Overview of Osteoarthritis

Osteoarthritis is a chronic disease affecting the synovial joints, particularly the large weight-bearing joints.

Prevalence (in US)
It is the most prevalent musculoskeletal condition that causes joint pain. The incidence of OA increases with age

•At age 18-24 years, 7% of men and 2% of women show signs of OA in the hands.
•At age 55-64 years, 28% of men and women show signs of OA in the knee, and 23% show signs of OA in the hip.
( Jane’s case – 57 yo, experienced intermittent pain in knee and hip)
•At age 65-74 years, 39% of men and women show signs of OA in the knee and 23% show signs of OA in the hip.
•At age 75-79 years, approximately 100% of men and women show some signs of OA.

There isn’t any significant correlation between incidence of OA and race, save for Chinese with a decrease of incidence of OA

Age wise, adults older than 55 years show radiographic evidence of osteoarthritis (OA). Males develop OA before age 45 years, possibly because of a higher incidence of posttraumatic OA.

After age 55 years, women are affected more frequently by OA and tend to have more severe disease than do men.

History

The usual complains that physician gets includes:
1.complain of insidious throbbing arthralgias with activity.
2.Resting relieves the pain initially, but eventually begins to suffer pain even when he/she is at rest.
3.Morning stiffness, which usually lasts less than 30 minutes(experienced in the joint).
4.Physician will most probably be able to feel intermittent joint swelling. Give-way weakness in the knees (ie, quadriceps pain inhibition)might be noted as well.

Signs & Symptoms

Early in the disease process (physical examination findings)
oJoints may appear normal.
oGait may be antalgic if weight-bearing joints are involved.
(Jane’s case – on standing, her pelvis dropped down on the other side when she stood on her painful leg. Elevated when stood on the good leg)

Later in the disease process ( physical examination findings)
oVisible osteophytes (out-growth of bone) may be noted.
oJoints may be warm to palpation.
oPalpable osteophytes frequently noted.
oJoint effusion frequently is evidenced in superficial joints.
oRange-of-motion limitations, due to bony restrictions and/or soft tissue contractures, are characteristic.
oCrepitus with range of motion not uncommon.
Causes?
•Primary osteoarthritis (OA), either localized or generalized, is most often idiopathic, except in rare cases in which a defective gene has been found to cause a familial form of OA.

•Secondary OA can be caused by the following:
o Obesity (increases mechanical stress)
o Repetitive use (ie, jobs requiring heavy labor and bending)
o Previous trauma (ie, posttraumatic OA)
o Infection
o Crystal deposition
o Acromegaly
o Previous rheumatoid arthritis (ie, burnt-out rheumatoid arthritis)
o Heritable metabolic causes (eg, alkaptonuria, hemochromatosis, Wilson disease)
o Hemoglobinopathies (eg, sickle cell disease, thalassemia)
o Neuropathic disorder leading to a Charcot joint (eg, syringomyelia, tabes dorsalis, diabetes)
o Underlying orthopedic disorders (eg, congenital hip dislocation, slipped femoral capital epiphysis)
o Disorders of bone (eg, Paget disease, avascular necrosis)

Pathophysiology

Traditionally, teaching prescribes that OA affects primarily the articular cartilage of synovial joints. Pathophysiologic changes occurs in the synovial fluid and the subchondral (underlying) bone and overlying joint capsule.
- Affected cartilage develops small tears (fibrillations) at articular surface

- Followed by large tears

- Eventually, cartilage fragments off into joints

The cartilage forming cells replicate to keep up with cartilage loss. Sadly, unable to do so eventually, so the underlying bone becomes exposed when gross areas of the bone become denuded of cartilage.

