ask orthopedic questions

drashokshyam  says:
2 years ago

well rudra askorthopedics

is rather 'ask orthopedics' where you can ask about orthopedics

and well i might tell you what orthopedics means

it is derieved from two greek words; ortho- meaning straight and pediatrics- meaning related to children

in older times orthopedics was mostly related to childrens fractures that is to make there crokked bones straight and hence the name orthopedics

at present it involves a whole lot of specialities like spine , joint replacemnet, fracture care, pediatric orthopedics, arthoscopy, chondroplasty, rheumatology etc.

drashokshyam  says:
17 months ago

well anita,if u are operated just a month ago then you need a x ray 6 weeks after surgery to confirm bone union

the only reason i can think of ,about why yr surgeon did not call u back after 6 weeks is that he has noticed a very well uniting fracture at the end of one month after surgery [ i presume he has taken x ray at the end of one month]

as for nonunion, it is a stage where the bone has ceased all activies to acheive union. before u reach the stage of nonunion u will go through the stages of delayed union and ununion. during the above stages the joint will be painful on movements and u will not be able to lift your arm above your head. these stages last from 3 months to 9 months. once the stage of nonunion is reached the pain will decrease but the functional use of the limb will be difficult.

as far as you r concerned , when the fracture is open reduced and fixed the chances of non union are very less, although i will still advice a x ray at the end of 6 weeks period just to confirm union

sorry for the delay in reply.

drashokshyam  says:
16 months ago

hi matt

thanks for the question

well rupture of short head of biceps is rare but not as much as you are beleiving

i am currently treating a female patient wwith traumatic complete tear of short head of biceps with some rotator cuff injury. your case however differs from her as she had a fall on the point of her shoulder and the tendon was torn due to anterior subluxation of the humerus bone. coming back to your case, you had no trauma or injury to the shoulder and had a seemingly bening onset, which makes me very sure that your tendon rupture is of degenerative type. that means your tendon was already weak and pathological. tendons are very strong structures that do not tear very easily and you had tendon torn without any sort of tension on the tendon. such a pathological tendon is most likey secondary to degenerative process over a period of time, however your age does not seem to be very supportive of the degenerative theory unless of course it is a secondary degeneration. secondary degeneration happens when the structure is previously injured. so maybe during your early year you might have had some innoccous or subclinical injury to the tendon which had healed partially and then degerated over a period of time [ this is the most likely scenario i suspect, however a detailed history taking would have helped us better]. as per the treatment part , any tendon injury that is traumatic and patient presenting early to the surgeon, the best option is to surgically repair the tendon in young individuals and to go for a more conservative approach for older patient. tendon injuries that are of degenerative type do not respond well to surgical repair as the tendon itself is not normal and has snapped because of failure of a long healing process. thus this degenerated tendon is not going to heal well when repaired surgically. thus from my side surgical treatment will not help you. as per the line of treatment started for you, i would suggest a strong analgesic and anti-inflamatory drug conbination along with trypsin-chymotrypsin combination with local heal application and sholuder immobilisation for atleast 2 weeks. after 2 weeks starting of sholuder range of motion excersises sholud commence. inadequeate analgesia and antiinflamatory drugs and no immobilisation is causing you the continued distress even after 12 days, so this matter should be definately looked into. now coming back to the seriousness of the injury to short head of biceps we need to understand its anatomy. biceps originates from scapula bone and is inserted to the forearm bone and helps in movements of the forearm.[http://www.google.com/imgres?imgurl=http://ligwww.epfl.ch/~maurel/Pictures/CHARM/WP3/biceps_brachii.gif&imgrefurl=http://vrlab.epfl.ch/~maurel/CHARM/WP3/Anatomy.htm]

at scapular attachment it helps stabilise scapula during shoulder movements, long head plays major role than the short head. thus after your injury heals , you might feel a discomfort for few months in doing overhead activities with your affected side. yet we have many muscles to stabilise the scapula that will eventualyy take over and the stronger long head is still well functional. also since during the healing process most likely the distal part of the torn muscle will reattach to the humeral shaft or fibrose with the surrounding muscle, thus it will find its own anchorage to the humerus shaft and hence movents at the elbow joint will not be affected. the very main use of short head of biceps is during strong throwing of say a baseball etc. thus in your case the functional handicap will be very limited and if the other muscles are excersised well there will be eventually no functional limitation at all. this is in view that left arm is the non-dominant arm of yours. thus for you surgery is a definate no no, yet conservative treatment should be more specific and the following rehabilitation is of utmost significance. as far as later reconstruction is concerned, it is not at all necessary as short head of biceps is just an acessory shoulder muscle.

drashokshyam  says:
16 months ago

you are welcome Matt

do tell others of this site and service

best of luck , get well soon and any further queries about your injury is welcomed

god bless take care

drashokshyam  says:
15 months ago

hi nicholas

from what you had i can figure out that you had a secondary tendon repair that is repair after almost three months of injury

from what you have said it seems you have a zone 4 injury to the extensor tendons of the wrist

hand and wrist are divided into 4 zones as far as tendon injuries are concerned. in the area where u had injury the tendons have mesotenon. it is a vasculat sheath surrounding the tendon. they are retaqined by the dorsal carpal ligament which acts as pulley and are ensheated into fibro-osseous canals . thus repaired tendsons are likely to get stuck in their canals as they heal. thus the area of repair of tendon requires release of the overlying carpel ligament. thus with wrist in extension a bowstringing of the extensor tendons may occur.

with this back ground lets come back to you.

well the primary health care provider is at fault to miss the injury. however the results of acute and chronic repair do not differ very much . its just that chronic repair is much more technically demanding surgery . also when the ends of tendons have retracted or a portion is destroyed the repair options incluide tendon trasfer or side to side suturing.

so the hand surgeon has done a good job to suture your tendons and to immobilise for a month. now the tendon must have healed to a great extent and rehabilitation is to be followed up step wise.

you had zone 4 injury that are prone for stiffness. but then good and monitorer therapy will give you back a good range and adequeate power.

i am saying this because tendons as they are, are a vascular structures. so there healing is never 100% and they hardly ever reach back to there original performance status , unless a very vigrous and specialised rehabilitation is undertaken.

for you therapy will be required for some time to get back to being 'within normal limit'

taking glucosamine and chondroitin hels in tendon healing thus it is justified in your case.

i guess i have answeared all your questions

if u have any more do let me know

take care

Nicholas  says:
15 months ago

Thank you very much for your answer Doctor. I really appreciate it. Yes, I beleive the tendon that I severed is the main tendon that radially deviates the wrist, the extensor carpi radialis. Am I right? And I believe he did side-to-side suturing. What exactly does that mean? The doctor here is Ukraine isn't the most explanatory. He is a good doctor and also his English isn't that great so you can imagine the confusion I am in but for the most part I understand what he did. I have some great pictures he took of my tendon during the surgery. I would like to send them to you so you could see exactly what he did. Can I send them to you? If so what is your email? Anyway, the surgery was done on FEB18 and now it is APR11. I took the splint off on MAR 18 and the doctor told me to massage the tendon everyday and too soak my hand in very hot water. He said the tendon is still healing and not lift anything heavy or do anything forceful as the sutures can be undone. I do not visit him everyday because he is in a city 8 hours away. So this first month I have been massaging my own tendon and on APR 20 I will go to see him and he will do some work then with the hand therapist. From your experience how much use can I expect to regain? 90-97%? When can I expect to be back to "normal" again? 5 months post op? I must tell you that now my tendon is very tight. I can bend my wrist up a lot more than down. I can hardly bend it down but I have seen some improvement in less than a month after removing the splint. Is this normal for less than one month after removing the splint?

drashokshyam  says:
15 months ago

Hi Nicholas

Sorry for the delay , a weekend conference had held me tight

well first i would like to know your age and what is your occupation, whether your right or left hand is affected and which is your dominnt hand

do send me yr pics. i wd love to see them

thanks

P.S. my email is drashokshyam@yahoo.co.uk

Nicholas  says:
15 months ago

WOW!! That is great news then! Thank you for all of your knowledge and advice Doctor. I am very grateful for you. I am going to visit my surgeon on the 21st of April and I will give you an update of what he says.

Also, my left hand IS my dominant hand and I injured my right hand. So tennis should be no problem as I play with my left hand but in basketball I shoot with my right hand. Will this be a problem after I do lots of rehab and strengthen my right hand? Will I be able to use my right hand like I did before and not worry about it re-rupturing? Also, can I play golf and baseball where both wrists are used?

Also, right now there seems to have been some scar tissue buildup because the skin is pinching when I try to bend the wrist. I have been massaging it as much as I can. Is it possible that I would need another surgery to remove scar tissue buildup or will massaging and therapy break up the scar tissue adhesions? In your opinion therapy and time should get my movement back, right?

