Rudra  says:
2 years ago

what is askorthopedics

Anita  says:
2 years ago

What is the symptoms of non-union after a surgery? I am 22 years old female, had a surgery a month ago to put a plate on my fractured proximal humerus. I am functioning pretty normally now but am just wondering whether i am prone to non-union of my fractured bone. Do i need to do another x-ray to confirm union of bone? Will my hand hurt or any discomfort if there is a non-union or will i not be able to tell the difference? My doctor did not require me to come back for check up.

Matt  says:
2 years ago

Recently I had an intense pain in my armpit for no apparent reason, the next morning I woke to find a large bruise on the inside of my bicep(left) which eventually spread all the way to my wrist along with swelling of the arm, pec, and underarm area on that same left side. My Doctor ordered x-rays which were negative and then an MRI which showed a complete tear of the short head bicep tendon. I am told this is very unusual(short head as opposed to long head)and in fact I saw one website say that bicep ruptures only happen on the long head side.I was referred to an orthopedist who said I should do nothing except put heat on it and rest it while the tendon scars over. I don't have much faith in this course of action and can find no info on short head rupture treatments. From what I have read when a long head tendon tears it may be appropriate to let the injury heal without surgery, is this true for a short head tear as well? What do you know about this type of injury? What are my treatment options? If I later decide to have surgery is it possible once the tendon has "scarred" over or is it to late at that point?12-days after the injury I have some swelling still and pain running down the length of my arm that feels sort of like I whacked my funny bone, and I wake frequently during the night with waves of pain that subside and then return over and over.

thanks,

43y/o male

Matt  says:
2 years ago

Thanks for the detailed response, I wish my doctor had taken the time to explain that to me.

Nicholas   says:
2 years ago

Hi Doc,

First of all, I want to see this is a rather long story and I hope you read it. My name is Nick and I severed a tendon on Nov. 26, 2007 after punching through a glass window in my door. It was very bad to say the least. Right after I did this I thought that I cut an artery because so much blood was coming out. Also, I couldn't lift my hand up with my wrist. It was just hanging there but I could move my fingers. I thought I had cut a tendon but since I could move my fingers I wasn't sure. You must know that I am living in the country of Ukraine right now and when this happened. It was about 1am when this happened so the ambulance came and picked me up and took me to the emergency room. The doctor said I didn't cut a tendon and stitched me up. That night the pain was excruciating to say the least and I had no pain killers. The doctor gave me some but they didnt work in killing the pain. The next day I visited a doctor at the local hospital to get follow-up. The doctor was about 32 years old and he assured me that I had not cut a tendon. He said in two weeks we would take out the stitches. So I waited like a good boy and after two weeks he took out the stitches. After he took out the stitches and the bandage I could see a small bump on the opposite side of my wrist to where the initial cut was. I pushed on it and it hurt very much and I could hear something like crunching inside so the next day I went to the doctor and told him about it. He did another X-Ray and there was a peice of glass lodged in my wrist. It was about an inch long. So he cut open my wrist and removed it. Now I thought after him removing it my wrist would feel much better and start to heal. After one week I still couldnt bend it right and had no power. So I started investigating the internet and comparing my bad hand to my good hand and I saw a major difference. I noticed when I made a fist or exerted force a tendon popped up in my good hand and it didnt in my cut hand and I could also feel an obvious difference. If you make a fist and follow an imaginary line between your index and middle finger down to your wrist you will see the tendon pop up. It is a very strong tendon. I am describing my dorsal wrist so you know. It was very obvious to me but I thought it might be partially cut so I went to the doctor and told him this and he said that yes I could be right! WOW! What a horrible doctor. The same doctor who said I didn't cut a tendon 3 weeks ago and never even recommended getting some test to make sure. I pretty much diagnosed myself the whole time. After this he referred me to a "specialist" hospital here in the city of Dnepropetrovsk. SO I went there with my wife one day and met with a doctor. He sat me down at his desk and asked me to flex my fingers and etc. I could do everything so he said there is no tendon damage and that it's all in my head!! Honestly he said that but in Russian of course to my wife! I was done with Ukrainian doctors at this point. I just walked out and decided I would have to leave the country to get decent help so I took a train to the Czech Republic where I saw a doctor who told me that it could be partially cut and that an MRI would show if it was cut or not. Now you must know that I recommended the MRI and he said it would be expensive. I found out it cost like $900 bucks! Again he was rather young and didnt seem to knowledgable. I couldn't pay that so I decided to come back to Ukraine and search more. I kind of gave up in Prague beacuse it has become like the USA in their approach to medicine. Insurance based. Bad. Ukraine is still more social but it's bad because there doctors are some of the lowest paid in the world and they know what doctors make in the western world. I am not saying they are bad doctors because of this but it does have an effect. So I came back to Ukraine and it is now 2 months after the incident and I am getting worried because I know tendons need to be repaired very soon after they are cut or it's bad. So my wife asked her friends in Kiev if they could recommend a good orthopedic hospital and they did so we were off to Kiev. We met there with a doctor who first of all said to get an ultrasound which cost $30. I got the ultrasound and it revealed exactly what I feared...a torn tendon. Now I still don't exactly which tendon it is. I think it's the extensor longus or radial carpi..I don't know but I know you know. :-) So anyway I made an appointment to have the surgery. The surgery was done on Feb. 18, 2008 and the incident occured on Nov. 26, 2007 so about 3 months had passed. The total cost for hospital stay and medicine was $1,000. I paid a lot more than Ukrainian citizens but I earn an American salary and the average Ukrainian salary is about $250 a month so for me that price was great especially since I didn't have health insurance. I don't know what I would have done if this happened in the USA. It would have been bad for me I know. The doctor who did the surgery studied in Austria and is considered to be one of the best in Ukraine when it comes to the hand/wrist area. There are not many hand specialists in Ukraine as you can imagine many of them move overseas to make more money. So I had the surgery on Feb 18 and I had to wear a gypsum splint for 1 month and it came off on 17March. When the splint came off my wrist was stiff as a board. I went to see the doctor at that time and he said that I need to massage the area everyday to break up scar tissue and adhesions and to soak my hand in hot water. Also he prescribed electro therapy. Today is April 6th and I can bend my wrist a litte more but it is still very stiff. I can bend it up much more than I can bend it down if you understand what I mean. In other words I can lift my fingers above my wrist but not below them very well. The doctor is in Kiev and I live in a city that is 8 hours away by train so that is why I don't go to him everyday if you are wondering. I am supposed to go and see him on April 20 and he will do some serious work with the hand therapist there and give me some more directions. Also he said not to lift very heavy things and not to use the hand very forcefully because the tendon is still reattaching itself. I think I put that right. The doctor took many great photos of the inside of my wrist and forearm. It shows the ruptured tendon along with his work and the completed job. I would love to send them to you and see what you think and also your advice on my situation. I know it takes many months before I will be anything close to normal but want to know another doctor's opinion in the USA. I will be returning to the USA on June 1st and may need to visit a specialist for further therapy. Also, I have been taking Glucosamine/Chondroitin supplements everyday. Please respond to me. Thank you for your time.

Sincerely,

Nicholas Batt

batt_nicholas@hotmail.com

Mark  says:
2 years ago

I am a software developer and have been typing pretty heavily for 20 years now. In the past year I have begun to experience the feeling of stiff fingers in the morning and more troubling a burning sensation on the back of my hands. The burning sensation starts behind my knuckles and runs back towards the middle of my hand, about 1.5 inches along each of the 'flexor tendons', I believe that is what they are called. I do not experience this burning on my thumb. Finally, the burning sensation increases with the duration and intensity of typing and seems to disipate some when I cease typing for a few days. Is this a form of tendenitis, is this a permanent condition, what are some options for treatment other than not typing since that is how I make a living.

I have asked my doctor about this and he syas that it is nothing to worry about but the fact is it is getting to the point of becoming a bit debilitating.

Thanks for any insight.

drashokshyam  says:
2 years ago

dear mark

from what you have told me , i can tell you one thing that it is something to worry about

According to me you are suffering from 'overuse syndrome'

in your case you are overusing your hand intrinsic muscles that explains the stiffness of your fingers

also an altered sensation like sensation of burning in your finger indicates either inchemia or pressure on the nerves of your hand

Both these symptoms and there localisation to the particular area indicats affection of ulnar nerve.

read my hub on ulnar tunnel syndrome and do let me know if you have any more questions.

also at this point i would like to start neuroprotective drugs like mecobalamin.

for you activity modification and neuroprotective drugs are needed at present.

certain activity modifications are listed in my other hub, like taking frequent breaks, application of heat, doing frequent stretching excersises etc

this is something that is in a early stage and needs to be tackled with care.

best of luck

drashokshyam  says:
2 years ago

hi nicholas

from what i see from the photographs certain things are clear

1. there is complete tear of your extensor carpi radialis longus with partial tear of extensor carpi radialis brevis.

2. your surgeon has done side to side suturing of the tendon and also used tendon graft to anchor the tendons distally too. a pretty good job done.

its a good thing that its your left hand that is affected and only the wrist stabiliser that is affected.

now with tendon repair there is always loss of strength of the tendon, but a continues therapy might help in making the disability disappear.

as you work most of the time on computer, you might face some difficulty in the begining but with continued excersises this should stop bothering you after few months.

about excersises nicholas, they not only help the injured tendon regain strength, they also make the surrounding muscles strong so that they can take over the function of the injured tendon. so in due course of time your other muscles will partially take over the injured tendons functon.

also there are four set of wrist stabilisers whicjh hold the wrist stable while the tendons of the fingers work. these are extensor carpi radialis longus and brevis [ these are injured in yr case], flexor carpi radialis, extensor carpii ulnaris and last one is flexor carpi ulnaris. all these 4 sets of tendons are like 4 pillars. in your case at present one pillar is weak and what we are going to do is strengthen the weakened tendon and also strengthen the good tendons and thus with this treatment hopefully the joint will be as stable as normal and you can take part in contact sports [ luckily the sports you have listed mostly use the dominant hand much more than the left hand] so i guess playing will not be a problem for you,

at present the only concern is to maintain the excursion of the tendon, that is the ability and extent of tendon sliding. to do this you need stretching excersises and application of heat and cold to the affected part . later on strengthening excersises can be started.

y ou can continue to be in touch of your primary surgeon and of course i will help you, but you will need few settings with an occupational therapist and a physiotherapist.

anyways your prognosis looks good to me and you dont have to worry much for now, just take care of your hand. avoid further injuries and keep me informed

take care

Nick  says:
2 years 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

drashokshyam  says:
2 years ago

well as we anticipated you are healing well

it a great news

take care

drashokshyam  says:
2 years ago

Hi elias

well fibula is the smaller of the two bones in the leg and it carries about 1/6 of the weight the leg bears.