The osteoarthritic joint is characterized by decreased concentration of hyaluronic acid because of reduced production by synoviocytes and increased water content because of inflammation, particularly during later stages of the disease.
The onset of pain is usually insidious, is generally described as aching or throbbing, and may be the result of changes that have occurred over the previous 15-20 years of the patient's life. Most often, the pain worsens with activity involving the affected joint and is initially relieved with rest; eventually, however, pain occurs even at rest. Since cartilage itself is not innervated, the pain is presumed to arise from a combination of mechanisms, including the following:
• Osteophytic periosteal elevation
• Vascular congestion of subchondral bone, leading to increased intraosseous pressure
• Synovitis with activation of synovial membrane nociceptors
• Fatigue in muscles that cross the joint
• Overall joint contracture

Treatment

Lifestyle modification, particularly exercise and weight reduction, is a core component of the management of osteoarthritis (OA). Importance of strengthening all muscles that cross the given joint affected by OA should be emphasized.
Most research focuses on quadriceps strengthening in knee OA. Also important are stretching exercises, which increase range of motion. The importance of aerobic conditioning, particularly low-impact exercises (if OA affects weight-bearing joints), should be stressed.

Surgical interventions for OA of the hip
• Joint realignment (realignment osteotomy)
• Joint fusion (arthrodesis) - Surgically fusing the joint to eliminate motion
• Joint replacement (arthroplasty)
o Hip replacements generally are classified as either hemiarthroplasty (ie, replacement of the femoral side of the hip joint, while leaving the patient's acetabulum intact) or total hip arthroplasty (replacement of the femoral side of the hip joint and the acetabulum).
o Further classification often involves specification of the specific hardware used (eg, unipolar prosthesis, bipolar prosthesis) and whether or not cement is used to hold the hardware in place.

Medication

The American College of Rheumatology issued the following pharmacologic guidelines for the treatment of osteoarthritis of the hip and knee:
• Arthrocentesis with corticosteroid injection can be used only for knee OA if effusion is present.
• Up to 4 grams per day of acetaminophen can be administered. This is the preferred initial treatment for patients with OA.
• Topical anti-inflammatory medications or capsaicin can be administered only for knee OA.
• Low-dose nonsteroidal anti-inflammatory drugs (NSAIDs) (ie, analgesic doses) or nonacetylated salicylates may be indicated.
• Administer full-dose NSAIDs with misoprostol if risk factors for upper gastrointestinal bleeding are present.
• Narcotic analgesic use may be indicated in cases of severe pain.
• Simple analgesics
• Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have osteoarthritis.

Simple analgesics

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have osteoarthritis.
- Acetaminophen (Tylenol, Panadol, Feverall, Aspirin Free Anacin)
(*Jane takes paracetamol every afternoon which seemed to help for a few hours)

Topical analgesics
Topical analgesics are used for osteoarthritis involving relatively superficial joints, such as the knee joint and the joints of the hands. These agents are much less effective for deeper joints, such as the hip joint.
- Capsaicin (Dolorac, Capsin, Zostrix)

Nonsteroidal anti-inflammatory drugs
NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. May inhibit COX activity and prostaglandin synthesis.
- Ibuprofen (Motrin, Advil, Nuprin, Rufen)
- Meloxicam (Mobic)

Cyclooxygenase-2 inhibitors
This class of medications can be particularly useful in the OA population, because patients in this group tend to be older and are therefore at increased risk for adverse GI effects due to NSAIDs.
- Celecoxib (Celebrex)

Opioid analgesics
These agents are used in patients whose pain has not been controlled with weaker analgesic medications. They are a particularly reasonable choice in patients who do not want joint replacement surgery.
- Oxycodone (OxyContin, Roxicodone)

Reference:
http://emedicine.medscape.com/article/305145-overview

Causes of Carpal Tunnel Syndrome (CTS) by Ridz

Causes or Carpal Tunnel Syndrome
In general, Carpal Tunnel Syndrome (CTS) is resulted from the increased in pressure of the tunnel which then compress the median nerve. This increased pressure could result from anything that reduces the space in the carpal tunnel. Possible causes include:
1. Physical characteristics
• Congenital predisposition – the carpal tunnel is smaller than the average.