And I can also see how strong the other tendons have become in my right wrist. It's truly amazing how the human body adapts.

Talk to you soon.

Nick

Nick  says:
15 months ago

Hi Doc.

I just wanted to give you an update on what the doctor said since I visited him yesterday. He said I have healed great and then I went to see the therapist and he stretched me out good and gave me stretches and exercises too do and said within 1 month I should almost like normal. He told me to do the stretches everyday every 3 hours. He also me to soak my hand in hot saltwater every other day. I feel much better now and after he stretched my hand I can almost bend it like normal. It's pretty amazing! Thank you for all of your help and I will keep you updated.

Nick

Elias  says:
15 months ago

hello well i fractured my lower left fibula in two places playing lacrosse. my doctor has told me that it will take 6 weeks in a cast and then another 3 weeks of therapy before i can play again. its been 4 weeks and he has not let me begin walking on it. I was just wondering if this is a reasonable diagnosis because in my mind 9 weeks to recover from such an injury seems very long. Also im not sure if you can help me on this but is there anything i could possibly do to speed up the recovery process

Moe Hammoud  says:
14 months ago

Hello Dr. Shyam,

Thank you for taking time to answer everyones questions.

I unfortunately cut my left thumb flexor tendon in Zone 1. I had repair exactly 13 days ago 20 hours after injury. My thumb was very stiff after surgery and I am in rehab and physio therapy. I have not been able to move my finger on my own will since.

Yesterday i was doing my passive motion excersices and finished. A minute afteer i finished my thumb brushed up against my pants and i felt a shift or pop , something inside my finger I cant exactly describe it. At this time my hand is in 30degrees bend with my thumb in flex in the splint.

After the incident, my finger is able to flex and extend a further and with a lot less tension when bending the tip of my finger with passive motion. I am worried the tendon ruptured but can this just be scar tissue breaking or ??.. I really dont know since I could not flex my thumb before this or after. But I can go further with my passive motion excersises.

one thing i can do is extend my finger upwards a little bit but is that not my extensor tendons working?

Thanks,

Moe

Moe Hammoud  says:
14 months ago

Hello again,

So to update I am on week 6 and have switched therapists. I was seeing an overpriced and inexperienced therapist and now finally at a Certified Hand Specialist. My tendon did not re-rupture thank god.

these are the measurements from the specialist.

Thumb MP - 0/83 degrees

Thumb IP - 5/20 degrees

Gex to DPL - 2.5 c m

Sorry it is hard to read the note im giving to my surgeon from this specialist.

I cannot bed the tip of my finger very much at all which is a little worrying. I have been givin excersis such as actively bending thumb to bottom of pinky, passivly bending just the tip of the finger, and scar massages.. deep pressure in circles along the thumb.

I can fee like 3 balls or knots in my thumb around each crease in the finger where it bends. They hurt when i do the massage, I was told this is scar tissue buildup around the tendon.

I was just wondering what you suggest to help bring some movement back?

Thanks so much,

Moe

steve  says:
13 months ago

Dear Dr Shyam:

Thanks very much for sharing your valuable advice. I came upon your pages after searching the net for people with relatively similar injuries to mine in order to find out whether they improved and how much.

On April 19th I borke my left wrist when i fell off my bike while cycling, and had surgery on April 23rd. I had an external fixator anchored at one point in the bones of my forefinger and at the other in my radius, plus three other pins. From the xrays it showed that I had broken the ends of both the radius and the ulna. On June 2nd my fixator along with three pins were all removed. Upon viewing the latest xrays my orthopaedic surgeon told me that, it all looks good and he expects me to recover an almost full range of movement.

But here is my question, its six days since the removal of pins and fixators and my wrist is still extremely stiff, like it's locked in place. i can't rotate my palms to face up or down. What can be the cause of this, and is this 'normal'? If the xrays look 'good', why is there such little mobility in my wrist. Am i being impatient?

Hope you can respond soon.

many thanks

Steve

Bryan  says:
13 months ago

Hello doc, I had surgery on my right ankle(9 screws and a plate) on May 16 after a fall at the park, my foot still gets darkish red when I crutch myself to the bathroom, how long until atleast I get the color back?, it used to get a lot darker but not as much anymore, the sugeon said it could take 6 weeks to heal but I'm pretty optimstic about all this seen how they have been treated me on the past, I got the x-ray of the operation and there is a chip that could be seen in the fibula, does the bone disappear or do i have to go back to surgery to remove it? I got a lot of x-rays to show so you could give me an advice on how is it healing and any other inside information you could give me, im taking oneadays for men(vitamins) and a calcium 500, Im 24yrs old none smoker, thanks in advance.

Evan  says:
13 months ago

I have a weird shoulder pain that is killing me, last night I went to bed at 10:30pm with a minor pain, I woke up at 1:30am and my shoulder was killing me and coudn't go back to sleep. This have been happening almost every day with both of my shoulders, usually the right one is the one that is most frequently in pain but today the left shouldet is killing me.

I have full mobility in both my arms and the pain is not associated to moving them, so I don't think it's either rotator cuff tendonitis or bursitis. But the pain is there, burning my shoulder all day and it doesn't seem to be associated to bones, I actually had x-rays taken on my neck and shoulder and everything looked fine for the doctor.

I have always slept on my sides and there wasn't any problem till a couple months ago so now I try to sleep on my back or stomach but it doesn't seem to help much (unless I go back to sleep on my sides when asleep). What can it be?? What should be my next step? ask my doctor for an MRI to the neck?

Evan  says:
13 months ago

Thank you, it's good to hear from you.

I live in the US, Chicago to be exact, I'm 31 years old male and work as an algorithmic trader, so I spend most of the time either coding or using the mouse and cliking it hundreds of times per day.

The problem started in my right shoulder around late April early May, and since 3 weeks ago I have it on and off in the left shoulder. I went to physical therapy for my right shoulder during May and although it felt better it never dissapeared completely. Once the pain on my left shoulder started early/mid June I decided to go see a chiropractor but after the first "adjustment" I felt so sick that I never go again.

Now the pain in my shoulders have come back strong and it doesn't even let me sleep for the last 5 days.

I sometimes feel pain in my arm/forearm and wrist but not that often, and the pain is more like a sharp pain for a few seconds and dissapears, like if I were getting painful cramps on my arms. Not like the pain in the shoulders that once it starts it lasts all day.

Right now I'm not taking any drugs. What is neck traction btw? I think I have read about spondilosis before, is it common to suddenly be present?

My MRI is scheduled for next Monday.

drashokshyam  says:
13 months ago

hi evans

thanks for all the information

now i get a better view of yr problem

shoulder pain of this type is very commen in people who work a lot on computors. it is a type of repitative strain disorder

you must have heard about ulnar and cubital tunnel syndromes which are again repetitive strain disorder affecting programmers

nerves are like electrical cbles that have to traverse through narrow spaces in the muscles of the arms.

sitting on the comp for long time, needs continous maintainence of same posture for a extended period. this leads to excessive tensioning or thighteness in the muscles. the muscles get faatigued and one feels discomfort and pain. however as one continues to carry out the same activity there is repetive fatigue and strain injury to the muscles . this leads to areas of muscle swelling and abnormal tightness causing entrapment of the nerves passing thorugh them. this compounds the problem. the dull muscle ache now gets compounded with sharp burning nerve pain.

this is what best explains you.

my suggestion to test this theory is stop working on the comp for 2 days give yrself complete rest from typing.

i wd still like you to go ahead with the Mri. but you should start neurotonics like mecobalamin tablets

wish you well

J. D.  says:
13 months ago

Thank you for the prompt response to my question Dr. Drashokshyam. As to your question about feeling discomfort in the elbow region prior to my tendon rupture I can't say that I did. I do remember feeling an unusual soreness in the belly of the biceps though within the week prior to the workout that resulted in failure of the tendon while performing a heavy set of preacher curls.

As for my current situation, would you recommend that I wear an elbow brace or sling on the right arm when I'm on the job? I work in a gym training people and often find myself lifting dumbbells or weight plates when helping them get set up to perform certain exercises.

Matt  says:
13 months ago

Hi. I tore a ligament on my ring finger (1st knuckle nearest the fingernail). An orthopedist told me to splint in for 4 weeks and it should heal ok. I stopped splinting it after 4 weeks and a half weeks. It's been 10 days now since I removed the splint and I still can't bend my first knuckle and I don't think I have any control over it, like I do my other ring finger. I try to massage it and bend it a bit every so often. Should I just wait a little more and would I eventually regain movement on this finger? Or should I go check with my orthopedist again? My finger is still a bit swollen, about 5-10% more swollen than my other uninjured finger. It was 80% more swollen when I first injured it when a rope got jerked from my hand causing the torn ligament. Thank you so much for your time and help. I appreciate any kind of suggestion you can offer. Thanks!