anyfracture takes 6 weeks to unite in an adult. so your fracture will take 6 weeks to unite. this fracture union does not mean that the bone is as strong as it was before the fracture. union here is a relative term that can indicate that there are less chances of the same bone breaking under 'normal' activities. even with this union in place i have seen bones refracturing due to excessive load put on the bone or a repeated but trivial trauma. to reach the prefracture strength the bone needs remodelling which is a gradual process and takes months. since fibula is one of the less used bones the 3 weeks period given by your doctor is very reasonable. even then i think it will be early for you to be involved in sporting activity unless your doctor confirms good bony union by taking a x ray at the end of 9 weeks

bone union is a natural process which rarely needs boosting as things might go wrong. there are certain precautions you can take to make sure that this union process continues normally . do not use tobacco in any form, do not use alcohol in any form. keep moving your toes constantly to increase the blood flow to the leg, have healthy food avoiding junk food, avoid putting weight on the leg till bony union is seen on the x-ray or else there are high chances of refracture.

let the nature take it course and 9 weeks is pretty reasonable. [ i would have told you to avoid sports for 3 months straight and then start training gradually to return to the pre-injury level only after 6 months. fractures are to be taken seriously or they start misbehaving]

take care, be well

drashokshyam  says:
2 years ago

hi moe

well as you have informed me , i guess the tendon repair is unduely stressed

any tendon repair is weakest between 5 and 20 days of tendon repair and there really is very less scar tissue at this time.

the increase in extension that you reported also indicates the same

so i am afraid there may be a re-rupture of the tendon

my advice - stop passive rehab, report to your operating surgeon,. he can do an ultrasonography and confirm the diagnosis

and yes the extension of your finger upwards is due to extensor tendons

take care

also check out this article about flexor tendon injuries

http://www.emedicine.com/orthoped/TOPIC94.HTM

drashokshyam  says:
2 years ago

hi moe

well it is a good news that there was no rerupture

about your tendon healing, well tendons are a relatively avascular structures and they do take a long to heal. even after healing they might not get back the original strength. we have to be very realistic about the results

the key is slow gradual and specific rehabilitation

at present the rehab u are geting and the results that u have acheived seem to be good.

my word , stick to the rehab programme [there are really no shortcuts]

the scar tissue will arganise in due course and will start transferring force to the tip of the thumb. till then take care and continue rehab

you will be well soon :) :) :)

drashokshyam  says:
2 years ago

HI Steve

well before commenting on anything first i wd like to know few things

1. did you had any wound over your fractured wrist

2. after how many days of your injury were you operatedand where were you operated and by whom.

3. do you have any burning sensation in your hand

4. does your skin looks shiny and reddish when compared to normal side

5 do you feel any difference in warmth over your wrist [ ask another person to feel it simultaneously over both your wrist]

6.are your fingers stiff too.

7. is there any swelling around your wrist

also it would be very helpful if you can email me snapshots of your x rays and a snap of both your hands to me

coming back to your problem

stiffness in the wrist after fracture healing by an external fixator is a commen occuring that takes about 2 weeks of rehab to get well, so be patient for now.

if yr doctor has said x rays are good then it is just matter of few eeks that u will be well

meanwhile send me the above details and x rays and i will be in a better position to help you

take care

drashokshyam  says:
2 years ago

hi bryan

post operative discloration of the skin and swelling below the surgical area is commen occuring that go away in 6 to 10 weeks. if u are not having any pain itching at the surgery site and fever then i think all is well with yr leg.

about the chip in the fibula- many a times there are small fragments of the bone that cannot be really fixed in that case we align the major fragments and keep the small fragments where they are. the bone healing process produces a lots of new bone and these small fragments get incoporated in the new bone so u dont habe to undergo a repeat surgery to remove.

also i wd like to see x rays of yr ankle so do send me the x rays by email

take care

drashokshyam  says:
18 months ago

hi evan

a burning pain is always associated with problems of the nerves

shoulder nerves come from the neck

also the fact is that most commen cause of shoulder pain is a neck pathology

so the most logical next step is - as you have guessed rightly- MRI of the neck

few queries frm my side

-how long have you been having this problem

-does this burning cross the elbow

-what kind of work do you do

-where do you live

how old are you.

in India we practise something that is called a therapeutic trial. it means we start treating patient according to out clinical judgement without going for costly investigations to confirm the diagnosis. so if you were a patient coming to me i wd have directly started treating you as cervical spondylosis patient with neck traction, anti inflammatory drugs, muscle relaxants and neurotonics.

anyways you can go ahead and get the Mri done

take care

J.D.  says:
18 months ago

I commend you for your generous effort to help those in need of sound, clear orthopedic advice and have a question of my own. I'm a reasonably fit, 45 year old man in good health. Five years ago I suffered a distal rupture of the left biceps while working out with a heavy barbell. I had it repaired with good results. About four weeks ago I began to notice irritation in what seems to be the distal attachment of my right biceps tendon just below the crease in my elbow.

My previous biceps rupture was obvious. I heard it tear and my arm lost tension in the biceps. What is happening with my right arm is more of a mystery. It isn't too painful but I do feel it now and then when I pronate or supinate. Curling exercises are painful when my biceps reach a semi stretch position so I have stopped doing them. I can flex the right arm and the tendon itself feels rigid.

Though I'm not sure what caused this I first noticed it four weeks into a physical therapy program for my left shoulder which may or may not have a slap lesion according to the orthopedist who examined it. One of the exercises I was instructed to perform involved maintaining a supinated grip while doing prone horizontal abduction raises and I wondered if this didn't irritate the tendon. I was performing all the exercised prescribed by the therapist up to twice per day every day for three weeks before I noticed the biceps tendon irritation. I mentioned the tendon discomfort to my physical therapist but recieved no advice. Anyhow, my shoulder is now feeling somewhat better and I've narrowed my shoulder rehab exercises down to those that have less chance of irritating the biceps tendon. I ice the tendon as needed and have not been taking ibuprophen or any other pain medications. Still I wonder if I might have a partial rupture. I'm also wondering how much time I should give my approach of rest and ice. I realize there is a time limit on how long I can wait if a surgical repair is needed.

drashokshyam  says:
18 months ago

hi JD

muscle and tendon units are prone to just injuries however a complete rupture is rare unless the tendon is having something called as a repetitive strain disorder or one has really overloaded and overwhelmed the tendon-muscle unit.

your first rupture seems to me as an acute overloading, however i wd like to know if there was any discomfort in the elbow region ,lasting for few days to weeks, before the rupture.

the muscles strains are of three grades where grade one is teaaring of some fibres, grade 2 is partial tear and grade 3 is complete tear.

at present you are suffering from grade one strain of the right biceps muscle tendon unit. you need to rest the part for around 5 to 6 weeks. rest here means to avoid lifting weights . you can do activities like writing typing etc.

icing is of help only for first 2 weeks after that just take rest.

biceps is the muscle that is most powerful supinator of the forearm, so avoid doing the prone excersises you mentioned.

you can comtinue the shoulder rehab for slap lesion with above precautions that i have mentioned

i guess things will be alright soon

take care

drashokshyam  says:
18 months ago

hi jd

yes you can wear a elbow pouch/ sling for 2 weeks or till you feel absolutely no discomfort lifting a 5 pound dumbbell: whichever is earlier.

the soreness you felt was you biceps tear which was initially may be grade one progressing through stage of grade 2 to finally lead to complete tear. this is especially for regular gym visitors. persons who are visiting the gym for the first few days will feel soreness of the tendons that they have excersised, however soreness of muscles in a person who works out regularly is a alert sign. also soreness of only one or 2 muscle groups is a sure indicator of damage in these muscle groups.. so in future too you have to take care and be alert of these warning signs .

take care, be well

dr ashok shyam

drashokshyam  says:
18 months ago

hi matt

ligament injury of the first knuckle , as your orthopedic surgeon has informed u , does not really give an idea to me

anyways injury of such kind commenly are tendon injuries callet mallet finger

read this article and tell me if you have this injury : http://www.emedicine.com/orthoped/TOPIC413.HTM

if you just have a ligament injury, then it will heal with some more time but if you have a mallet finger you have to go and see your orthopedic surgeon again .

well the bright side is that both the injuries are benign and will heal with time

take care , be well.

matt  says:
18 months ago

Hi Dr. Shyam. I appreciate a lot you taking the time to answer my question. My injury is most likely not a mallet finger. I can sleep much better now knowing that my finger would heal in time. I was just kind of worried that it has been taking so long to heal (six weeks now). Thank you again.

Laura  says:
18 months ago

Thank you doctor for your advice! You asked about pain prior to the cyst. Yes, I had pain and the cyst may have been there in smaller form. I wasn't aware of knee swelling, prior to that but I had experienced persistent pain for about 5 months prior to the cyst (that is, from about October 2006). I was also experiencing my knees giving way when standing after sleep or sitting for long periods. My GP didn't bother to look at the knee and simply said that the pain and giving way were "what happens when you get old." My guess is that there was more at play for some time, but I just never aggressively pursued better diagnosis.

Laura  says:
18 months ago

Thanks so much! I have to say I'm very disappointed in my OS, since he is *well* aware of all of this, and persisted in continued attempts to treat the cyst. I will be sure to take your advice into account when I meet with him next week.

Again - I am SO thankful. This is a very kind service you're providing!