2. Repetitive/Overuse movement of wrist
• Flexion and extension of the tendons (forcefully & prolonged) – lead to inflammation of the flexor tendon sheath

3. Injury/trauma
• Fracture or sprain – causing swelling due to inflammatory response.

4. Hormonal disorders (perturbation in the endocrine system)
• Diabetes
• Hypothyroidism
• Pregnancy (last few months)
• Oral contraceptive pill consumption

5. Other health conditions
• Rheumatoid arthritis
• Acromegaly
• Amyloidosis

Epidemiology of CTS

Incidence highest in women over the age of 30. The condition may be more prevalent in people who use their wrists in repetitive activity

United States
· incidence of CTS may be as high as 3.7% in the general population,
· Higher incidences in individuals who frequently and repetitively practice wrist maneuvers, for as many as 50% of cases are bilateral.
· Male-to-female ratio of 1:3-5.
· Patients aged 30-60 years but many other factors have an influence on the age of incidence of CTS.

Malaysia
Arthritis foundation Malaysia
Three times more common in women than in men
More common in middle aged women
More commonly seen in older people

• Carpal tunnel syndrome is the most common nerve compression disorder of the upper extremity, affecting 1% of the general population and 5% of the working population who must undergo repetitive use of their hands and wrists in daily living (plastic and reconstructive surgery – the incidence of recurrence after endoscopic carpal tunnel release : volume 105(5) april 2000 pp1662-1665)
• Currently, carpal tunnel syndrome affects over 8 million Americans (NIOSH YEAR 2000)

http://www.afm.org.my/info/carpal_tunnel.php
http://www.repetitive-strain.com/national.html

psychosocial affetcs

Well there is NOTHING i can find on the net about this topic im stuck with....so im just gonna write something off the top of my head...

First, Ill talk about Nora..Being a writer she depends alot on her hand, if it werent for her hand she wudnt be able to write. since she is a professional writer ie makes a living out of writing, she wont be able to make a living for herslef anymore...or she wud have to find another source of income, most probably one that she doesnt enjoy much and pays less...this will probably make her get stressed, worst case scenario she could commit suicide...lucky for nora is that she has a sister who can take care of her, though she would be a burden on thier family...this can only add to the stress if not managed properly...

For people who dont use thier hand for making a living, it can be a life changing experience too...we use our hands for many things in our daily life...so we will be incapable of coping...causing stress and depression...

if there is anything i missed out dont be shy to point it out =D

Treatment and Management

Treatment and Management of CTS

by- SYUKRIAH

Initial treatment usually includes rest, immobilization of the wrist in a splint, and occasionally ice application.

Patients whose occupations are aggravating the symptoms should modify their activities. For example, computer keyboards and chair height may need to be adjusted to optimize comfort - (can be apply for our patient)

• Treatments for carpal tunnel syndrome should begin as early as possible. Underlying causes such as diabetes or arthritis should be treated first.
• Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms.
• Immobilizing the wrist in a splint to avoid further damage from twisting or bending.
• If there is inflammation, applying cool packs can help reduce swelling.

Non-surgical treatments

1. Drugs - In special circumstances, various drugs can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity.

2. Orally administered diuretics ("water pills") can decrease swelling. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Corticosterioids should not be taken without a doctor's prescription.)

3. Exercise - Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist, who is trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.

Surgery

Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay. Many patients require surgery on both hands. The following are types of carpal tunnel release surgery:

1. Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.

2. Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about ½" each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. One-portal endoscopic surgery for carpal tunnel syndrome is also available.

• About 70 percent are very satisfied with the outcome of their surgery. Some variables that are associated with lower levels of satisfaction include drinking more than two alcoholic drinks a day, smoking, lower mental and physical health status before surgery, and exposure to repetitive, forceful activity.
• Symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar.
• Occasionally the wrist loses strength because the carpal ligament is cut. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.
• Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.

Alternative medicine

1. Additionally, some studies show that vitamin B⁶ (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.
2. Alternative therapies - Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome
3. You might also want to try wearing a wrist splint at night and avoid sleeping on your hands to help ease the pain or numbness in your wrists and hands. The splint should be snug but not tight

http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm#115153049

http://www.mayoclinic.com/health/carpal-tunnel-syndrome/DS00326/DSECTION=treatments-and-drugs

Diagnosis and Investigation

* overlaps with Jas' cause we're both doing the same topic. HAHA.*

1. Our Monash way of taking the musculoskeletal history.

2. See if there is a presence of risk factors

3. Conduct a physical ( The examination – Ask, look, feel, move, measure and perform specific tests ) and neurological examination ( yet to learn.. )

A physical examination of the hands, arms, shoulders, and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome.