Laura  says:
12 months ago

Hello doctor - I'm really hoping you can provide me with some advice, especially in talking with my orthopedic surgeon.

In Feb 2007, I noticed a baker cyst on my LEFT knee. I began treatment with a sports med doctor, who first had me undergo ultrasound to confirm the diagnosis. Then in April 2007 we had the cyst aspirated by a radiologist - it was 8 cm in length, 4 cm in height and 25cc of fluid. They injected cortisone. The cyst returned within 48 hours.

I underwent an MRI in August 2007 which showed: (1) partial ACL tear (2) chondromalacia patella (which I understand is normal for a woman in her 30s like me) (3) a patellar spur

I then went to see an orthopedic surgeon, who prescribed an NSAID (no difference to the cyst after 6 mo) and also physiotherapy to strengthen the legs and possibly help with other problems. The physiotherapist had me do the following - daily exercises to strengthen legs (I'm very skinny, and had lost a lot of muscle on the left leg since I have been unable to put weight on it since December 2006), weekly treatments of ultrasound and laser. I continued to take anti-inflammatories and use the RICE method after painful physio.

The physio did result in strengthened muscles, but the cyst kept getting bigger and hardening. I was unable to get time off of work until this month.

Last week (June 24 2008) the orthopedic surgeon decided to aspirate the cyst again. It was 30 ccs of fluid this time, and much had hardened so he caused a lot of bruising after manipulating the area to remove it. He injected cortisone, and I have used a compression brace and stayed off my feet since. THis is ONE WEEK, and the cyst seems to be back.

I will be seeing him within a week, but I'm really concerned. The cyst is very painful because of its size and location. I have had pain in BOTH knees since December 2006 - the left I think from the cyst OR ACL, and the right because I have been limping for a year and a half. It is also having implications on my back, from all the limping.

The surgeon, so far, has been reluctant to do any surgery, because he thinks I"m too young and also something about the difficulty in healing from the size and area of the incision that would be necessary to address the cyst and/or ACL.

I feel it is imperative to get this problem solved before I go back to work in September.

Do you see an alterative to surgery? Are there questions or options I should raise with my surgeon to get this resolved? My work involves some physical activity (lecturing), and so it's quite important that I be able to get to work and then able to lecture to large groups. ANY advice you can offer would be excellent.

drashokshyam  says:
12 months ago

hi laura

understanding of the baker cysts is very important for its treatment

cysts are abnormal collection of fluid in soft tissues. there are 2 types of baker cyst one primary where the soft tissues secrete the fluid and the other secondary where the fluid is formed in the knee joint which then seeps out of the joint into the tissues spaces via a small opening on the back of the knee.

the treatment of a primary cyst is aspiration and cortisone injection, however this treatment is doomed to fail when given for the secondary cyst. with secondary cyst the problem lies in the joint where the excess fluid is secreted, so one has to tackle the problems in the joint.

your MRI showed u have a partial ACL tear and chondromalacia. these 2 pathologies are the root cause of your problem and they have to be tackled.

the best way to tackle them both is surgery and rehab.

about the incision , there are minimally invasive surgical options available like arthoscopy.

do tell me if you had any history of knee injury or knee swelling or knee pain before this episode because Synovial fluid caused by repeated effusions may replete the gastrocnemius-semimembranosus bursa (GSB) communicating with the knee joint. Fluid trapped inside the GSB through an alleged unidirectional valve-like mechanism forms a so-called Baker’s cyst. Since a significant association of Baker’s cysts with knee joint disorders has been reported, treatment should primarily address articular lesions causing recurrent effusions. Arthroscopic surgery provides an effective treatment in that both the cyst and associated joint disorders can be optimally visualized and accordingly treated.

precise and effective techniques of scopic repair have had good results with baker cysts, however always remember baker cysts do recur if the primary problem in your knee is lft unadressed

do talk abt these issues with yr OS

take care , be well

drashokshyam  says:
12 months ago

hi laura

as you have told me, you had symptoms of pain with giving way episodes, i can now tell you that the partial ACL tear picked up on the MRI is the primary lesion causing your baker cyst and has to be adressed. the ACL tear is causing knee instability and recurrent 'nipping' of the synovium by the bones of the knee joint. this leads to synovial edema and increased fluid production.

as we have solved the 'mystery' of yr recurrent baker cyst , i hope your OS wd be in a better position to treat you.

take care , be well

sharada  says:
12 months ago

I underwent surgery for Carpal Tunnel Syndrome one year ago. Is it okey for me to workout in the gym using dumbells?

Coralee Sisel  says:
11 months ago

Dear Dr Shyam,

I'm a 36 year old female, I have been having a great deal of discomfort and pain on the inside of my left elbow. I have a very physically strenous job. About a month ago, I was doing a lot of digging of dirt and carrying and as well a lot of heavy lifting. For approximently a month now, I have been having pain in the inside of my elbow which seems to have pain that follows up my forearm (on the top) in two completley parallel lines it feels like it could be tendants. I have been researching on the internet what I could have possibly done to my arm and it seems if anything, it could be possibly golfers elbow but the articles that I have read said, that if this is what I do have, then I should have pain when I curl my wrist, which I do not have.

My pain seems to be at it's most when I extend my arm out straight and when I curl my arm up towards my body, or when I am lifting things even a simple glass of water. I feel as though I have lost about half of my strength in that particular arm. When I continue to work each day (because the bills to need to be payed) I sometimes have some days where it feels like its warm or burning a bit, especially when lifting. When I first injured my arm, I was continously applying ice for 20 min. here and there and it didnt seem to help it. I have just ignored it this week as best as I can because, the ice wasnt helping. I know I need to make an appointment to see a doctor but time to do so, seems to be almost impossible at this time. Is there any information that you could give me to help me with my problem or possibly tell me what it is that I have done to it.

Deepak Patil  says:
11 months ago

Dear Doctor, I have been suffering from ankle pain since a month. While I am sitting, it doesn't pain, but during the initial few steps of my walk, the pain steeply increases. It persists heavily for a while decreases then but it is never gone. Kindly suggest me some remedy for this problem...

-- Deepak P Patil

Dhannjay  says:
11 months ago

My grand father 82, had Slip Disk problem 3 months before, now he is alright but he discontinued his routine of morning & evening walk hence getting swelling on his feet. Can we use the 'Walking Machine' which shows in TV channels, by means using 15 min. of this machine will get equivalent to 10000 steps or 2.5 KMs walk.

Kindly suggest me whether use of such machines are useful or not.

Laura  says:
11 months ago

HI Doctor,

I am in desperate need of advice. I am a 32 year old female. I work out of my home, and have never experienced any greater pain then child birth until NOW:(

Two days ago my husband and I were playing around while hugging and lost our balance and he fell completely on top of me with all his 200 lbs of body weight on my left shoulder. When I hit the floor I heard many cracking sounds ( the sound when you get your back popped or realigned) it was stuck in the same position as when I feel ( hugging him around his waist) I briefly went out and then proceeded to vomit due to the pain and then after regaining myself he attempted to relocate my shoulder. I have been to the doctor however in my small town orthopedics will not see me until x-ray's have been done and I have been seen by a regular doctor. I did this yesterday and now I have to wait until Sept 4 for an MRI. I can not move my shoulder, when i move my arm, try to hold something, or twist to the left I have to hold the top of my lft shoulder to keep it from moving and locking in a very painful place. My doct seems to think it is a cuff tear, where I think it is something more along the lines of a separation, because i feel it move and then i have to manually put it back into a more tolerable position. The x-ray's have not come back yet, but is there anything this x-ray's can show besides a fracture. I can not imagine sitting helpless in this much pain for two weeks, and not being able to see an Orthopedic.

A little more info, I am 5 foot at 120 lbs, husband 200 lbs, at 6 foot. I feel onto stone tile floor with him on top of my shoulder we feel at an angle.

Thanks so much for your site, I look forward to hearing from you soon

Laura D

Matt  says:
11 months ago

Hi Dr. Shyam. My doctor told me I tore/ruptured my flexor digitorum profundus of my ring finger. He said I will no longer be able to move my first knuckle but I would still have most of the important function of my hand and finger. He said surgery is possible but not vital for this type of injury. I would like to get a second opinion from you. Right now, it's been 4 months since my injury and my whole ring finger is still a bit swollen. I can bend the 2nd knuckly but not completely. The 1st knuckle is stiff and immovable. My doctor said I need to excercise it everyday with a clay mold and a hand excerciser. Would you recommend or discourage surgery for this type of injury? Also, do you think there's even the slightest chance that it may not be ruptured completely, even though I really can't move it and it's been stiff ever since the injury. Thank you so much for your time and help. Sincerely yours, Matt

kno1  says:
10 months ago

Two months ago I fx my R. prox humerus. I had surgery with plate and screws.