Laura

drashokshyam  says:
17 months ago

well i need to knw a fw things before i can advice you

how old are you, what was the cause of your carpal tunnel syndrome.

are you suffring from any other diseases like diabetes or thyroid disorders

drashokshyam  says:
17 months ago

hi Sisel

well as per the work you do thiese symtoms can be because of two thins

golfers elbow and ulnar tunnel syndrome.

the first one is disease of the muscles where the muscles of the inner aspect of the elbow are overworked and they develop inflammation inside them leading to pain . the manuvers described in books or net are not 100% diagnostic and by the things that you have described in your letter i guess yo might be having a golfers elbow rather than ulnar tunnelsyndrome.

for information on ulnar tunnel syndrome read my hub on the same topic.

the treatment part in both these diseases is same initially.

rest, ice , antiinflammatory drugs.

rest to the part- apply an elbow band it restricts the muscle expansion and decreases the pressure generated and thus plays a role in healing

ice for 20 mins three times a day.

antiinflammatory drugs- acelofenac with paracetamol for 7 days.

we can aseess your pain after this protocol and can decide on further treatment.

drashokshyam  says:
16 months ago

Hello Mr Patil

well you will need to answer me some questions

your age, where do you stay, Did you had any injury to the ankle, is your ankle stiff especially in the morning, are you having any fever, do you play any sports.

in the mean time you can start some medications

tab aceroc-P twice daily

tab famtac 20 mg twice daily

also apply hot water to your ankle twicw daily for 10 mins

the most probable diagnosis is a subacute synovitis of the ankle however i would have a better diagnosis after you send me all the details

you are welcome.

drashokshyam  says:
16 months ago

hello dhannjay

well i am an orthopedic surgeon and i am not really aware of how 'such' machines function and so i cannot really endorse any for you.

however you can meet a physiotherapist or an occupational therapist who can really help you in these matters.

thank you for your comment

drashokshyam  says:
16 months ago

hi Laura

Rather unfortunate for you to have the injury

from the history you told me, i think it is a fracture of the proximal humerus.

rotator cuff tears will settle in two weeks

peice of advice. get out from your town and show your shoulder to an orthopedic surgeon. IT IS ABSOLUTELY URGENT .

waiting for two weeks is not good for your shoulder, no matter whether you have a fracture or cuff tear.

check in with an orthopedic surgeon as soon as possible

thanks for consulting me and best wishes

drashokshyam  says:
16 months ago

hello matt

well from the history you have given me

i think there is severe tendon injury to your index finger.

such injury should be repaired by an hand surgeon as soon as possible

hand and especially the fingers are very important for activities of daily living

i think you should consult a hand surgeon as soon as possible

drashokshyam  says:
16 months ago

hi angeka

well yes sometimes this is a real problem we face in fracture proximal humerus

the solution. allow the bone to heal and remove the plate.

time frame anywhere between 3 months to 6 months.

the plate removal has to be titrated with the discomfort of the patient.

with full ROM i guess we can still wait in your case for about 2 months before removing the plate. if during this period you start losing range of movement or have unbearable pain we can remove it anytime after 3 months.

best protocol. continue therapy, pop in occasional pain killer, wait for a month, get the plate out.

thanks for consulting. hope it helped you

drashokshyam  says:
16 months ago

hello david

before answering your question , i must ask you few things

how old are you

was your finger swollen after initial injury

also if you can click digital pics of your hand and xrays and email me, it would be most useful

drashokshyam  says:
16 months ago

Hello david

send me the pics and the details on my email

drashokshyam@yahoo.co.uk

or you can upload on webhart and send me username and password

drashokshyam  says:
16 months ago

hi isis

sorry to hear about your ordeal

frcture in the collar bone of a child is commen and the good news is that it heals very well

all you need is to keep her entire arm in a comfortable poistion

best will be a collar and cuff sling made from simple bandage vailable from the medical store

keep her hand in the sling for 3 weeks and all will be fine

she can take some painkiller syrup, like syrup paracetamol 1 tsp if she has pain, otherwise no other treatment is required for such fractures.

if you have any other query please ask me

drashokshyam  says:
15 months ago

yes david

i received the pics

it was routed to my spam box so the delayed response

you have a rare tendon injury

it is called swan neck deformity

splints you are using are appropriate

however you need to meet a hand specialist and a rehabilitation expert so that you have a fast recovery

otherwise it is a very benign injury with very less lasting effects

you finger might have some less power but otherwise it will be fine by conservative treatment

i dont think surgery will be needed for you

consult your hand specialist

learn about the disease on the net

Andy W.  says:
15 months ago

Background: I had a head/neck injury. It was explained to me from an orthepedic surgen that I have a vertebra that moves out of sync with the other vertebras when I turn my head in a certain direction. A neurologist told me that I should do some light resistance training to build the muscles in my neck, and thereby take some pressure off the vertebra and onto the muscles in my neck. So, four weeks ago, I decided to enroll in a gym class at the local college. Since last week, I have begun to experience what feels like sudden jolts of electricity in my neck. The "shocks" can't last more than a second. I believe I experienced it for the first time last week in the gym, and today at school in the library, while sitting at a desk, looking down, reading a book, it must have happened four times. It feels the same as when you get those tests done, where they shock the nerve in your neck with electricity to measure the response times. This causes me to be fairly certain it has something to do with a nerve. I am no longer seeing those doctors anymore. Do you have any more information for me that might help. I live in the US, and like many college students, I don't have, and cannot afford health insurance. Though there are free clinics. Thank you for taking the time to read this post, and if you decide to, to answer it.

Sincerely,

Andy W.

runningpelican  says:
15 months ago

Good Morning Doc,

I am the mother to a 14 year old athlete. About 2 years ago, she developed tendonitis in both of her feet. Shortly after, she was unable to run more then a mile without her feet experiencing mild pain and heaviness which developed into drop foot. Her school initially sent her to their orthopedic physician, which an mri was done, it showed tendonitis of the main tendon of both feet, orthotics were prescribed, and physical therapy to stretch her tight achilles tendon. None of these things helped with her uncontrolled foot motion at about 1/2 to 1 mile runs. So as a concerned parent my suggestion to my daughter was to lay off of sports for a while. Upon returning to running 5 months later, same scenario. So recently we visitied a podiatrist who ordered a ct scan, which only showed a prior fractured ankle, which has since healed, and im sure came about from her drop foot in running. He has suggested a referral to a neurologist, but I can't help but thinking she has comparment syndrome, and nothing neurological at all. I suggested this to him, but he said she was to young for this. I am really worried and would appreciate any suggestion or help that you can provide.

Thank you so much for listening.

drashokshyam  says:
15 months ago

well cjs

do let me know few details abt u

what do you do [job], whats yrs age, which hand is involved, r u involved in any sports acitivity and where do u stay

what were yrsymtoms before u got operated and for how long

why did u go for surgery

and what surgery was done

drashokshyam  says:
14 months ago

well matt

hand surgeries involving tendon ijurires have unpredictable results

the contibuting factors are the state of the joints, the tendon state, the surgery done but most important is the expertise of the surgeon.

the results greatly vary from surgeon to surgeon and the opinions vary too.

still results are very unpredictable and there is lots of dissatisfaction on the part of the patient in most of the cases.

my opinion- if the injury is interfearing with your acivities at home or at work only then go for surgery, but then u can still wait for few months to let yr hand and yrself to get used to the limitation of the DIP joint. most of the time the hand adapts to these limitations. I personally have seen patients working fine wih a stiff DIP joint for all their lives without any limitation.

surgery in this case would be a luxury rather than a necessity, and a luxury that can be distasteful in the end, both to yr pocket and the finger.

take care, be well

drashokshyam  says:
14 months ago

hi gary

well about a tendon rupture, it can be a minor injury, a partial tear or a complete tear.

since u r working fine now i guess u had something of a partial rupture.

for these cases we can really avaoid surgery and go in for a rehabilitation programme.

u have to talk to yr orthopedic surgeon and rehab consultant regading this programme

be well

shuhel  says:
14 months ago

i have a humerus midshaft fracture and have been treated non operatively with a plaster. after 4 weeks they put me in a brace as saw healing on x-rays. its been nearly 8 weeks now presently and i the arm is feeling fine, there seems to not much pain but im feeling cracking or clicking on my arm like the bone is moving. i went to doctors and took an x-ray and said that theres no way the bone could be moving as there is suffiecient callus and healing. the doctor even lifted my arm and moved it around and i felt no pain or movement, he says it cud just be muscles but i wanted to know what you think it could be. pls help!

drashokshyam  says:
14 months ago

hi shuhel

well fractures of humerus especially spiral ones are known to respond very well to cast and brace treatment.

as it is 8 week there would be abundant callus over the fracture site.

any bone heals with excess of bone tissue , this is called callus. since it occupies more space and the soft tissues like muscles tendons have to move or slide over it, sometimes there is this crakling sensation. it is mostly a tendon snapping over the callus bulk. with time the callus will reorganise into proper shape and thew sensation will be gone.

another cause of this cracking could be a nonunion of the fracture. however this seems less likely in your case. but do take a digital pic of yr recent x ray and send to me so that i can be in a better position to tell you definately

my email is drashokshyam@yahoo.co.uk

be well

shuhel  says:
14 months ago

just out of curiosity what is the solution of non union if it was the case?

Mike  says:
14 months ago

Dr. Shyam,

I am a 30 year old male and I injured my shoulder while pitching about three months ago. For the first week after the injury my shoulder was extremely sore and it caused me pain to raise my arm above my shoulder. The pain slowly subsided, but still remains when I make a throwing motion. Currently I have a lump in the proximal deltoid about three-four inches from the top of my shoulder. My shoulder makes a clicking sound when I make an (overhead) throwing motion. Further, my throwing shoulder now hangs about an inch or so lower than my other shoulder. Unfortunately, my current situation finds me without insurance, so I have not had an MRI. After some internet research, I ruled out proximal biceps tendon rupture because the lump/bump on my arm is on/in the deltoid instead of the biceps. I am starting to think that my symptons are consistent with a SLAP tear or lesion. The pain only occurs when I make a throwing motion, and the pain only occurs when my forearm is moving forward past my shoulder (toward the release point in my pitching rotation). The pain is a sharp pain that seems to be deep within my shoulder, but toward the front of the deltoid muscle. Do the symptoms I describe seem consistent with a SLAP tear? A rotator cuff injury? Additionally, do I risk further injury by continuing to throw? I have discontinued any throwing activities until my insurance kicks in, I just want to make sure that I do not do any further damage to my shoulder.

Thanks very much for your time and help, your services are much appreciated!

shuhel  says:
14 months ago

hello again doctor,

i know i have asked you this before but right now 2 months have passed since the injury and obviously i have started physiotherapy about 2 weeks ago. i just wanted to know that when i am walking for a while for like 30 to 40 minutes continously i start to feel aching at the fractured humerus midshaft. and gradually the aching starts to get more severe to the point where its almost unbearable and i have to stop and lay down. the aching at my arm is not 24hours, i only feel it aching when i start walking for a while and gradually the aching gets worse. what do you think is the cause of this aching and do you think it could be permanent or is it just still part of healing, im really worried doctor and i need ur info!

drashokshyam  says:
14 months ago

dear sneadhead

the clavicle fractures in childrens heal ver well, bu the period of healing may be painful for he child

we apply a figure of 8 bandage or a commercially made figure of 8 harness with a collar and cuf sling for this injuries so that the child will be comfortable.

only a sling is rather insufficient to immobilise the fracture.

do get an orthopedic opinion and get a figure of 8 bandage or harness applied

u can even buy the figure of 8 harness, of appropriate size, directly from the medical stores and apply it yrself for 3 weeks

the clavicle needsa to be rested for some time, also continue he painkiller medications prescribed by your GP for few more days so tha yr daughter sleeps comfortably

don worry ab the fracture as it will heal well

be well

shuhel  says:
14 months ago

doctor what is a soft tissue interposition?

drashokshyam  says:
14 months ago

well shuhel

its just soft tissue caught up in the healing tissue

and well delayed union means it is still healing.

so its just either of the two

soft tissues that get adhered to the healing bone are mobilised over a period of time by rehabilitation.

drashokshyam  says:
13 months ago

get an x-ray and mail me and i can tell u that

be well

drashokshyam  says:
13 months ago

well jenifer too many questions

Can something that is non-repairable to one doctor be repairable to another?

yes.