Look : Discolouration, Swelling, Wasting of the muscles at the base of the hand, Erythema, Asymmetry, Trauma and Scars.
Feel : Tenderness and warmth, identify numbness in certain fingers and test the grip of the patient.
Move : Flexion, Extension, Radial displacement, Ulnar displacement.
Measure : * I .. don’t know * :(
Specific tests? * refer to the section below *

Neurological examination

a) Testing the muscle that abducts the thumb away from the palm (called the abductor pollicis brevis)
b) The ability to bend the thumb toward the palm (flexion) and ability to move the thumb toward the other fingers (opposition).
c) Tinel's sign - Tap on or presse on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs
d) Phalen's sign or wrist-flexion, test - having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute


4. Diagnostic tests
Nerve conduction velocity (NCV) and electromyography (EMG)

Used to evaluate nerve and muscle function

EMG :
Records and analyzes the electrical activity in the muscles.
When a normal muscle is at rest, it is electrically silent.
A very thin needle electrode is inserted through the skin into the muscle.
The electrode on the needle picks up the electrical activity given off by the muscles.
The activity is displayed on an oscilloscope, and may be heard through a speaker.
Patients are then asked to flex the arm.
The action potential produced on the monitor provide information about the muscle's ( APB ) ability to respond when the nerves are stimulated.
May reveal delayed nerve conduction in the median nerve or the area of the carpal tunnel

Risks? Trauma to the muscle from EMG may cause false results on blood tests, including creatine kinase, a muscle biopsy. There may be a small risk of bleeding


NCV :
Usually done with EMG.
Diagnose nerve damage or destruction.
In healthy nerves, electrical signals can travel at up to 120 miles per hour, if the nerve is damaged, the signal would be slower and weaker.
Placing electrodes on the skin above the median nerve to monitor the speed at which an impulse travels along the nerve.
Electrodes, similar to those used for ECG, are placed on the skin over nerves at various locations. Each electrode patch gives off a very mild electrical impulse, which stimulates the nerve.
The nerve's resulting electrical activity is recorded by the other electrodes.
The distance between electrodes and the time it takes for electrical impulses to travel between electrodes are used to determine the speed of the nerve signals.
Electromyography is often done at the same time as this test.

Extra precautions :
Normal body temperature must be maintained (low body temperature slows nerve conduction).


Ultrasound imaging : show impaired movement of the median nerve.


Magnetic resonance imaging (MRI) : shows the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.



CT Scan and X-Ray : To rule out arthritis and other bony conditions.

* Here's a link from Para-Para Sakura, there are pictures, so.. yeah, go ahead and read :) *
Click here.




References :

http://www.neurologychannel.com/carpaltunnel/diagnosis.shtml
http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000433.htm
http://www.mayoclinic.com/print/wrist-pain/DS01003/DSECTION=all&METHOD=print
http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003927.htm
http://orthoinfo.aaos.org/topic.cfm?topic=A00270
http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm

Diagnosis and investigation

One of the most important first steps in diagnosing CTS is to rule out any underlying medical disorders that may be contributing to the condition. Relying only on CTS symptoms, and personal or work histories may result in the failure to detect (and thus properly treat) underlying medical conditions that could be serious. If the doctor suspects that an underlying medical condition may be exacerbating the symptoms of CTS, laboratory tests will be performed. Tests for thyroid disease and rheumatoid arthritis may be helpful. The doctor may take an x-ray, for example, to check for arthritis or fractured bones.

Arthritic Conditions. Arthritic conditions, including rheumatoid arthritis, gout, and osteoarthritis, can all cause pain in the hands and fingers that may mimic carpal tunnel disease. The treatment for these conditions, however, is different.

Muscle and Nerve Diseases. Any disease or abnormality that affects the muscles and nerves, including those in the spine, may produce symptoms in the hand that mimic carpal tunnel syndrome.

