ORTHOPEDICS

CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome is the expression of pain in the median nerve compressed as it passes through the wrist. Tingling, numbness of the first three fingers of one or two hands, sometimes waking you up at night, is an expression of carpal tunnel syndrome.

Your doctor will look for a sensory deficit or hypoesthesia, in the affected area, a muscle deficit and above all will try to reproduce the sensory disorders by compressing the anterior face of the wrist, this is Tinel’s sign. the diagnosis is generally easy, in case of doubt, an electromyogram will confirm the neurological damage.

Local causes such as micro-trauma, fractures, infectious or inflammatory tenosynovitis, as well as general causes such as pregnancy, diabetes or endocrine disease; can also be responsible for this syndrome, but in the majority of cases no cause is found.

In addition to the etiological treatment of a specific cause, such as for example a thyroid disease, the medical treatment consists of the local injection of corticosteroids by infiltration. In case of failure or recurrence, the surgeon decompresses the nerve, neurolysis, by cutting the upper annular ligament of the carpal. The immediate consequences are not a problem. The results of this surgery are excellent. After a little rehabilitation, activities can resume from the third week after the operation.

Copyright photo : Par Henry Vandyke Carter — Henry Gray (1918), Domaine public,

Bibliography : Carpal Tunnel Syndrome. Carpal Tunnel Syndrome causes, symptoms, treatment, exercises, management, therapies and prevention by Lucy Rudford 

CHILD LAMPS AND / OR HIP PAIN

Any lameness in the child is abnormal and should lead to a consultation. It witnesses either pain or a decrease in mobility in the hip, in general.

After making sure that this lameness does not have an infectious origin, the doctor will look for other causes. A basin radio is always necessary. Two causes are common in children between the ages of five and nine.

Most often, it is a cold of the hip or acute arthritis benign or transient synovitis. The child limps, the mobility of the hip is reduced. The radio shows only a slight increase in the volume of his joint, the capsule in general. Simple rest may be sufficient, but it is sometimes necessary to put the child in traction for a few days, until he regains painless mobility of the hip. An x-ray of the pelvis is still necessary two months later, in order to formally rule out primary osteochondritis of the hip. This condition also called Legg-Perthes-Calvé disease is a necrosis of the femoral head. For some unknown reason, the blood supply to the femoral head is no longer made, leading to the death of the latter. But the natural evolution is towards the reconstruction of a new femoral head. The duration of this process is unfortunately long. The aim of the treatment which will be undertaken is to allow the reconstruction of a regular and well rounded head. Several techniques are used: traction to make the hip more flexible, wearing an appliance, or surgery; these techniques can be combined. In the absence of treatment, the evolution will be towards the reconstruction of a deformed head leading later to osteoarthritis.

If it is a teenager, and especially if it is a bit fat, the diagnosis of epiphyslolysis must be mentioned. The femoral head gradually slides over the neck of the femur causing serious changes in the architecture of the hip. It is the x-ray that will make the diagnosis. The treatment is imperatively surgical. If the sliding is not very important, one can avoid its aggravation by fixing the head to the femoral neck with screws. If the slip is too great, the result is more random. Your child should be monitored in particular, as this disease affects the other hip in 20% of cases. If the diagnosis is made early, the long-term prognosis is good.

Copyright photo : Public domain, Henry Gray (1918) Anatomie du corps humain 

Bibliography : Pediatric Orthopedic Deformities: Developmental Disorders of the Lower Extremity: Hip to Knee to Ankle and Foot by Frederic Shapiro 

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