If non-repairable will I have complications from this in the future and/or as I get older?

yes.

if so what kinds of complications and will those complications require surgery?

i cannot really comment on this till i know the details . if u have and mri or sonography report u cant mention them

Will that screw stay in there or come out?

u shd ask that to yr surgeon, it depends on what technique is used.

Also will I get full range of motion back or lose my range of motion?

u will have some restriction of motion

Will I have complications from this as I get older and if so what kind?

setting in of early arthritis is a possible but unpredictable complication.

I am right handed and hurt my right hand. So will the fusion effect my daily activities?

well u will eventually learn to modify yr activities as per yr discomfort.

Jennifer  says:
13 months ago

I was also wondering what function is that ligament between the distal radius ulna do?Does it hold the distal radius and the ulna bone in place?

drashokshyam  says:
13 months ago

from what i gather from yr post , is that you underwent the open reduction of the humerus fracture twice within a period of 3 weeks.

it was a case of implant failure

about your wrist what i can tell you is that you had an injury to your radial nerve during surgery.

this is a well known complication of ORIF of fracture humerus. get an NCV done and all will be clarified.

Dana  says:
13 months ago

Three years ago during soccer practice I was tripped and landed on my shoulder and I ultimately ended up with a broken clavicle which was broken into three pieces. I saw the orthopedic specialist and he decided just to sling it and let it heal naturally. Now, three years later I am finding that I can move the bone back and fourth. Also, I am still unable to lay on it for more than a minute without alot of pain to which I have to change positions. I even find myself sleeping with a pillow under it most nights because it hurts. At times it also hurts when I lay on my good side it will ache from being hunched over. I was just wondering your opinion on this. If it might possibly be a malunion from the fracture or what? Thank you for your time!!

drashokshyam  says:
13 months ago

hello dana

since u had this fracture three years ago and still are able to move it, it can be a non union.

best way for me to excactly know is to see yr recent x-ray. send me yr recent x-ray and i will be able to comment more accurately

be well

drashokshyam  says:
13 months ago

hi trudy

well it appears that the extensor tendon of yr big toe is cut

as a sports person u shd get it repaired

tendon repair can be done till about 6 month or even after that tendons can be reconstructed using tendon graft

so dont worry, u shall be all right, its a new age of medicine.

take care be well

drashokshyam  says:
12 months ago

hello park

well from what i gather, you had a broken bone in the 4th finger and now it has malunited.

the bone has healed in a rotational deformity. this ia a commenest deformity seen in these cases and it does not correct spontaneously.

however many a times the body adapts to the deformity and the person is not troubled by it.

however if u have a severe deformity, which interferes with ys daily activities, then u might have to undergo surgery to correct it.

so u have a rotational malunion of the broken finger bone and if it interferes with yr activities, u might require surgery for it.

be well

gary  says:
12 months ago

Hi dr. im 46 male have a complete tear of distal bicept tendon. its been comming up on 3 months since the injury. i went to aorthopedic who said he can insert the tendon into the bone behind the musscle on the arm or use a cadavers tendon to reattach the tendon to the forarm. or we just leave it . he said if we cant attach it to the forearm then i can still gain strength by attaching it to the arm bone. im a plumber very upset with the loss of strength. when i had the injury i was told people can live with this your strength does come back. it has come back a good deal of the way but im still bothered by it everyday. do i just wait and keep working the musscle and hopfully in a years time i wont even notice it. or should i jump into surgery before its way to late. the fatigue seems to be better but will that go away too. sorry for so many questions but im just confussed. i would be out of work for maybe 6 months and that has me equally scared.

drashokshyam  says:
12 months ago

dear gary

biceps tendon is a important muscles both at shoulder and elbow

and so nature has provided with fail safes at both shoulder and elbow

at elbow a muscle called brachialis takes care of elbow flexion

however still some limitations remain.

my advice is to continue rehabilitation for another 3 months, see if you can do yr daily activities without mimitation and only then comtemplate surgery if u feel unsatisfied

be well

drashokshyam  says:
12 months ago

well i will agree with yr doctors

some pain will be there till all the s oft tissues are healed

and well u will gain the rest of the power within some time.

best luck

mitchell sloane  says:
12 months ago

ROTATOR CUFF MRI RESULTS--PLEASE INTERPRET!?Here is the report from my right shoulder MRI, done to rule out RCT (40yr old male complains of pain for 3 months, diminshed range of motion)Examination consists of oblique coronal, oblique sagittal, axian proton density, and coronal fast spinecho fat-suppressed T2-weighted sequences. The rotator cuff musculature is normal is signal, no atrophy or denervation edema. Teres minor is intact, the infraspinatus tendon is intact. the supraspinatus show some intermediate signal at the enthesis with the tendon margins appearing intact. the subscapularis shows intact tendon fibers with somewhat increased intensity indicating tendinosis. the biscpes tendon is located within the bicpital groove and show normal contour and signal. the biceps anchor is intact. supreior labrum shows increased signal throughout and appears degenerated w/o any displaced fragment appreciated. the posterior labrum below the equator has a rounded focus of bright signal reflecting an intralabral cyst indicative of a labral tear. more inferiorly the posterior labrum has a normal appearance. the anterior labrum at the equator has a cleft appearance and more inferiorly shows increased signal w/o disruption of the morphology. the capsule ligamentous complex appears of normal thickness. the humerus head shows enthesopathic cyst deep to the infraspinatus insertion. jugular cartilage appears well-preserved as is the glenois cartilage. there are no oseous proliferative changes a the inferior margin of the clavicle or acronium with normal morphology of each. there is no synovial proliferation at the AC joint. coracoacromomial ligament is normal. rotator interval appears normal..Can someone with knowledge of orthopedics please translate this into English for me? Thanks

shuhel  says:
12 months ago

question doctor!!1

1. so how long does soft tissues take to heal for a person like me?

2. is aching to be expected after broken arm has healed?

3. I read somewhere that aching can be permanent if the injury was severe, if that was the case do i come into that equation?

3. how long does remodelling take and does that play a part for my arm to get back to normal without any pain?

4. when do you think is a good time to return to physical activity after this kind of injury?

P.S sorry for asking so many questions as i am very young and i get worried and depressed about these things. i know it would help if i send you pictures of my x-ray but they dont let me take pictures in hospital. the best i can do doctor is to give you the xray picture of humerus fracture at the time of the accident when it was manipulated back in place, would that be ok????????

drashokshyam  says:
12 months ago

:) dear shuhel

soft tissues take anuwhere from 3 months to 6 months to heal [its not just healing it is a regeneration and realignment process to acquire the original framewprk.

yes some form of ache is expected but its temporary.

bone remodelling is a much longer process going into years and it remodels not only the bone but the surrounding soft tissue too.

3 months for normal daily activities and 6 months for sports activities however much depends on the x ray evidence of bone strength.

drashokshyam  says:
12 months ago

hi madhu

from what u have told me , i gather that yr mother is sufferring from periarthritis of shoulder simply frozen shoulder.

what is needed is medication and therapy.

since u stay in thane , u can come and see me too

my no is 9869320119

be well

drashokshyam  says:
12 months ago

subham hospital, opposite spinach shop, at hariniwas circle, thane west

drashokshyam  says:
12 months ago

dear mary

well edema and cellulitis are two very different things for us surgeons

they are in no way related

post-operative edema is something that we expect and are never worried of

development of cellulitis indicates infection.

causes of infection in an ORIF case has variety of causes, but post operative edema is not really a likely cause

worry with post operative edema is compartment syndrome and not infection.

so please try to look for reasons for the case getting infected rather than focussing on the edema factor

post-operative edema managment includes a plaster, elevation, ice packs[if fesible] and enzymes [trypsin etc]. and this works for all the patients in about 1500 cases i have operated of trauma.

if u have any more queries, u r welcomed to continue the discussion

take care, and a happy new year to you too

drashokshyam  says:
12 months ago

dear Cindy

Go see the Doc

unnecessary delays are not recommended

drashokshyam  says:
12 months ago

hi mark

meniscal injuries will require an assesment by an mri or by a direct arthroscopic examination.

how do you know thw meniscus is injured?

if a meniscal injury is found, it has to be tackled with either repair or excision.

many a times the surgeons allow for the rest to take care of the meniscal injury whichworks sometimes. the bleeding inside the joint helps in meniscal regeneration. however after 3 months one should go ahead with an mri or an arthroscopy.

Dear Doc  says:
12 months ago

I am 27 years old and my joints crack or pop just about anytime i move, and when I say my joints (feet, ankle, arms, hip, shoulder and chest) i mean all of them. My muscles are always tight as well, It doesn't hurt, but alot of discomfort. This has been going on for about a year now. Do you have any idea what can be causing this.

creaky

drashokshyam  says:
12 months ago

dear creaky

some questions for you

is this complain more in the mornings

are any of your joints stiff in morning or swollen

how well can you bend your back

do you booze/smoke? how frequent?

the problem seems to be something close to a spondyloarthropathy, will be able to tell u better after u answer these questions.

be well

1998KG  says:
11 months ago

Hello,

I have a few questions about an injury I acquired 18 days ago. I fell and twisted my ankle. After my pcp tested my foot he recommended an mri. It showed tennovitis (sp?) and a partial tear in a brevis tendon. At first I had no pain just numbness. The last three nights I have had intense pain in the calf. It starts in my arch of my foot and shoots upward (not past my knee). Is this common of tendon pain? The only thing that stops this stabbing pain is walking and it is persistant if I lie down or elavate that foot. I have been taking tylenol which briefly helps.

Thanks

drashokshyam  says:
11 months ago

1998 kg

first tell me were you walking on this leg with partially torn tendon?

drashokshyam  says:
11 months ago

hmmn as per my guess, the injury has aggravated or some edema swelling around the injured muscle-tendon complex

while walking the other muscles sheild it from harm but at rest when the gaurds are down the muscle aches

start on antiinflammatory medications, limit activities for a week and take hot water compressess.

be well

Lynch  says:
11 months ago

I forgot to ask. When I had the surgery for the tfc could something have been done to that tendon?

Lynch  says:
11 months ago

The finger is bent at the main knuckle above the palm. the middle" phalange? (is that correct term)

Yes the deformity happened after surgery.

I can correct the deformity and straighten the finger by manipulating it. With the other hand of course. Yes there is pain and the finger feels "heavy" Like when I try and move it there is weight to it and can not move it properly I have never hurt the finger it was just like this after surgery of the tfc surgery. I can send a picture just tell me where I can send it to. Thank you so much.