How is carpal tunnel syndrome diagnosed?

- most accurately diagnosed using the patients' descriptions of symptoms, and electrodiagnostic tests that measure nerve conduction through the hand

Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome.

1) In the Tinel test, the doctor taps on or presses on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs.

2)The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute.

3)Pressure Provocation Test. The doctor presses over the carpal tunnel for 30 seconds to produce tingling or shock in the median nerve.

4)Tourniquet Test. This test employs an inflatable cuff that applies pressure over the median nerve to produce tingling or small shocks.

Doctors may also ask patients to try to make a movement that brings on symptoms.

Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests.

Nerve conduction study.

In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel.

Nerve conduction tests are fairly accurate when done on patients with more clear-cut symptoms of carpal tunnel syndrome. They are less accurate in identifying mild CTS, however.

Electromyogram.

Electromyography measures the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscles your doctor wants to study. An instrument records the electrical activity in your muscle at rest and as you contract the muscle. This test can help determine if muscle damage has occurred.

Electromyography can be painful and is less accurate than nerve conduction. Some experts question, in fact, whether it adds any valuable diagnostic information. They suggest it be limited to unusual cases or when other tests indicate that the condition is aggressive and may increase the risk for rapid, significant injury.

Portable electrodiagnostic testing. Portable electronic devices are being evaluated for measuring nerve conductivity. They are relatively quick and easy to use on a large scale in an industrial facility. However, these devices are not well studied in clinical trials.

Limitations. Electrodiagnostic studies are not well standardized, and certain conditions can skew the results of either test:

· Obesity can slow the speed of electrical conduction.

· Women and the elderly normally have slower conduction times than younger adult men.

EXTRA INFO:

Other Cumulative Trauma Disorders
Location	Description
The Median Nerve in Other Locations	Repetitive work can cause pressure on the median nerve in locations other than the wrist and can also affect other nerves in the arm and hand. The branch of the median nerve that runs through the palm of the hand can be damaged directly by repeated pounding or by the use of certain tools requiring a strong grip using the palm, such as needle-nosed pliers. The median nerve can also be pinched in the forearm.
Guyon Canal Syndrome (Commonly called ulnar tunnel syndrome)	The ulnar nerve can, like the median nerve, can be trapped as a result of repetitive stress. When this nerve is trapped, the condition is sometimes referred to as ulnar tunnel syndrome. It is more correctly known as Guyon canal syndrome, however, since this is the name of the passage through which the ulnar nerve passes. General symptoms are similar to carpal tunnel syndrome, but patients experience loss of sensation in the ring and little finger and in the outer half of the palm. It can be a separate problem, although it commonly occurs with CTS. In such cases, release surgery for CTS usually also relieves the ulnar nerve entrapment. The ulnar nerve can also be affected at the elbow.
De Quervain's Tenosynovitis	Tenosynovitis is swelling of the slippery covering of the tendons that move the thumb. When it causes pain on the side of the wrist and forearm right below the base of the thumb, it is known as De Quervain's tenosynovitis. (Finklestein's Test may help identify this. Make a fist that encloses the thumb, and bend the wrist sideways and down away from the thumb. If it causes pain, it is likely to be De Quervain's tenosynovitis.) It may be treated with splints or corticosteroid injections. In severe cases release surgery is effective.
Digital Flexor Tenosynovitis (Trigger or Snapping Finger)	Digital flexor tenosynovitis, commonly called trigger or snapping finger, is brought on when a tendon thickens, leaving the finger or thumb in a bent position. This disorder usually occurs when the tendons form a knot and may arise in those with hypothyroidism, diabetes, gout, rheumatoid arthritis, or connective tissue disorders. It can cause pain and a clicking sound when the trigger finger or thumb is bent and straightened. It can be effectively treated with corticosteroid injections.
Thoracic Outlet Syndrome	Thoracic outlet syndrome is caused by compression of nerves or blood vessels running down the neck into the arm. It can produce symptoms very similar to CTS. Other symptoms may include Raynaud's phenomenon (changes in sensation and temperature in the hand). The compression occurs at the first rib in the front of the shoulder. This may happen after an accident or simply from chronic slouching posture. A doctor may be able to diagnose the condition by detecting diminished blood flow in the arm as the patient raises the affected hand and turns his or her head toward the opposite side. Although the condition is uncommon, a correct diagnosis is important to differentiate it from CTS, since treatments differ. Surgery may be required to relieve pressure on the nerves and blood vessels.