My arm stays swollen and irritated right over the plate. Otherwise, I'm good and have decent ROM. Incision has healed nicely, no fever. My PT said that I may be rejecting the plate and screws. Anyway, how can I convince the surgeon to remove the plate and screws? I actually feel that this plate is limiting my ROM and causing my discomfort. The tissue over the plate and surrounding the plate are always very tender to the touch.

Thanks,

Angeka

David  says:
10 months ago

Hello Doctor,

I have a Ulnar deviation of fifth finger without evidence of underlying fracture, i was informed of this by rediologist when he took four x-rays from my fifth fingure.

I cant stretch my finger all the way, the finger has an arch. I sustained the injury playing basketball and it happend about two month ago.

I used a splint for a day and I forced the finger to be stretched all the way in which I stretched it but I had a lot of pain since I put to much pressure on the finger so that it would remain stretched all the way in the splint.

The next day I took my finger out of the splint and after a 20 to 30 minutes of not using the splint the finger went back on looking the same way with the arch in the pip.

I did not use the splint, just used it for about 12 hours.

Doctor what should I do? should I keep on wearing the splint for a much longer time and make the finger go under lots of pressure to make it stretched?

Please advise, thanks!

David  says:
10 months ago

Hi Doctor,

Thanks for reply to my earlier massage.

I am 31 years old and my finger was swollen after initial injury. I have also pictures from my finger but I dont know how to paste and send it to you please advise how I can send the picture to you. Thanks!

Best Regards,

David

isisonline  says:
10 months ago

Hi

I have a 2 1/2 yr old girl, who borke her collarbone about 5 days ago. We went to the er, and the doctor wanted her to see an orthopedic surgeon. He says that the collarbone is broken, and dislodged. When you look at the xrays the bone is sitting on top of eachother with the top one at a high angle. I took her to the prthopedic surgeon who was rude , and kicked me out of his office. I went back to the er, to see if I really needed to go, and they said yes. Im not sure what to do. Will it heal on its own? It is starting to get a yellowish bruise also.

David  says:
10 months ago

Hi Doctor,

I e-mailed you the pic from my finger. Did you recieve it?

Let me know thanks.

David

isisonline  says:
10 months ago

thank you!

drashokshyam  says:
10 months ago

hi andy

from what you have told me , you have an unstable vertebrae

the electric shocks you are talking about are called 'lhermitte's sign

and they are a sign of nerve tensioning

what you need to do is to contnue the excerses , wear a soft cervical collar for 3 weeks and start on neurotonic drugs [methycobalamin, pregabalin etc]

take care and all will be well

cjsmom  says:
9 months ago

I have a question

I had a SL tear an LT tear and a TFCC tear (along the attachment to the ulna) the arthrogram I had also said additional evidence for ligament tears is seen between the distal radius and ulna. Is this different from the tfcc tear? Should that ligament also have been fixed? Also I had my surgery done 8 months ago and I have been going to PT for 4 months and I have no rom still and my doctor said that the anchor holding the tfcc is coming out and will eventually need to be fixed and that he wasn't sure if it is torn or not. So wouldn't the best thing to do is get an mri or another arthrogram done? and if I need all that what does my recovery time look like?

Matt  says:
9 months ago

I was misdiagnosed 6 months ago with torn DIP ligaments instead of a complete rupture of the flexor digitorum profundus tendon. I just got back from a consultation with a hand surgeon (after getting several "2nd opinions" from different general orthopedic surgeons). He said that in order to restore some movement to my DIP joint, he would have to graft a tendon from my wrist to reconnect the torn FDP which has just retracted to the PIP joint. I asked him if he would highly recommend the surgery since all of the orthopedic surgeons I visited discouraged such surgery because of the "scarring" that it would create. He said that he would recommend it to me because I was still relatively young and may require mobility to my DIP joint for my activities, although the mobility that may be restored would definitely not be 100%.I would really prefer to gain back some mobility for my ring finger. However, I am scared that the "scarring" may affect my PIP joint which thankfully still has about 80% mobility (due to the swelling that never subsided), or that the surgery may yield no significant improvement on the DIP joint. I already discussed these concerns with the hand surgeon. I would say that he is a man of few words and he didn't really go into detail explaining what I wanted to know. He just basically said that although movement would be restricted due to the scarring that it would cause, at least I would have the use of these joint again. My parents, who are very much supportive of me, still doubts that surgery would be beneficial to me since an orthopedic surgeon who is a very close family friend discourages it. I was hoping to get any sort of opinion you might have with my case. Thank you so much for your time and help.

gary  says:
9 months ago

i have a distal bicept rupture left arm 3 weeks ago. i dont want surgery since my work schedule is full and cant take the time to rehab. im 46 working fine with the arm now is there some therapy to manage this problem. for the rest of my life or is surgery the only way to go.

Matt  says:
9 months ago

Thank you for answering my question Dr. Shyam. Right now I am leaning more on the side of not getting the surgery. I think I'll wait another two or three months and see if I can live with a minor disability such as a non-functioning DIP joint. I've talked to a lot of people about this, some also doctors, but you've definitely been most helpful. You are a blessing to us all that you've advised and helped. I wish you more success. Thank you.

shuhel  says:
9 months ago

by the way im 20 and im non smoker and non drinker. what i forget to mention also that the fracture is kinda like a spiral or oblique and they have now referred me to start pysiotherapy. why im a feeling like cracking or clicking like its moving at my arm when its healing and the doctors send me to physio to start. pls help!

shuhel  says:
9 months ago

hello doctor. i will try and send u a pic of my x-ray. in the meantime where are the symptoms of non union, i feel crackling and clicking at the imnjured site but also a mild one at the elbow so if it was a non union then i would have to feel pain right. and also if my doctors have started me doing pyhsiotherapy then its gotta be a good sign that its not a non union. i have started to move my arm around in simple ways like lifting my arm up as much as i can but right now i have joint stiffness but im in no severe no pain plus as far as i know during the whole time i havent had a fall or a bang at my injured site. the only thing i cud say is that if im walking along a road for a long time at a long time i do get abit of aching at the injured site, is that normal cause i presume its still healing. your help wud be g8 thanks.

drashokshyam  says:
9 months ago

hi shuhel

as i said non union is unlikely in yr case

these aches ec are commen occuring after prolonged immobilisation

so don worry

as you are able o move your arm fine, is just a mater of time that you will be back to your normal activities.

take care be well

sneadhead  says:
8 months ago

My 8 year old daughter broke her right clavicle 5 days ago. We went to the pediatrician who x-rayed and gave us the diagnosis. We were told to buy a sling from a drugstore and come back in a month. She still has episodes of extreme pain. She is in tears at the moment because it "popped" as she was trying to lie down. Should I make an appointment with an orthopedist? Is there any other treatment that can be done to help?

drashokshyam  says:
8 months ago

dear mike

yes your symtoms are consistent with a SLAP tear along with a proximal biceps ear [long head tear]

yes it will get worse with furthe throwing movements.

you will ned a surgical intervention for your injuries

be well

[the delay was coz of personal reasons and i apologise for it]

drashokshyam  says:
8 months ago

dear shuhel

well since it is 2 months now

u can get anoher x ray done to check the healing

mail yr xray to me and i shall tell u whas happening to the fracture site more clearly

meanwhile i guess you are having either soft tissue interposition or a delayed union

bu dont worry boh are redily amenable to conservative treament

be well

shuhel  says:
8 months ago

also what kind of treatment is done for soft tissue interposition.

what if its niether a soft tissue interposition and delayed union, would that mean its still healing?

shuhel  says:
8 months ago

how long do you think this aching will take for it to go away doctor?

Jennifer  says:
8 months ago

I am a 32 year old female from Florida and I have a few questions.

I have a ligament tear that is between the distal radius ulna that by my doctors interpretation is non-repairable. Can something that is non-repairable to one doctor be repairable to another? If non-repairable will I have complications from this in the future and/or as I get older? and if so what kinds of complications and will those complications require surgery?

Also I had an intercarpal fusion w/autograft. My doctor held the two bones together with a screw. Will that screw stay in there or come out? Also will I get full range of motion back or lose my range of motion? Will I have complications from this as I get older and if so what kind? I am right handed and hurt my right hand. So will the fusion effect my daily activities? I am still in a cast and will be for at least another month.

I would greatly appreciate your swift response in this matter.