Theo  says:
11 months ago

My x ray looks exacly the same as fig 10. I am going for a check up in a couple days. Would you opperate on this or let it be? Im hoping they will not need to.

Thanks!

Nikki Ribble  says:
11 months ago

I am a 20 year old female and I have been out of high school since June of 2006. I had an osteochondroma removed from my knee when i was in 8th grade, i was about 13 years old. I think i recently discovered a smaller bone growth near the surgical site where the previous growth was removed. Knowing you were only practicing for 6 years I'm not sure if you knwo the answer to my question. Can osteochondroma regrow? I mean its not that painful right now..Every once in awhile it hurts to go up and down stairs. Please message me back.

drashokshyam  says:
11 months ago

DEAR HAVEN

cause of pain after 2 years wd be probably a loose implant

many patient benefit from implant removal

if we are sure about the bone union we can remove the implant at this time

so consult yr surgeon and get the implant out

be well

drashokshyam  says:
11 months ago

dear nikki

get an Xray. that will answer all of yr questions

and yes osteochondroma can grow back

be well

Nikki  says:
11 months ago

I don't want to get an xray and make a fool out of me if its only scar tissue or something. I just don't to sound crazy because its been so long since the surgery and i have probably stopped growing so i thought bones don't grow anymore after 20. The dr originally told me I would be on crutches for a week. I was on them for two months. didn't go to school for a week because my ankle got as big as a softball and never fouind out why. I just don't want to look like a hypocrandriac or something befcause its been so long and it is the same thing, its smaller so its harder to feel.

Nikki- Different question now  says:
11 months ago

I know have another question about my left ankle. about 2 years ago i was on a stage behind a basketball hoop and i was being dump and i was jumping off of it. well, I landed on my boyfriend foot and my ankle rolled both ways. I felt the worst pain of my life. I felt horrible stretching and tearing. It was the night before thanksgiving so I just used crutches for 2 days and iced it. I even bought an ace wrap. It was almost a week before i went to the dcotor because it was hurting soo bad. The doctor was really old and just said it was a sprain and sent me on my way. I was walking with horrible pain at the time. I went home and started to cry because my ankle was stinging inside the bone and i thought for sure something was broken, xrays were negative. Awhile later I went back to the dr because my ankle was really swollen and would usually stay that way. He said i just have nerve damage and gave me some kind of anti-inflammatory and sent me on my way, no xrays, nothing. To this day its still tender to touch and it swells up after showering. What is wrong with it? I mean i have really bad insurance and i don't really complain about my ankle but im just curious. Thanks.

drashokshyam  says:
11 months ago

dear nikki

take an X-ray

about the ankle u had a serious grade 3 tear of the ankle ligaments which was not treated well

xrays are not normal in these cases, however one need a good orthopedic surgeon and special x rays views to understand these injuries

the doctor u visited seems incompetant in this regard and has treated u in a very casual manner

now ur ligaments have tried to heal with thick fibrous tissue, that pains when unduly strecthed

as for as the present condition - get an xray- that wont certify u as hypochondriac- trust me

be well.

drashokshyam  says:
11 months ago

dear lynch

i think one of yr nerves is been injured during wrist surgery

and that has led to the non-functional tendon in yr finger

discuss the same with yr surgeon

Nikki   says:
11 months ago

Thank you. i thought i had a grade 3 sprain. So what would a orthopedic surgeon do? I don't understand why my xray was normal. What can they do for it now? I just don't know. I mean should i go to an orthopedist or an podiatrist? you seem like a very good and thorough doctor. How did it try to heal with thick fibrous tissue? What does that mean? What would an xray do for it now?

Steve W.  says:
11 months ago

Hi again Doctor,I had arthroscopic surgery on my right knee in October for a tear in my medial meniscus which went well.At the same time I noticed pain on the outside of my right ankle,I thought it was from walking funny from the knee pain.The pain never went away so I had an MRI done revealing I had a partial intrasubstance longitudinal split tear in the peroneus brevis tendon extending from the level of the tibiotalar joint to the peroneal tubercle of the calcaneus.There is also mild tendinopathy in both the peroneus longus and the brevis tendons.There is also fluid within the peroneal tendon sheath compatible with tenosynovitis.There is moderate marrow edema in the calcaneus in the region of the peroneal tubercle,likely reactive to the previous image changes in the peroneal tendons.I am a 49 year old runner and have been running fairly avid for the 18yrs.I do remember trainig for a marathon in 2006 and my ankle bothering me than especially in the mornings being stiff and sore no real swelling and would subside during the coarse of the day enabling me to run by late afternoons and complete the marothon.I have done 8 marathons,and I do remember rolling my ankle in the past but not specifically to this injury.The surgeon I saw recommended surgery he said he tries not to suture the tendon for anything forein in there is not good.He said he has had good results with this procedure but could not gaurentee that I would not have any pain after healing.I would be in a cast with no weight bearing for 2wks and after that a walking boot with weihgt bearing for 3mo.He said I could resume running in 4to5months.I am wodering how long of atear this is and what you think.Thank You Steve W.

drashokshyam  says:
11 months ago

dear hafiz

i think you have trapezius muscle spasm

trapezus is a big flat muscle that covers the most of the upper back

u need to take some muscle relaxant and take hot water foementation regularly about 2 to 3 times per day

be well

drashokshyam  says:
11 months ago

dear steve

u have an overuse tendinitis which has caused injury to yr peroneal tendon over a period of time

this can happen to sportsperson like you

if u need to pursue yr runnin the best thing is to get it repaire, undergo rehab and hope for the best recovery.

leaving it untreated is just going to worsen it and will restrict yr sporting activities

be well

jess  says:
11 months ago

Hey Doc,

glad to have found you, I am in grave need of some help,

2 months ago I was hit by a car.......unfortunately my knee took most of the impact which resulted in a total knee dislocation, 3 ligaments were torn and the 4th was damaged. As a result I had reconstruction surgery with graphs from my own knee a few days later. This left me with 6 screws in the knee.

Now 2 months later i'm in physio 5 times a week and using a brace to increase flexion, I can currently bend it to 95 degrees on my own, the os told my pt no more than 110 degrees, my question is whether this 110 degree restriction is for my intire life or just for the time being, is it possible to gain back my ROM after such a surgery? I'm in my 20's I can't live without ever bending over.

thanks so much

Jessica

James Greene  says:
11 months ago

I had a complete rupture of my left distal bicep tendon. It was repaired and im doing well. I am 18 weeks post op and my ortho doc wants to release me to full duty. im a paramedic. Is this to soon?

James Greene  says:
11 months ago

Thanks for the response, I will talk with my ortho doc next week. I will keep you updated. Thanks again

drashokshyam  says:
11 months ago

dear jay

get an Xray done to rule out injury to the healing bone

my opinion, its nothing serious , just some injury to highly sensitive healing bone tossue

nothing to worry, as it does not appear serious, but do protect yr arm for about 2 weeks more

be well

Sharron  says:
11 months ago

How old must a fracture be to show up on a bone scan?

drashokshyam  says:
10 months ago

bone scan will detect fracture very early

as soon as bone is fractured one can detect it on a scan

however bone scan is very less sensitive meaning it cannot differentiate a fracture from infection or other lesions

be well

Jay  says:
10 months ago

so doc how long do you think this ache will take to go away if it is injury to highly sensitive healing bone tissue?

What if it is injury to main healing bone tissue, what happens next?

drashokshyam  says:
10 months ago

dear mark

1. there might be injury to your Anterior cruciate ligament [acl] of the knee which is the main stabiliser of the knee jiont. in view of obscure injury they have suggested rehabiliation for it.

2. some inflammation or blood accumulation at the site of the patellar tendon insertion http://factotem.org/library/images/Knee-anatomy-ph

3. yes that means a lcl tear

4 this means that you had previous injury to your medial collateral ligament too

5. this is really inconclusive spillting hair stuff

what you need now is to get an arthroscopy done to confirm these lesions

none of them are definately confirmed by the mri

be well

Jay  says:
10 months ago

sorry doc but i'm waiting for your response?

drashokshyam  says:
10 months ago

dear jay

i have already given u my comments

we further need an x-ray to confirm or refute our speculations

JAAM  says:
10 months ago

i had orif on my right humerus, mid shaft spiral break 4 weeks ago. i now have swelling/numbness/needles and pins in my thumb, index, middle and half of my ring finger. will this subside? i am going to be starting pt next week.

drashokshyam  says:
10 months ago

it is likely you had a muscular injury with hematoma formation in the muscles of your forearm

as far as sensitivity at night is concerned , it is related to something about the nervous syatem which becomes more sensitive to such pains at night

do not worry you should be well in another 2 to 3 weeks time

be well

hunta007  says:
9 months ago

Hello Dr. Shyam.  I am a 49 year-old male.  I am an avid weight lifter.  On Jan. 7 of this year, I was doing curls on a preacher bench when I felt the pop and burning in my left arm and my arm dropped with the weight of the dumbbell.  I had not bruising nor swelling.  Unfortunately, I didn't have the presence of mind to see a doctor and instead, just rested the arm for a period of about a week and then tested my ability to get back into the gym.  It only took about 2 weeks to be back into my routine workout regimen, but while using lighter weights with the injured arm.  I have been working out regularly without noticing much weakness in my left arm.  While I am not sure how I could have missed it for the past 2 months, early last week, I noticed that my bicep looks deformed such that it no longer reaches the elbow joint.  I did extensive reading about distal bicep tendon ruptures and discussed my situation on many forums.  I suspected mine to be a partial tear and went to see a GP 6 days ago.  He concurred re: a partial tear.  I have an appointment to see an Orthopedic doctor 9 days from today (next Friday). 

It has been two months since the injury and I don't notice much strength loss.  I am concerned re: the retraction of the bicep from my elbow.  Perhaps it is vanity, but as well as lifting weights to stay in shape, I also lift because I like to look muscular and fit.  The gap between the bottom of my bicep and my elbow due to the retraction is really bothering me because I am very self-conscious of how weird it looks compared to my good arm.

If I do have a partial tear, is it possible to think that I can do weight exercises to minimize that gap such that I can get that area to grow again... even a little?  Or is surgery the only option to have that come back.  If I can expect to get some growth to fill the void in my muscle, am I just too anxious and it will take more than the two months I have been working on it? 

I live in Hawaii (Maui) and we have somewhat limited resources at our avail as regards medical care.  My carrier (Kaiser) has only one orthopedic surgeon on the island.  When I spoke to the orthopedic area about my appointment, the nurse indicated that the Dr reviewed my file and said that I am not high priority because it has already been two months... so waiting another few weeks will make little difference.  In your opinion, if I can't get the lower biceps deformity to be somewhat rectified by weight training, am I not a candidate for surgery?  I really want to have my bicep back to somewhat of how it looked 3 months ago.