Reference:

http://www.google.com.my/search?rlz=1C1CHNH_enMY326MY326&sourceid=chrome&ie=UTF-8&q=htm

http://mayoclinic.com/health/carpal-tunnel-syndrome/DS00326/DSECTION=tests-and-diagnosis

http://www.umm.edu/patiented/articles/how_carpal_tunnel_syndrome_diagnosed_000034_7.htm

Hand and Wrist week 8

hey....since no one divided the practical work for tomorrow i took the librty of doin it...hope u guys dont mind...

Activity 1
ridzuan, zhi mie, jess

Activity 2
syukriah, viran, arma, daksha

Ativity 3
shakir

Activity 4
chang tai

Activity 5
jasmine, carmmen

Activity 6
sandhya

Thoracolumbar Spine

*refer to Group H's blog for the full history*

Nerve Stretch Tests.

Lie patient on their back.
Knee extended, elevate the leg.


Criteria for positive test

• Pain at 30 to 70 degrees
• Aggravation of pain dorsiflexion of the foot
• Relief of pain by knee flexion

Interpretation: What patient experiences

• Radiating pain into the legs
• Suggests radiculopathy
• Higher likelihood findings suggesting radiculopathy
• Excruciating Sciatica-like pain
• Pain occurs at 30 to 40 degrees of leg elevation
• Pain radiates into opposite leg (Crossed straight leg raise)
• Indicates severe impingement
• Almost always due to a large disk herniation

I don't know why but I seem to find sources saying that Lasegue and Bragard's they're both the same thing.. Can someone clarify? :S Is it because one test follows the other? Or that we have to do both tests? HUH?! :(

Bragard's test :

Elevate the leg, dorsiflex the foot.

Is there pain?

Return the foot back to the normal position

Lasegue's test :

Now, flex the knee. There shouldn't be any pain.

Extend the knee again, and the patient feels a pain.

Such pain would indicate sciatica and spinal cord nerve root compression

Cross straight leg :

Lifting the healthy leg would cause pain in the other.

Straight leg raise
Test Sensitivity: Up to 98%
Test Specificity: Up to 61%

Crossed straight leg raise
Test Sensitivity: Up to 43%
Test Specificity: Up to 98%

*sensitivity : pateints with disease who has physical sign.

* specificity : patients without the disease who lack the physical sign.

Reference :

http://www.fpnotebook.com/Ortho/Exam/StrghtLgRs.htm

http://www.stanleyconsulting.ns.ca/Files/Neuro_Ortho_Tests.pdf

Risk Factors

MODIFIABLE RISK FACTORS

žCigarette smoking

žDrugs: some eye drops used to treat eye problems contain steroids. If unsupervised and taken over a long time, they can cause cataracts.

žDiabetes: proper treatment can reduce the risk of cataract

UN-MODIFIABLE RISKS

žAgeing - the single-most important cause of cataract

žGenetic predisposition- in 25-50 per cent of cases there is a family history of cataract

žEye conditions such as short sightedness and inflammation in the eye seem to be linked to cataract. Severe trauma to the eye can also be a cause.

žEnvironmental factors - cataract occurs more often and at an earlier age in developing countries

žExcessive exposure to Sunlight or ionizing radiation

žPrevious eye surgery

Underlying Health conditions

•Diabetes

•Systematic Lupus Erythematosus

•Amylidosis

•Rheumatoid Arthritis

•Menopause

•Pregnancy

•Down’s Syndrome

•Hep C

•Hyper Thyroidism

•Multilple Sclerosis

•Long term Heamodialysis

These conditions could contribute to developing CTS either because they share similar causes or their effects heighten the risk. They maybe a warning sign for each other.