedure that can either be performed by traditional means or a minimally invasive procedure. The primary difference between the two procedures is the size of the incision. The procedure begins with the doctor administering local anesthesia, though in certain cases, general anesthesia is also administered.

1. An incision is then made along the hip and the muscles that are connected to the thigh bone are shifted, so that the hip joint is exposed.

2. An equipment is then used to remove the ball socket of the joint by cutting the thighbone.

3. The artificial joint is then fixed to the thighbone and it is allowed to adhere properly.

4. Once the joint is fixed, the ball of the thighbone is then put in the hip socket.

5. The fluids from the incision area are then allowed to drain.

6. The hip muscles are then put in place and the incision is closed.

Post -surgery-

After the surgery, the recovery stage begins. The period of hospital stay post-surgery usually lasts for 4-6 days. A drainage tube is attached to the bladder to get rid of waste products from the body. Physical therapy begins immediately after the surgery and you will be able to walk after a few days with walking aids. The physical therapy continues for a few months after the surgery.

After care-

It is advised to avoid activities that involve twisting your leg for at least half a year. You should also avoid crossing the leg along the mid portion of your body. Your physiotherapist will provide you with exercises that aid to help you recover. Avoid climbing stairs and sit on chairs that have strong back support.