I should mention, I am concerned re: nerve damage via surgery in such a small medical market here.  I am a guitar player and my left hand is my fretting hand.  I am also a computer professional who needs to have full use of that hand.

Thank you so much for any advice you can offer.  I am very happy to find this forum and you. 

drashokshyam  says:
9 months ago

dear hunta

as mentioned in the above post the biceps has two insertions over the elbow and even a partial tear will give the cosmetic problem

also as only the main tendon is sutured some part of cosmetic problem might continue to exist

as far as function is concerned you will have some limitation with heavy activities but it should have no effect on your efforts to keep fit

in my opinion dont worry about the cosmetic part too much

be well

Lin Liangtai  says:
9 months ago

Was this a human femur shown in my article in my above blog at http://www.wretch.cc/blog/lin440315 and at

http://groups.google.com/group/fossil-id?hl=zh-TW

I will pay if necessary for you to find any mis-identification of cells, tissues, organs, etc. in my article.

ritchie  says:
9 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?

ed  says:
9 months ago

Hi doc, I was injured in a car accident in oct 2008. Torn labrum in my right shoulder. 12 oclock to 6oclock anterior. Had surgery 12/17/08 three screws and anchors. about a week ago i noticed during therapy I was getting a squeaky sound coming from it. No pain with the squeaky sound. today at therapy the sound got worse, more like a crunching sound and caused alot of pain. Any thoughts on what it is. still waiting for call from ortho. thanks

Stephanie Beck  says:
9 months ago

Dear Dr. Shyam,

You helped me with one daughter and alot of fear a few months ago; thanks :). My other daughter has a knee injury now; which I'm hopeful will be fine in time. She injured it jumping over a hurdle, in track, a month ago. She says her level of pain is still the same, though. It is her left knee; after she has been sitting with her knee bent and under her right leg, then she straightens it and feels a sharp pain. After it is straight the pain turns into feeling sore with no throbbing pain? She is still running track, long distances only, with no hurdles. She had stopped track for a week and when she started again she said it did feel a little sore then. We don't want her knee to receive a worse injury. What do you think it might be, and should she not be running, even if it doesn't usually hurt when she runs?

Thank you so much,

Stephanie Beck

Blake  says:
9 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

Hannah  says:
8 months ago

Hey! I have several questions about the muscles in the neck, in particular: the sternomastoid. Is it connected to the collarbone, or first rib? Is it considered a flexor and extensor when turning the head? How would I model it and how it connects to the skeletal system? Does it split in to two muscles that are connected in different places? Thank you for taking your time to answer my questions.

vene  says:
8 months ago

I am a 47 year old female who is 70 pounds overweight, on 2/1/09 I broke my ankle in three places and dislocated it as well. I had surgery on 2/2/09 to insert screws and pins. Two weeks later the staples were removed and I was placed in an aircast and was told not to put any weight on the broken ankle. On 3/8/09, I was instructed by my surgeon that I can now walk on the ankle and while at home to walk in tennis shoes and when I return to work to use the aircast for the first 2weeks back at work. I inquired about therapy, the surgeon instructed me to raise up on my toes and shift my weight from strong to week ankle. I am to do this every hour for 5minutes. I am active in many sports which require the shifting of weight on my ankles and quick stop and go movements. Should I be in some type of guided physical therapy and is this the norm? I have never broke any bones before this, should I seek a second opinion?

Tom M  says:
8 months ago

I had a distal rupture of my biceps 1997. I was without insurance at the time, so I chose not to have surery. Since then, I've noticed a slow, steady atropy of the muscles of arm below the elbow, most notably my hand and little finger.Recently, I started expeiencing a tingling and numbing of the outside of the little finger, extending up the hand. Also I've just noticed that the nail on the little finger has diminished to 1/2-2/3 tthe size of that on the non-injured limb.

Have you heard of this before, and is there anything I can do about the numbness and wasting?

drashokshyam  says:
8 months ago

dear hunta

i think you should avoid surgery

be well

drashokshyam  says:
8 months ago

dear lin

i am not specialised to comment on this topic

be well

drashokshyam  says:
8 months ago

dear ritchei

you should take Xray of your arm to see the amount of healing

Xrays do cause cancers but when exposed to beyond a certain amount, otherwise people working in Xray department will not be willing to work there

the risk of routine Xrays of causing cancers is almost nil.

be well

drashokshyam  says:
8 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:
8 months ago

dear rose marie

stress fractures do heal and heal well

but i should know which bone is fractured

please send me the name of the bone injured and preferably the xray on my email.

be well

drashokshyam  says:
8 months ago

dear blake i apologise for the delay in response

i think the prickly pain u r getting is pretty commen in atheletes like u

it is form of muscular pain.

as u know muscles are made of sheets of muscle fibres

its one or two of these fibres that snap under stress and then cause such kind of distress

dont worry it should get well in around 3 weeks

do rest the part, avoid overloading on the knee and take hot water foementation. u will be well

thanks for faith

Justin  says:
8 months ago

Dr Ashok Shyam:

My name is Justin, In november I did something to cause a stress fracture in the the middle of my fibula. I have rested best as I can but I am a strength and conditioning coach and my job is still standing and demonstrating exercises. March 18th I consulted with my Ortho and he said the fracture was healing and to give it 4 more weeks before resuming activity. I ran lightly yesterday for the first time doing maybe 6 200yd jogs. It felt fine at the time, today I have that slight ache in the back of my calf that is not DOMS. Should I be concerned or is slight ache normal? I am rather pressed for time to train as I am going into the police academy May 18th. Should I continue to ease into running?

Thank you

Lynn  says:
8 months ago

Thank you in advance, Doctor! I cannot find the answer to my question anywhere else. I have a torn meniscus from a downhill skiing accident. I am also overweight at 65 inches tall (female) and exactly 200 pounds. I understand that the surgery/recovery success would be much better if I lose weight before surgery. Here is my question: What is the tradeoff between taking 6 months to a year to lose the weight and having a better outcome with the downside of doing additional damage to the knee during that 6 months/year? I don't know if I should stop damaging it by having surgery now vs. walking on it trying to exercise while losing weight to get a better outcome? My level of pain varies unexplainedly, but is always painful, ranging from approximately a 4 out of 10 to downright tear-causing worse-than-labor-pains agony. Thank you for your website and your time.

Lidu  says:
7 months ago

Hello!!

My feet shape is a bit not normal. My fourth toe is elevated than the other ones. When you look at my feet you can see it sticks out. It seems that it comes from down the bone. I went to get it check and the answer was only operation. Whats your point of view?

dantescritic  says:
7 months ago

Thanks for the service doc.

20 year old male

I believe it is called the Lateral Malleous. About a month ago I felt a bruising feeling 1-3 cm above my inner ankle though saw no discoloration of skin or anything of the sort. I went to my general doctor after about two weeks because a lump had formed. The doctor felt around and said it was a liquid filled bump, probably a ganglion cyst. He said come back in a week but I called and called and he gave me a referral to an Orthopedist. The Orthopedist got me to do some x-rays and said he didn't see anything to worry about in the x-ray and only saw some slight calcification in the bone "Broke my ankle 2 years ago". Now he is sending me to get an MRI for the same place.  Usually when I wake up or wear socks the lump is much smaller although hard like a small pebble, sometimes not hard at all.  Other times it is large like a grape and hard. My questions are, is he asking me to get an MRI because he suspects something serious or is it standard procedure?

Doc also said "Not to worry" but I guess he says that to everyone right?

brian  says:
6 months ago

i broke my fibula 1 week ago, doc put me in a boot and said when i go back to see him in 3 and a half weeks i will start putting pressure on it, meanwhile from time to time i get burning pains around where its broke, is this normal? thanks

Dr shahzad   says:
6 months 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:
6 months ago

dear justin

sorry for the delay

i think you should continue your training, some aches etc are commen but will go away with time

nothing much to worry

drashokshyam  says:
6 months ago

dear lynn

extremely sorry for delay

well i will suggest you to go for surgery immediately

be well

rebecca betson  says:
6 months 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:
6 months ago

dear rebecca

Xray is a must in your case

please get the xray done as soon as possible

forward any queries after u get the xrays

be well

drashokshyam  says:
6 months ago

dear jeff

i guess the muscle end that was detached has not taken up the attachment [this happens sometimes]

best is to wait and watch for another 3 months

be well

drashokshyam  says:
6 months ago

dear Robert Hammond

it takes 3 months to 6 months for complete recovery

u can take nervetonic suppliments [methycobalamine, folic acid etc] to speed the recovery

be well

drashokshyam  says:
6 months ago

dear ashish

finger stiffness after hand injury is very commen

u shd continue therapy and shd have regular followups with yr surgeon

it might take 2 more months to resolve

be well

brian  says:
6 months ago

how long is it until you can walk normally again with a fractured fibula after you start putting weight on it? thanks

drashokshyam  says:
6 months ago

dear brian

this depends on what kind of fracture and where in fibula one has the fracture

however in general the time period is of 3 weeks and can vary depending on the above mentioned variables

Leah Lemoine  says:
6 months ago

Thanks, Doc. Can this thing you say i have, heal on it's own or will i have to get surgury?

Nancy  says:
5 months ago

My significant other, a 58-year-old male, has been walking around on a very painful hip joint for 3 years with what he though was severe arthritis (a doctor's diagnosis). Some days he has been in agony. Other days he feels better, never pain-free but at least able to ignore it for a day or so. Yesterday he went to another doctor at a free county clinic (he has no insurance) who told him his hip was dislocated! Now he is waiting for an orthopedic doctor to review the x-rays. I am not even sure what questions to ask, but to start: What is the likely treatment for a 3-year-old hip dislocation? Surgery? Physical Therapy? Everything I have read focuses on emergency treatment immediately after the dislocation, not on an old injury.

colm lynch  says:
5 months ago

i have a minor intrasubstance tear of my proximal acl.Iwas unsure weather it would be safe to use a skipping rope with a knee strap on

drashokshyam  says:
5 months ago

dear lynch

you need to undergo a period of physiotherapy after which you will be fit to play any sports you want

be well

drashokshyam  says:
5 months ago

dear shwan

well why did u have to wear a custom orthotic in the first place.

also are u suffering from any other illnesses like diabetes or hypertension

Well according to me this is a postural problem secondary to change in the gait following your use of orthotic device

if u can please dicontinue the use of orthotics, start excersising and u shall be well

in case my reply do not satisfy yr query do detail me your situation with apt background

be well

drashokshyam  says:
5 months ago

dear imj

what u have is a clear case of delayed union.

the are many reasons for bone to go into delayed -union, starting from severity of injury, the bone injured to general health of the patients. the resons in many cases cannot be pin-pointed.

the next step is to confirm the diagnosis. a CT scan with multiplanar reconstruction is best modality to assess the delayed -union.

when a delayed union is confirmed a surgery to bone graft or fix the bone with plate or screw and then bone graft it has to be undertaken.