Jennifer  says:
8 months ago

I have the MRI report and it states that contrast extends into the distal radioulnar joint representing a ligament tear. Then I have the doctors surgery report that says this (mind you I tore all the ligaments in my hand.)

The lunotriquetral joint and the TFC were approached through a transversal incision just distal to the unlna, carried through skin and subcutsneous tissue. Hemostasis was obtained with a bipolar. Blunt dissection was carried out down to the retinaculum. It was split in the direction of its fibers and retracted. The fifth and sixth compartments were mobilized retracting the tendon. The joint was then opened. Opening the flap, there was a hole in the TFC that was non-repairable and a flap. The flap was debrided with a rongeur down to new surface and then irrigated.

So I had the first doctor do all the repairs and because one repair failed another doctor did the intercarpel fusion with autograft.

So the second doctor was just looking at the failed ligament repair that was held with k-wires (anchors) nothing more.Because the anchor came loose. Should I ask him about this tear my first doctor said was non-repairable?

If you need any more information or more mri reports i can scan them and email them to you. I greaty appreciate your responses.

Gokul Singha  says:
7 months ago

My wife aged 52 had complete humerus (right arm) fracture on 10 Sep 08 and had ORIF with single plate on 24 Sep 08. But during x-ray the operator turned the arm causing breakage of 4.5 cm bone piece with the plate and screw. Re-surgery was carried out on 01 Oct 08, used three plates and removal of the bone piece. There is no other problem except that wrist cannot be lifted at all. there is swelling around wrist area and the thumb. All five fingers can be moved as normal. Nerve Conduction Study test has been advised. Question: Why I am Not able to lift or control my right wrist even after two months of open surgery of right humerus bone fracture?

Mjak  says:
7 months ago

Over the last few months I have been feeling lots of stiffness in my arms and feet. I found I was walking with a funny robotic like gait. I went to my doctor who after blood tests determined I had a vitamin B12 defiency and started me on shots. She said this could be causing my problem. Several weeks ago I began having non stop pins and needles in both hands. First it was primarily the right hand now it is both. Again, my doctor said the B12 defiency could do this. Now for the two weeks I am experiencing pain in my neck, difficultiy moving it and a feeling of constant preasure on the back of my neck. The pins and needles in my hands continues. I still have robot walk, lol. I am no longer convinced this is all from a B12 defiency and wondering if this could be an orthopedic problem. I do have osptopenia. Do you think an orthopedist could help me.

thanks mjak

drashokshyam  says:
7 months ago

hello mjak

well the symptoms that u have put forth are seen in B12 defficiency.

however it should not have progressed during treatment

a vitamin defficiency occures over a period of 5 to 7 years and only after that the patient starts to have symtoms and so even the cure is slow

however as u have commented yr symtoms have increased so there lies the doubt in diagnosis.

u should be throughly investigated again, by a rheumatologist and by a neurologist.

orthopedics consultation in not necessary at this particular juncture

take care be well

trudy  says:
7 months ago

Hi Dr,

I am a 24 year old female.. I was running in the hallway of my house last week ( thursday 27th of November) and I ran into glass and cut my right foot just above my big (great) toe.. I went to the hospital and got 6 stitches,, I told the Doctor I could'nt life my toe upwards and he check the nerves! Silly I know. So I went back on wednesday nearly a week after and told the doctor( a different one) that I can't move my toe upwards he said the tendon has been ruptured and I will need to get an operation urgently! so now it is Friday the 5th of Dec! and I am still waiting for the referal to get the operation.. I am starting to worry alot!! I play alot of soccer and sports and I am scared about not being able to play as well because of this.. Please can you give me some advice? like about the operation? and if the longer I leave it the worse it gets ? yes or no? and how long is too long? I am hoping I can get this operation next week but I have no idea when they will contact me!! also recovery? how long does this take and what happens?

so today I can bend my big toe toe down i just can't lift it.. its constantly feels funny.. like numb ish or tingling... and is just dead and floppy.. I have no problems with any of my other toes or foot just lifting the big one!

I look forward to your response.

trudy - tsandle@hotmail.com thanks

Chan Min Park  says:
7 months ago

Hi doctor!

I am a 17 year old teenager living in China!

So I recently broke my finger, well, 7 weeks ago to be exact. (October 23rd) Well I had a cast on for about 4 weeks, then a splint on for another 2 weeks. Now I have taken everything off. The finger is fully healed, I cant bend it fully now but i understand if I do rehab it'll be fine. But the problem is, the finger bends sideways. When they take an x-ray the finger is straightened out. When the finger is straightened out, it looks fine, it's straight. However once i try to make a fist, the fourth finger (the finger I broke) overlaps my fifth finger. When I broke the finger initially, it was also like that. My doctor told me in the beginning I had two options: surgery or cast and I picked the cast. He told me cast will probably not make my finger 100% like before. Some tell me after time, it will bend normally again, but I am still a little worried. Could you help me out?

Thank you so much for your time!

- Chan Min Park

- cmp118@hotmail.com

stephanie  says:
7 months ago

Hello Dr.

My 13 year old tore a ligament on her ac joint in her shoulder this past tuesday. She does want to play basket ball for the rest of her school years, but I am concerned about her having a surgery. My son past away last year from Trisomy 18, and the thought of another child going under in surgery scares me! I was told that if it heals on its own that the scar tissue could be strong enough to support her shoulder and allow a full range of motion? I was also told that she should be seen again one week after her injury for more pictures? Does it need to be a full week to get the best idea of how its doing, or would 3 and 1/2 days or about 90 hours after the injury be O.K.? One of the doctors I was recommended is seeing patients in a clinic tommorrow?

Thank you so much for what you are doing!

Stephanie

drashokshyam  says:
7 months ago

dear stephanie

well AC joint ligament tears are not a very serious injury.

and the repairs can be done later too.

infact we prefer a late reconstruction.

presently a period of rest and then rehabilitation should be fine for her.

some questions. cand u see any abnormal swelling over her shoulder, is it bony or soft. how was the diagnosis done, what does the mri report say?

be well

shuhel  says:
7 months ago

hello doctor again.

i have just seen my orthopedic doctor in london uk and obvioulsy it has been now 16 weeks since my humerus midshaft fracture. i went to see the doctor and he felt out my arm telling me to push in and out with my arm and he has said that it has united now without even me havin an xray done. i finished physiotherpy about a week ago before i saw the doctor and i told her that i still feel a little bit of pain at the site and also obvioulsy the aching which i told about doctor and the phsio tells me that its just musles thats weak and that i should continue excersising my arm to build up strength and mobility. i have spoken to my doctor and he has said the same thing. I have almost full range of motion but just a few niggles. just wanted to know doctor, do you agree with what they told me and that the slight pain and aching is from weak muscle, is this common. they have currently discharged me now.

how to increase vertical  says:
7 months ago

Its a very useful hub for all the beginners and newbies.. Thanks for the pertinent info Keep it up!

drashokshyam  says:
7 months ago

hi mitchelle

well the MRI is just communicating with yr surgeon in its own language

the labrum is a soft pad that surrounds the joint and yr mri says that the labrum shows some tears here and there and that there is small fluid collection [cysts] around the joint

show it to yr surgeon and he will help u with it :)

be well

shuhel  says:
7 months ago

doctor, i am still awaiting your response for my previous question.

madhu  says:
6 months ago

Hellow dr.Ashok

first of all thanks for the humanity you are showing to the people,I think this is one of its kind service.Thanks once again.Pl help me

My mother of 65 years old having shoulder pain since a year.We have been to orthopedician four months ago.after taking x-ray and all he adviced some medicine and given an injection on the shoulder.That night she got severe pain but reduced in the morning.after that there was no pain for two months.Again since a month she is geeting severe pain again.pl suggest us what to do and where to go solve this problem.Along with shoulder her right hand also pains.It crosses the elbow.Now she is getting pain for both the hands and shoulder.She is not sleeping due to pain,Pl help us.We live in Thane.She can not move her hands to back,can not up stright,we have taken the phygiotherapy also but that also not helped us

Madhu.

MADHU  says:
6 months ago

SIR

THANKS FOR YOUR REPLY,PL GIVE ME UR HOSPITAL ADDRESS

REGARDS

maryegbertpt  says:
6 months ago

Hello Dr

I am a physical therapist, wound and lymphedema certified. I have a patient that just had an ankle ORIF and developed significant edema and cellulitis. She came to us about 4 days post surgery. She did have some edema so I applied some light compression, but I feel it was not soon enough and she developed cellulitis. She is non weight bearing and is wearing a posterior ankle/lower leg splint with the ankle set into neutral. I feel due to the non weight bearing status and inability to perform ankle pumps fluid builds up in the limb. What do you think about applying short stretch compression wraps in the OR? They would be changed in 48 hours and daily after that. Do you think this would prevent cellulitis in ankle fusions or ORIF's? Thank you for your reply.