In Your case i would suggest u to continue the brace for another 4 weeks get a x-ray after that to check union and if the bone is still not united to go ahead with CT and surgery

drashokshyam  says:
5 months ago

hello paul

well what u have seems to be some ulnar nerve irritation

there are many causes for this

but mostly is is very bening disease

there is no way there will be any paralysis or anything bad happening to u in recent future because of this

i have already written an informative hub on this

rean my hub on ulnar tunnel syndrome

this thing will mostly not require surgery

what happened is a temporary irritation , dont worry

keep me posted thou every week abt yr condition and do renew yr insurance if possible

be well

Paul  says:
5 months ago

Thank you for the quick response Doctor. I read your hub, and from that I will start my at-home treatment, and will keep you updated every week about my condition for your advice.

drashokshyam  says:
5 months ago

your shoulder had gone stiff due to surgery and also the bony contour is lost means setting in of early arthritis of the shoulder joint.

decision abt shoulder replacement will depend on yr age

also meanwhile you require a very goal oriented physiotherapy sessions to recover the range and gain the muscle power back. the physiotherapy will also decrease your pain and will postpone the need for replacement to a fair extent. Since it is the left shoulder [non-dominant] i guess with reasonably good range and very less pain you will be able to get along comfortably.

be well

Henry  says:
5 months ago

Dr,

I've been diagnosed with AC Joint seperation grade 2. I can't get into an ortho till next week. I'm going nuts wearing this sling. I've been told for every day i wear it i lose 1-1.5% of my muscle in my arm. I'm very active and was an avid weight lifter prior to the injury and am 43. Do i seriously have to splint this thing and "rest and ice" for a few weeks? Right before X-rays i was lifting almost normally, seems they are being overly cautious. When woud it be safe to start lifting again? From here on out would you suggest lighter weight and more reps? Should i avoid any further weight lifting that involves the scapula like squats where the bar comes across the clavicle? Are there certain weight lifting moves that are detrimental to the AC joint in particular?

Paul  says:
5 months ago

Dr. Ashok Shyam,

I have been wearing elbow braces for 4 days now, all day and in my sleep as well. The tingling feeling has subsided greatly, although there is minor, dull pain when the braces are removed for a prolonged period of time (about an hour). It seems to be healing the ulnar tunnel sydrome well.

How much longer do you recommend that I wear the braces, and how long after the pain is completely gone should I wait before going back to working out 4 days per week?

Andrew  says:
5 months ago

Dr. Shyam,

I am a 26 year old male and have been very active my whole life. About two years ago I was doing 50 yard sprints at the park when I felt a sudden sharp pain in the outside of my left knee. I limped home and it was tender for about two weeks after (I could walk on it but it felt like it was bruised). Ever since then it has not given me any problems except for when I try to go for a long jog, after about 1 mile of jogging I feel a slight pain in the outside of my knee (but it is bearable) and then after about two to three miles I start to feel aching around the back of my knee. The pain/aching in both areas is bearable but it limits me from jogging at full pace and taking shorter strides.

I would like to participate in marathons and possibly triathlons in the next few years but this knee problem is holding me back. I’m not sure if taking ibuprofen or some type of pain killer will only mask the pain and make things worse? Also, I play in an adult hockey league and my knee does not bother me when I play hockey?

...sorry for the long post! just trying to be thorough

THANKS!!!

andrew  says:
5 months ago

Thanks,

I am trying to schedule an apointment with an orthopedic surgeon this week. I was kind of hoping you would tell me its nothing major. lol...I read that I should be taking glucosamine every day?

Thanks for your help!

Henry  says:
5 months ago

Hi, i wrote you about 7 days ago. I have no AC Joint separation, but was told my pain was likely d/t tendonitis near the Rotator cuff. The sling is gone but i was still told 4-6 weeks of no heavy weights. They also recommended Physical therapy as he felt one ligament/tendon was being over used while the others were underused (?). Anyway, if there is no tear involved isnt' that an excessive time to not do any excercize involving the shoulder other than therapy? It seems i should be able to use weights as i tolerate. Does a tendon or ligament really need that much "rest" to reform? They said there were some "roughness" on the ball that connects to the cuff irritating it. Does heavy weight really irritate it that much? IT seems any movement would iritate it and unless i get surgery it's just going to be part of life. Also, how can "lower weight more reps" be less iritable to the cuff than heavy weight less rep?

drashokshyam  says:
5 months ago

well henry

its good news that u dont have a ligament tear.

talking about a shoulder tendonitis, it fall in the category of repitive strain injury. As you would have well guessed by the name itself its an injury that occurs over a peroid of time due to repeated small injuries. these small injuries may have occured in course of yr atheletic activities and since you continue yr activities , these injuries never really get time to heal. these injuries then lead to roughness of both then tendon and the bone and this inturn causes more of these injuries. the injuries accumulate over a period of time to become symptomatic as is the case with you.

basic aim of treatment is to allow time for healing which is really variable depending on the amount of injury. 4 to 6 weeks is a reasonable time.

how can "lower weight more reps" be less iritable to the cuff than heavy weight less rep?

this requires understanding of the joint. if any tendon is injured in the joint , the other tendons take over its work so that the injured tendon gets some releif. when u do lower weights more reps, its these supporting tendons u are strengthening that will inturn off load the injured tendons more effectively. more weight less reps will directly put strain on the injured tendons.

drashokshyam  says:
4 months ago

hmmn well henry

i will suggest u to leave the shoulder alone for 4 weeks , meanwhike tione the rest os the body and the elbow and wrist also and start light excersises of the shoulder after 4 weeks.

one should respect the injury and give it its due.

be well

Frank  says:
4 months ago

Dr. Ashok Shyam-

I am wondering what my treatment may entail from a knee injury I have sustained just over one week ago. I will give the details of my MRI.

Interpretation:

Mild thickening of the proximal medial collateral ligament could be a sprain.

There is a cortical impaction fracture with prominent trabecular microfracturing and indentation of the superior cortex with prominent concavity, prominent superior concavity involving the anterior half of the mid to inner portion of the medial femoral condyle. The superiorly concave impacted fracture of the proximal medial tibia undermines the anterior horn of the lateral meniscus. There is abnormal increased signal intensity in the far anterior horn likely reflecting a meniscal tear. The impacted fracture is approximately 2.0 x 3.0 cm in proximal dimension. There is minimal increased signal intensity in the medial anterior margin of the distal medial and lateral femoral condyles which may reflect additional areas of bone contusion. Prominent edematous changes seen, greatest in popliteal fossa. There is a moderately large joint effusion. There are small medial popliteal cysts. The medial meniscus appears intact.

Conclusion:

Prominent focal cortical impaction fracture involving the anterior medial femoral condyle with a crescentic superiorly concave post-tramatic depression of the articular surface which is approximately 25.0 x 30.0 mm in transverse dimension. There is a prominent irregularity and fracture of the cortex with prominent adjacent trabecular microfracturing extending into the medial tibial plateau. The superiorly concave bony defect undermines the anterior portion of the of the anterior horn of the lateral meniscus with likely tearing of the far anterior horn of the lateral meniscus. There is a moderately large joint effusion and prominent edema surrounding the knee. Questionable minimal contusions involving the anterior medial and lateral femoral condyles.

Could you please let me know what my treatments may be? Thank you for your time.

Sincerely,

Frank

H D Jones  says:
4 months ago

2 years ago I was working in a refrigerated warehouse and began getting a shooting pain from my elbow up my arm when I moved the joystick in a particular way. Then I had bad pain in my hand that felt like a cramp without the tightness. It was very painful and made lifting painful. After taking off work the pain in the hand went away but I found out I had medial epicondylitis and was treated for it. This was thru workmans comp. Well a couple of months ago the pain came back in my hand for no reason I can figure out. I reported it to the orthopedic and he asked the insurance company to refer me to the hand doctor. They refused saking if the elbow caused the hand problem.The pain will leave after a day or two but seems to return at random times. What could this be? Biggd4355e@peoplepc.com

Mike  says:
4 months ago

Doc,

I had complete ACL reconstruction in 2006. It was a graft using the patella tendon. No damage was done to the meniscus or MCL. Post op recovery went fine. I began a new work out regimine that included running before working out in Jan of 2009. I could comfortably run 2 miles at an 8 minute pace with no pain or discomfort. In late May I ended up on a treadmill that had a loose belt. I stumbled, and fell off the side of the treadmill and landed straight legged on the same leg that had been operated on. It was slightly painful but no popping sound. I believe i continued to work out on it, but it did not feel right so I stopped. slight swelling but nothing to terrible and a little bruising on the interior portion of the knee joint. I still had some minor swelling only after exercising (low impact, such as cycling, walking, or eliptical) also, my knee began to click a lot more than it ever used to. I still have complete full range of motion. I have had numerous x rays and an MRI with contrast and structually, nothing seems to be wrong. I have had it looked at by 3 different doctors. None of them seem to have a cure saying it will go away over time, perhaps up to a year. The last Dr suggested a shot of cortisone. I accepted an had a terrific week of no pain. The swelling disappeared and the clicking minimalized a little. The major source of pain now is the patella tendon that connects to the shin. That area seems less dense than the opposite leg and I attribute that to the harvest. I cannot run across the street or take and aggressive step without a burning pain onsetting immediately. I can still cycle, but even swimming hurts it a bit. My question thre part, 1)is this arthiritis and will it work itself out over time? 2)is it possible that i did do some damage to my knee that did not show up on exrays or mri and 3 drs cannot seem to figure out why I am having pain still? 3) how come when I point my foot a certain way i can feel a difference in the knee?