Mary Egbert PT WCC CKTP CLT

Cindy G  says:
6 months ago

4 days ago I bumped the top of my index finger middle knuckle. It hurt a little almost a stinging type feeling then turning to stiffness on the side of my knuckle nearest to my middle finger. The next morning I work up with some swelling. Nothing huge, but noticable and tight. The swelling is continued and the stiffness and swelling has now moved to my joint at the base of the finger. There's really no pain unless I move my finger, but nothing intense. It's mostly the swelling that is causing a stiff, stretched pulling discomfort. My Husband told me to give it a week and if I still have swelling go see the Doc. What do you think?

mark n  says:
6 months ago

hi dr.

i have a non-displaced tibaial pateau fracture to the right knee inside area fron a violent vehicle accident it has been 2 1/2 months so far on crutches in a moving brace.the doc's told me no weight bearing for 3 months and no surgery. but the menscus was smashed and is very painful, it also swells considerably. what is your treatment in thesecases . my doc is avoiding even talking about the knee.

mark n  says:
6 months ago

the joint crunchs in a flex. and it swells daily with some numb ness in the lower leg. there are mucsel spasm on the medial side also.any contact with the plateala area is painful an follow by swelling.i am on celebrex,vicoden es, and percocet which i don't want to take(2 strong).1st mri showed(degradation)in his termsand that was all he would say.that was 11-20-08

drashokshyam  says:
6 months ago

dear mark

the problem seems to be much more than what i expected

some problem with your patellar tendon and the infrapatellar nerve

well how about taking a second opinion.

and a second mri too.

Creaky  says:
6 months ago

My joints are stiff, but not swolen. I can bend my back fairly well. It's worst

in the morning, but really all through the day. I use to smoke cigarettes, about 1 pack every 2/3 days. I used to be very active, and on my feet for 8 hours at my old job, with no problems, but now Im at a desk for 8 hours a day and now im starting to have these issues.

drashokshyam  says:
6 months ago

dear creaky

get a rheumatologist consultantation

i think it is one of the rheumatic diseases

nothing to worry thou, these diseases are treatable and u will be as active as you want to be in life

be well

1998kg  says:
6 months ago

Yes, I am walking with a 'boot" removable walking cast.

Lynch  says:
6 months ago

Hi my name is Lynch I am 32 year old male from the US.

I have a problem with my left pinky finger. About a year ago I had surgery on my left hand. TFC repair and after surgery it was bent. It is always bent. I had 3 1/2 months of physical therapy on it but nothing. My doctor says it is a tendon that is causing it to bend like that. He said the tendon is tight. Physical therapy seems pointless, is there anything that can be done to make it "normal" again? It really is annoying cause it makes it difficult to use my hand properly. Please help thanks

Lynch

drashokshyam  says:
6 months ago

hi lynch

a few details

where is the finger bent

did the deformity occur after the surgery

can you correct the deformity and straighten the finger by manipulating it

do u have any pain in the finger

do u have any weird sensation in the finger [heaviness, numbness]

was the finger hurt anytime

is it possible for u to send me a pic of yr bent finger

be well

Haven  says:
6 months ago

Hi,

I'm the mother of a 22 year-old female in rural US. Our health care is not like in a city. She broke 3 ankle bones - tibia, fibula and "cleaved" the tarsus. She is 22 months from the injury and surgery (done immediately to save the foot.) There are 9 pins and a plate in the ankle. She is grateful to have a foot but the pain is still a terrible problem. She cannot stand for very long, walking even several blocks is painful, running is out of the question. The ankle swells almost daily. X-rays show good healing and tarsus remains healthy. She ices, takes an anti-inflammatory as needed, massages and elevates the foot. She feels the pins may be loose. Is pain of this type normal after nearly 2 years? Are pins routinely removed at some point? Would removal of the pins effect her pain level. Thank you very much for your opinions

drashokshyam  says:
6 months ago

dear lynch

send pics on drashokshyam@yahoo.co.uk

Jim  says:
6 months ago

My problem started when I came home from work and went to sleep. I was awakened by a severe pain in my middle finger that hurt so bad, I literally didn't wanna try and drift back off. The finger then began to swell and i was unable to make a fist anymore. As this continued, the whole hand began to hurt and two weeks later, my other hand began to feel weak and lose strength. Well the Dr gave me a steriod pack and it took the swelling down, but with me working a job wiith repeaditly frequent hand movement, it came back like three days after. About two weeks after that, my left foot began to ache. it was like this is spreading. I have had blood work done and everything came back negative. x-rays came up with nothing. Physical therapy made my hands ease for an hour and I was right back like I was. The only other medicene I have been told to take by the doctors was ibuprohen which hasn't helped whatsoever. Right now, I am fatigued, while aching in my wrist, forearms and biceps, and triceps. I honestly feel like I have weighs strapped all over my body. They keep tellin me at the moment that it is just tendanitis thats making me hurt all over which is crazy in my opinion. I need HELP!

drashokshyam  says:
6 months ago

dear Theo

the fracture will require surgery, i am afraid. but in long run everything will be fine

be well

drashokshyam  says:
6 months ago

dear Jim

from what you are telling me, the best i can deduce is that u r having either some rheumatic disease or gout

can u tell me yr age and

do u take alcohol.

have they tested you for rheumatoid factor, serum uric acid, HLA B27 and ANA

let me know the results

be well

Jim  says:
6 months ago

I am 38, always been extremely healthy, what ever it is just appeared over night. They did bloodwork for everything I presume. As far as checking specifically for them I am not sure but was told I had no diseases going on. I though It was Carpel Tunnel since the foot hurts only about once a week. My hand hurts at the moment down the side, along with the middle finger which is still swelled after 3 months and right on the carpel of the wrist. The forearm and biceps still feel fatigued and as if they had been in a boxing match.

Lynch  says:
6 months ago

Did the pictures come out all right or do you need me to resend?

drashokshyam  says:
6 months ago

dear jim

take a neurologist opinion

hafiz  says:
6 months ago

doctor i have this pain in my upper right side back close to my shoulder blades. its like a sharp pain that comes and goes and also i get this burning sensation as well. i went to see my local doctor last week and he gave me a CO-CODAMEL painkiller. i think it has reduced the pain but not completely. i have had this pain now for 2 weeks but i think the pain has eased but now i am also feeling pain close to my neck like the pain has spreaded or something. recently i had a serious injury to my left arm and i was required to do physiotheraphy after recovery. one of the excersie involved me squeezing my shoulder blades inwards, and i did this when i was doing push ups and did it 40 times 3 times a day. i did this for roughly 2 months and thats when i started feeling the pain i have described above. do you have any clue what it could be doctor?

Steve W.  says:
6 months ago

Hi Doctor,

Lynch  says:
6 months ago

If I have injured one of the nerves, is there a name for it?

What can be done to fix it, more physical therapy, splinting, splinting it with a pin or surgery?

I ask you because my surgeon said physical therapy but after 3 1/2 months of physical therapy nothing has changed. What test can be done to know for sure?

I thank you for all your help

drashokshyam  says:
6 months ago

dear nikki

please do not confuse

the x-ray is for the knee

and ligament injuries are managaed by orthopedic surgeons

i, here, cannot give u an overview of working of the medical institution. if u have a geniuine orthopedic question please restrict yrself to it

thank you

drashokshyam  says:
6 months ago

dear lynch

sorry about the mistake , u have a tendon injury not a nerve injury

the tendon name is extensor tendon to the little finger

one of the slips of the extensor digitorum superficialis may be stretched during scopy procedure

these injuries are very very rare

u need to meet yr surgeon again and he will examine u and tell u exactly

als u can ask ur therapist directly if he thinks yr tendon is injured

be well

drashokshyam  says:
6 months ago

dear jessica

the present restriction of moment is temporary

it is to safegauard you from damaging the reconstructed ligaments

do not worry you will regain all your movements

be well

drashokshyam  says:
5 months ago

dear James
three months is adequeate time to start activities of daily living in biceps repair


however do not lift weight or do heavy work till 6 months


be well

Jay  says:
5 months ago

doctor, im feeling some aching on my left arm. its my upper arm mainly but sometimes i get a little aching on the lower arm too. anyway i broke my left arm roughly 5 months ago and it was a complete mid fracture but its healed. just a couple of days ago i slipped and thats when i started feeling this ache. its not pain but more of an ache. can u help?

Clark  says:
5 months ago

hi, i wanted to know, what are the symptons of bone cancer and also whether someone who has had say a broken arm or leg quite a while ago which has held is likely to get bone cancer?

drashokshyam  says:
5 months ago

dear clarke

bone cancers are of various types with variety of presentations

commenly they present as swelling at a particular site

less commenly as pain in the particular bone

fractures never lead to cancers so no risk of somebody with a broken arm or leg to have cancer

although other way round is true

sometimes bone cancers also present as fractures called pathological fractures

be well

mark n  says:
5 months ago

this is my mri report can you help de cyrpt it???

injury was started with tibula plateau frature on the inside right knee in violent roll over accident.

1---proximal acl is not well-demostarted and may be partly torn,clincal rehabilitation for stabiality is recoomended. what is this

2--trace distal patellar ligament tendinosis. what is this??

3--- probable partial to near complete tear of the femoral attachment of the fibulo (febular???)collateral ligament. is this a lcl tear??

4--changes compatable with prior sparain of the proximal medial collateral ligament. what does this mean

5 --medial mensuci subtle oblique signal to posterior horn.it does not contact articular surface and is not definitive. ---is it torn .feels like it

drashokshyam  says:
5 months ago

dear jay

get an xray first please

Jay  says:
5 months ago

hi again. i went to my local GP doctor and he assesed my arm and said an xray was not needed so he gave me some ibuprofain pain killers to ease my aching which is always constant. so far i feel as though the ache is receeding but it still feels sore, what do you think doctor?

Dianne  says:
5 months ago

What could cause an intense burning pain in the lateral portion of the kneecap whenever I bend my knee or squat? It causes no pain at any other time.

Thank you.

drashokshyam  says:
5 months ago

dear dianne

how old r u

how long is the pain since

did u have any injury to the knee

does the pain disappear when u straighten the leg

hankster23  says:
4 months ago

Hi Doctor,

I am 38 years old. I was practicing a martial arts called Aikido last Monday, 6 days ago, and I was performing a lot of very hard blocking with my left forearm. After the practice, my forearm was in a lot of pain. I iced down my arm and took 800mg of ibuprofen for the pain and possible swelling. My arm seems to be getting a little better, but it is still very sensitive to the touch. The night of the injury, my forearm hurt much more when I moved my pinkie finger. That seems to be better. It now still hurts when I bend my wrist and hand back. I can function very normally during the day, but the strange thing is that it aches at night. If I move my arm in the slightest at night, a strong dull aching pain seems to engulf my forearm for about 20-30 seconds, waking me up. Do you think I need to go get this evaluated by an Orthopedic specialist or do you think that with time it should get better on it's own? Any thoughts on why it aches so much at night? Thanks for your help.

Mark in Detroit  says:
4 months ago

I had a distal biceps rupture on my right arm last summer (I was 52) and had it repaired about a month after it occurred (my doctor's receptionist set my appointment and didn't seem to indicate that it should be repaired immediately). My doctor repaired my arm and it seems to have healed well. The bicep, however, doesn't extend down into my elbow like the one on my left arm and the tendon seems very thick. Besides the vanity issue, I now have chronic tendonitis in my elbow. When I work out at the gym, my right bicep can't get a proper contraction and the muscle is shrinking. The muscle is obviously at a mechanical disadvantage. What happened here and what can I do?

drashokshyam  says:
4 months ago

dear mark

the biceps tendon has two attachment s at the elbow

one is the main attachment that is attached deep to the elbow bone the other attachment is to the superficial area on the inner side of elbow

the repair that is done is done to the deep part only this might lead to some cosmetic problems.

also after a tendon repair the muscle does lose power of about 30 %. this loss in power may not be significant is daily activity however on heavy activities is may show up some reduction in muscle mass

continue the rehabilitation process

get regular consultation with your operating surgeon as he can better guide you as he knows the extent of tear and the quality of repair

hunta007  says:
4 months ago

Thank you Dr. Shyam. 


As yet, it has not been ascertained what percentage of rupture I have.  If I may ask, given that I have a partial tear and that it has been nearly 9 weeks since my injury, am I still a candidate for surgery or is it too late/risky for that?  With a partial rupture, does my candicacy for surgery decrease or does the risk of successful surgery decrease with the amount of time that transpires from this point?


Also, I assume there is still some tendon/muscle connection to my forearm, so if I do not have surgery, is it feasible that the remaining muscle can develop somewhat to eliminate some of the cosmetic deformity?  The deformity is most pronounced when I have my hand palm up and flex my bicep.  When my hand is palm down, you can barely notice the retraction.  Does this imply anything to you re: degree of rupture?

While you have not examined me nor do we know the percentage of my rupture, do you recommend I have surgery or do you think I should not?

Thank you again.

ritchie  says:
4 months ago

i broke my arm while ago but its healed, anyway i havent taken an xray for 3 months, so is it safe to take another xray, and can xray lead to bone cancer?

Terry  says:
4 months ago

Good Afternoon,

I fell with all my weight hitting my hand (like a karaty chop) on my left hand and underwent sugery on my left ring finger mending the bone and repairing the collateral ligaments. I had major swelling in all fingers along with my hand... I'm still under the care of my sugerion and go to Therapy twice a week however I'm starting to get these knots in the palm of my hand. I started with 1 and now have about six.... I know I still have a long ways to go. My ingury was on 11/6 had surgery on 11/17 and was back to work in 6 weeks and like I said to date still going through Therapy due to I'm only 100% in 2 fingers compared to 5. What are these knots coming up in the plam of my hand?

Rosemarie  says:
4 months ago

Dr Ashok Shyam,

A year ago I injured my foot and was treated for a badly broken toe, but just yesterday found out that they missed a long stress fracture at the top part of my foot that should have been stablized at the time of injury for up to several months. Since that was not done then, they are having me wear a surgical boot for 4 to 6 months now. I've heard that stress fractures never actually heal anyway. What is your take on this? Do stress fractures heal? If so, can this occur a whole year after injury? I'm worried that I'm crippled for life here. I hope you have good news that this can turn out successfully still.

Blake  says:
3 months ago

I do a lot of cycling, weighting and weight training.

Towards my lower knee/upper right calf (right knee), a stingy/prickly pain has developed. It feels like i am been pricked with a needed for 5 seconds or so and then dissipates. It occurs infrequently, and has only come about recently.

I am very concerned. It isn't natural.

Please give my you advice.

Regards

Tom Hagan  says:
3 months ago

I injured my left leg ,and have to use a crutch to keep weight off mt left leg. which arm do i pet the chuch under, left or right.

Lisa Henderson  says:
3 months ago

Dr. Shyam,

My ex-husband had an accident in October and tore his right biceps tendon. He did not receive surgery until November due to his employer not submitting the paperwork to workers' comp in a timely manner. The surgery was very aggressive, the bicep had receded 7cm and was very difficult to pull back down. It was reattached to the bone with a button. About two weeks after the surgery he started getting spasms and severe cramps in his arm. Both are painful but the cramps are excruciating. He gets the spasms sporatically, but he gets the cramps, in which his forearm muscle and the bicep both tighten up and completely draw up his arm, every 2-1/2 to 3 hrs., 24 hrs. a day. He has been having this problem since November. He is seeing an orthopedist and a neurologist and neither of them have any idea why this continuing. He is taking physical therapy but it's not really helping because he keeps getting the spasms so they have to stop, they have performed various tests which show nothing, the neurologist has performed a nerve conduction test, and even tested him for MS. He is receiving botox injections but they don't really help either, they weaken the muscles a little, but that's it. He was told yesterday that they would do another MRI and see if maybe a nerve is caught in the scar tissue, or somehow got out of place during the surgery, and if they don't find anything he may have the spasms and cramps for the rest of his life. I refuse to accept that. There has to be something that can be done or some way to find out what's causing the spasms and cramps. He cannot use his arm at all, he can't dress himself, he can't shower himself, he can't even hold a bottle in his right hand in order to open it with his left hand.

I have been searching the internet trying to find some information about this, but haven't had any luck, then I saw this website and I'm praying that you can help.

Thank you for your time.

Abeer A.J.  says:
3 months ago

Hello Doctor.

About 4 years ago I jumped of the stairs, and I hurt my ankle. and my mom took me to the hospital and I did the X-rays And Stuff, they said that none of my bones were broken, so I didn't need a cast. But the pain was always coming back for periods of time. about 3 years later I went to another doctor complaining about the same ankle, he did another X-ray and told me that I had torn my Ligaments befor and that they should have put a cast on it. so he gave my physiotherapy I went with it for about a week but the pain got worse not better so I stopped. then I went to another doctor who gave me a MRI and a CT scane but all the results were perfect and nothing seemed to be wrong with my ankle. he gave me some exercise I could do at home, and that was about 3 months ago, but my ankle is not even a tinny bit better. and one of the other doctors I went to said that my Ligaments might have goten longer, he said that if it didn't get any better in 6 months we'd have to do surgery but I'm scared, because he's not sure about it -_-!

the thing that seemed to confuse the doctors was that my ankle was never swollen. that my whole foot changed color when it hurts. the color will stay for about two days and the pain will stay for 2 weeks or so, it would fade away but come back when I walked even for the shortest distance. knowing that I'm only 14 and that I've been using cains for the last few months.

I know I haven't asked a question but I want someone elses opinion

Thank you for your time.

drashokshyam  says:
3 months ago

first I apologise to all the hub page community

i have been myself unwell for a month and hafl and was unable to attend the queries posted in this forum

i thank you for the continued support for this hub

Dr Ashok Shyam

drashokshyam  says:
3 months ago

dear hunta

i think you should avoid surgery

be well

drashokshyam  says:
3 months ago

dear lin

i am not specialised to comment on this topic

be well

drashokshyam  says:
3 months ago

dear terry

the knots in your hand are most probably fascial thickemings that act as trigger for pain and also cause stiffness.

continue with your therapy at present and u may require release of the knots later on

be well

drashokshyam  says:
3 months ago

dear ed

i think the sqeaking sound is because of one of your suture anchors getting loose

do get an mri for confirmation

be well

drashokshyam  says:
3 months ago

dear stephaenie

i think your daughter has injured her joint capsule of the knee joint

it is another of the ligaments of the knee and the healing time is 6 weeks with complte rest from stressful activities

so please ask her to stop training and take rest and hot foementation to the knee

if knee is presenting problems in walking get an mri straight way

be well

thanks for yr faith in me :)

drashokshyam  says:
3 months ago

dear tom

the answer to this question is very debatable but then most use ful is to keep it on the injured side itself

however according to my experience it depends on the patient whatever he is comfortable with is the best position

be well

Celia  says:
3 months ago

Dr. Shayam,

What would you suggest for a knee that has a MRI result of:

1. Estensive tear and maceration of the posterior horn and body of the medial meniscus.

2. Large medial popliteal fossa Baker's cyst with moderate knee efusion. Moderate amount of fluid in the medial and lateral soft tissues of the knee.

3. Severe chondromalacia of the patella diffusely with moderate chondomalacia of the medial joint compartment and mild chondomalacia of the lateral joint compartment.

4. Chronic tear of the posterior cruciate ligament with marked bucklong.

5. Mild sprain of the medial collateral ligament.

I show horses so I want to stay active my knee is currently quite swollen. I had lidocaine shots in it. That helps to keep the pain down. Would you reccomend surgery?

heather   says:
2 months ago

I had a torn ligament in my ankle on the outside, and they repaired it with screws to restablize it. I am have really bad pain in it after barely turning about 7 weeks ago, My question is do the screw need to come ou? or does it sounld like they need to come out? I also am unable to bear weight at all on the back side of it

Jeff  says:
2 months ago

I was having occasional pain and loss of strength in my biceps at the shoulder. I had an MRI and the Dr. concluded the shoulder area end of bicep muscle was rubbing on the bone causing the occasional problem. The answer, before it ruptured and with insurance at the end of the year, he had the muscle moved attachment move lower, so it didn't rub. It has been 6 months and I still have very little strength. I have been following all the trainers and rehab to get the strength back. My Doctor said I should have the size back and most of the strength back by now. Is there any way the nerve to the muscle didn't get attached right? And so it couldn't respond. The Dr. said there might have been irritation at the neck, when I had the spinal block. Will this eventually come around or will I have to have something else looked at?

Robert Hammond  says:
5 weeks ago

Hi,

6 days ago a fell down a slight of stairs. slamming my elbow on the third step causing immediate pain ang tingling down my ring and little finger. I went to an orthapedic sugeon that said I have a bruised nerve and that it will take a while to heal. I still have tingling in my fingers. Any idea of how fast these symptoms will subside? What should I do to help speed recovery?

Thanks

RJH

ashish agrawal  says:
4 weeks ago

sir, i got fracture in 4th metacarpel head on 3 march 2009. i undergone through plaster of paris for 1 month. but after removing plaster it got dislocated and situation got deteriorated, then doctor suggested me for physiotherapy, i did it fro 1 mnth . bot after so many days what i find, that i am not able to make fist and that joint is not working. and when i get up in the morning my fingers get stiff and it does not take load and a little bit swelling is also there. would you please tell me how time will it take to my finger to get normal and i eill be able to carry load.

Dr shahzad   says:
3 weeks ago

Hello Sir ,i am a doctor ,i have done my MD from Ukraine in 2007 and i have cleared MCI screening test in India.Sir i want to become a orthopaedic surgeon ,i want to do my MS (ortho) from ukraine of russia .what will be your suggestion,and will i be able to work in India .my email add is shahzadqadar@yahoo.co.in. please help me out .thanx

drashokshyam  says:
3 weeks ago

dear celia

exteremly sorry for delay

yes a surgery for this case is a must

be well

drashokshyam  says:
3 weeks ago

dear heather

sorry for the delay

well i think the screw should be removed immediately

be well

rebecca betson  says:
3 weeks ago

i fell akward on my right hand yesterday fell on the back of my hand with my thumb stretched out im in a lot of pain having pain up my arm i have had a schaphoid fracture on this hand before and by my thumb towards my wrist i have a lump. i went to a and e last nyt they just looked at my hand and said i had stretched the ligaments and put a splint on it they didnt xray it which i think they should have what do you think?

drashokshyam  says:
3 weeks ago

dear lidu

sorry for the delay

and well surgery is the only option for u

be well

drashokshyam  says:
3 weeks ago

dear dantescritic

well i think it is a routine mri

what u r describing is indeed a ganglion cyst

be well

drashokshyam  says:
3 weeks ago

dear brian

u should contact yr doc if the pain has not subsided till now

some nerve might be getting entrapted there

be well

drashokshyam  says:
3 weeks ago

dear shazzad

i have very little idea abt the query u put forth

but i think both the ukraine and russia ortho degrees are not recognised in india

so better talk to official persons regarding this

be well

leah Lemoine  says:
3 weeks ago

Hi Doctor, Thanks for offering help like this to so many people! Especially to all of us who refuse to go to the docotr! On a different note, I am becoming worried about my knee. On/around the outside right corner of my left knee, it hurts! I think the pain is associated with a vollyball game when I fell completely on it. At the time of the accident, my knee became swollen and I could see a popped blood vessel. A couple days later, a bruise formed, but there was no pain. I went on with my life and then, about 3 weeks later the pain started. Now, if I sit too long with it bended, put direct pressure on it (goto a standing position using my bunked knee), straighten and bend it, it all hurts! It even makes a popping sound everytime I bend it and the pain is achy and sometime dreadful--especially up/down stairs. The pain even wakes me up when I am sleeping. Ready for the weird part? When I run on it (I play soccer) it doesn't really hurt, and even feels better the next day and doesn't even really bother me during the night when I sleep. What could this be? I just don't get it!? Why would it hurt doing little things but feel ok when I play sports? I hope you can help me! Thanks, Leah Lemoine, 27 yr old female

drashokshyam  says:
3 weeks ago

Dear Leah

according to me, you have a posterior horn tear of the meniscus

do get an mri done of your knee

[abt the weird part, the meniscus is one of the static stuctures in the knee and the posterior horn comes into play at extremes of movements so the pain on bending and straightening. while playing the dynamic muscles are into play that offload the static meniscus]

Be Well

Jess  says:
2 weeks ago

Hello Dr.

I was involved in a tragic pedestrian vs. vehicle accident last Nov. Which resulted in a total knee dislocation with four torn ligaments. About a week later I was operated on and had my acl, pcl and lcl replaced using synthetic ligaments and the mcl repaired. Everything . It has been 8 months at this point of my rehabilitation and I'm missing 8 degrees of extension and have 90 degrees of flexion. After constant physio I tried to bring this to the attention of my surgeon for the last 3 months, he eventually took a closer look at my x-rays. He noticed that I have a small ossification in the posterior of my knee and suggested that this was blocking my mobility. He went on to say that it is impossible to remove due to the location and the risk of complications.

Since then I have then I have gone for a second opinion and this doctor suggested that I need the scar tissue removed and didn't feel the ossification to be problematic. He wrote a letter of suggestion to my current sergeon,(arthroscopic lysis of adhesions with gentle manipulation). My current sergeon says that it is not scar tissue but the ossification blocking me. I'm very desperate to get the function back in my knee, at only 28 years of age I cannot believe that nothing can be done about this ossification, if this is the problem. I know that it is hard to make a judgement without first seeing me. But any advice would be truly appreciated. Is it dangerous to remove from the posterior as he stated? it seems to be atteched to the ack of the tibia, not directly in the joint space but close.

Sincelery,

Jessica