Thank you very much in advance

-Mike

jack r  says:
4 months ago

Hello Sir,

After lifting a heavy log a year and a half ago, I developed a limp that has never gone away on my left side. I am in no pain at all, but have a minor to severe limp depending on how long I sit. The longer I sit the molre severe the limp. What could be wrong.

lmj  says:
4 months ago

IM THE 45 YEAR OLD FEMALE WITH CRUSH INJURY TO ANKLE.NOW 16 WEEKS IN AND CT SCAN REVEALS A COMMINUTED FRACTURE NON DISPLACED OF THE DISTAL RIGHT FIBULA.STILL ONLY MARGINAL CALLOUS FORMATION.OS WANTS ME TO WEAR A BONE GROWTH STIMULATOR FOR 8 WEEKS THEN IF STILL NO UNION THEN SURGERY. WORKMENS COMP ONLY WANTS TO WAIT 4 WEEKS WITH THE STIMULATOR.OS SAYS BONE IS NON DISPLACED BUT IS CRUSHED IN MANY PIECES.NERVES ARE FINALLY COMING BACK TO LIFE IN ANKLE AND THE TWINGES AND PAIN CAN BE HORRIBLE.DOC,ITS ALREADY BEEN FOUR MONTHS I REALLY DONT WANT TO WAIT ANOTHER 8 WEEKS AND THEN HAVE THE POSSIBLE CHANCE OF SURGERY. THEY SAY MY REHAB WILL BE EXTENSIVE DUE TO THE CRUSH INJURY. I WANT TO GO BACK TO WORK!!!! WORKMENS COMP SAYS IN 4 WEEKS IF STILL NO HEALING THEY WOULD LIKE TO GET ANOTHER OPINION. WHAT DO YOU THINK ABOUT THE BONE GROWTH STIMULATOR OS IT MIGHT WORK IT MIGHT NOT

Mary  says:
4 months ago

Dear Dr.

I was wondering about the anatomy of the Posterior Cruciate Ligament. Does it actually hit/touch the tibial spine while flexing the knee. otherwise, why would so many surgeons want to save the eminence during PCL retention? Thanks.

Shirley  says:
4 months ago

Thank you for offering this forum. 6-7 weeks ago I fell and apparently injured my index finger. It did not appear injured until a bruise appeared several hours later and the next morning there was marked swelling over the knuckle and back of the hand. My doctor was certain there was a fracture, but there was no evidence on eray. I was referred to a hand specialist and placed in a splint for several weeks. 2 more sets of xrays still show no fracture, but the doc says it sure presents like a fracture. After the 3rd set of films he decided it must just be soft tissue injury. Now, almost 7 weeks later, the bruising is gone. There is still some swelling that feels kind of hars in between the knuckles and directly over the index knuckle. I have full ROM, but it feels weak and somewhat akward. It only hurts occaisionaly, which is kind of a piching or burning sensation. It can be very painful if stressed or bumped. It looks a little red, but does not feel hot. Will this just take time, or should I go back to the doctor.

Matthew  says:
3 months ago

I am a cheerleader and when i was catching one of the girls her elbow jabbed right into my forearm and at the time i lost control of my hand. It just seized up and it was tingling all the way up my shoulder and down to my fingers. After the athletic trainer massaged the muscles and iced it down it got better but for a few days when i would bend at the elbow or tried to grab something tight my hand would spasm. For a while my forearm was tender and was bruised. Also when i would bend my arm at the elbow it would get really tight and i would have to fight it to get it back strait. It's been about a month now and everything seems to be back to normal but the tendon on the back side of the elbow where in between my bicep and forearm feels larger than the other one but it doesn't necessarily feel swollen. It feel like it just balled up in that one spot. I didn't think it was a tear because my bicep didn't ball up like i saw in pictures but it does seem to be weaker than the other one when i flex it. I'm wondering if you think it's a tear or a rupture of the tendon and what can i do for it besides surgery.

Cindy  says:
3 months ago

Hi my name is Cindy and I am a 30 year old female from florida.

Last year I had a tfcc debribement and I am still having ulnar sided wrist pain. Could this be due to an ulnar variance?

Kayla  says:
2 months ago

Hi Doctor,

I am a 17 year old female and I just dislocated my left knee again playing football. I think this is the fourth time this has happened to the same knee. Every time my kneecap goes back in place on its own, I have never had to put it back in place myself. But this time I saw my kneecap all the way on the left side of my knee, but still it went back in place. I have been icing it every 20 minutes an hour and elevating it, and I plan on getting an MRI done just to be sure no ligaments are torn. Right now it is swollen and I have the pain on the right (inside) of my knee. I am trying everything possible to heal fast because I am at the end of my volleyball season and I really want to play. I am getting a brace for my knee that my trainer told me to get, but I want to know if it is the best brace for me or if there is a better one out there I should get instead. She told me to get the J-Lat Knee Support Knee Brace, but I was also looking at braces such as the DonJoy Tru-Pull Wraparound, the DonJoy Tru-Pull Advanced System Knee Brace, or the DonJoy TPAA. I don't know which one is best for me and I need help please.

Thank you so much.

Donny Stinebuck  says:
2 months ago

Hi, I saw your post and was hoping you could give me some advice. I broke my fifth metacarple and deeply cut my middle knuckle by punching a mirrored door. Stupid, I know. Anyway I can't raise my middle all the way now. Its been almost three weeks now. When I try to lift it all the way there is a deep ache in the knuckle. It seems like It may be getting slightly better. I don't know if it will though. I don't have insurance and the hand specialist wants 100 dollars down to even see me and 750 down if surgery is needed. I don't exactly have that kind of money on hand at the moment. Do you think the function will return on its own or is surgery needed? Thanks for any advice you can give. Donny Stinebuck

jacky  says:
2 months ago

hello doctor! i workout kinda, do a little of martial arts and lately im getting some elbow pain while doing tricep exercises...its kinda a sharp pain and it hurts when i bang the outer bump elbow on hard surface or just resting on it. is this tennis elbow? i dont remember ever injuring it though...both elbows. i also hear clicks when i bend my elbow!

Leah  says:
2 months ago

I hope you can answer this. I'm 18 years old. I've suffered all my life, since I can remember ankle problems, before I start I would like to say, i've been to physical therapy, I've had orthotics, I've even been to Shriner's hospital. None of these have helped me. I've had swelling in my ankles and they roll out when I walk, I can't play sports, walk for a long period of time, or wear heals. I easily can sprain them. They swell hurt and bruise even when I don't put pressure on them. I also experience when I stretch and my ankles point downwards I get a throbbing sensation from my foot to my leg it almost feels like a pulse. I also get a numbing feeling for time to time. Please help.

Lisa  says:
5 weeks ago

Hey Doctor

i would like a second opinion for my knee injury. the injury occured in march on the bus where it stopped suddenly, my foot was caught on a puddle on the floor and the leg either flexed/extended badly. there were no abnormal sounds from the injury nor swelling, but for the next 3 weeks it was very difficult to walk/run on it, going up and down the stairs and i had to limit the movement as extending the injured side caused pain. during those first couple of weeks it felt as if it was going to give away. i was unable to let it rest properly since i was in the middle of a tough uni semester, therefore i was walking on the injured knee. i noticed that during the doctors when i was lying supine and was asked to turn and lie face down that sort of twisting movement was quite painful on the knee.

i decided to get an xray and ultrasound done as soon as possible but did not report anything. i saw a physio a few times where they thought it would be patellofemoral pain.

it did start to get slightly better but i wanted to get an mri scan done to make sure. i remember during november after my mri on november it was quite painful to walk on and i would usually develop a few warm- red spots around the knee cap.

i saw the specialist today and he was a bit in a rush but he indicated that all is fine and what i need to do is physio and muscle strenghtening. but there was something that was bothering me afterwards that i wanted a second opinion.i got the copy of the report which indicates:

the axial fat suppressed PD sequence was degraded by patient movement artefact

there is no significant joint effusion. there is a tiny amount of fluid in the medial gastrocnemius semimembranosus bursa

Patellofemoral compartment: quadriceps tendon and patellar ligament are normal in appearance. retropatellar/femoral trochlea cartilage is intact

lateral compartment:no meniscal tear detected. there is no signicant chondral wear or subchondral marrow oedema or cysts. the tibial cartilage is intact

medial compartment: no meniscal tear detected. there is minimal surface irregularity of the central femoral cartilage laterally. there is no significant subchondral marrow oedema or cyst.

bones, tendons, ligaments: there is no high-grade bone marrow oedema to suggest recent fracture. PCL,MCL, LCL are intact. probably non-acute small partial thickness distal ACL tear with scar remodelling.

i do have images of the mri scan if required.

your help will be greatly appreciated. thank you for your help

Lisa.

chez  says:
5 weeks ago

Hi

one week ago i cut the palm side of my thumb on some glass it seemed quite deep, couldnt have stitches as it took a large part of the skin off. Anyhow the wound is healing but i cannot bend the knuckle joint fully and it hurts when i try to, my thumb is slightly swollen. please can you help me as i am worried sick i have slit the flexor tendon, am going for drs appointment tommorrow but i dont think i will sleep as im worried so much. thankyou for any advice.

lgps  says:
4 weeks ago

Is it possible to have a plate and screws removed from an ankle after 17 years? The doctor said this could be done after the surgery but it never caused a problem and I never followed through. Now I am 59 and have some autoimmune issues and metal allergies. I would like to have the hardware removed but am afraid I've waited too long. I realize I need to see an orthopedic surgeon but am curious about your opinion.

Maria  says:
3 weeks ago

Ok, I'll tell you my little journey to how I ended up not being able to move my toe... It was a while after I started karate and I didn't know that when you kick someone hard, without even knowing how to kick is very bad. I was sparring, and well, I kicked a boy a roundhouse and my big toe on my right foot popped. Pain, swelling... but I didn't think much of it, so I just kept doing everything normally; yet every time I sparred again, it swelled up again, and the excruciating pain came back; once again, I didn't think much of it, and just used my left foot to kick. A while, about 5 months passed by and I sparred a girl, and well, this time the pain was worse than ever, and I had no choice but to go to the hospital (the toe was blackish and very swollen... it looked like a marshmallow T.T). Well, the doctor said it was fractured and put a cast on it. 6 weeks (or was it 8?) later, cast-like splinter was taken off and the doc saw that my toe was only 'movable' from the 1st joint (metatarsal) and not the second (distal phalanges); but he said there was nothing to be done "for one toe" and laughed it off. At the time, I was just glad I was going to be able to spar again; yet, it's been a year since the splinter-like-cast was taken off, and I've gained no motion from my second joint. Now, I can't put sandals on because I can't grasp the shoe (no bending, remember?), can't walk on carpet because it gets 'stuck' , very painful, and yes, I can't spar normally now.... Is this normal after 6-8 weeks of immobilizing the foot? When I went to the orthopedist for a recent toe injury where I fractured my 2nd and 3rd toes from my left foot (I know, very unlucky toes) and he checked and said that it that the big toe was still fractured. Does this seem serious? Will this ever get better? Please help, I see no hope

simple d.r  says:
3 weeks ago

IAM A MEDICAL STUDENT I HAVE QUESTION I HOPE YOU CAN ANSWER IT FOR ME ;

Q. WHAT ARE THE DISEASES THAT CAUSE OSTEONECROSIS OF FEMORAL HEAD ?

THANKS.

Helen  says:
2 days ago

My husband cut his tendon (not all the way through) in his index finger (one that runs along the top) 3 weeks ago (near the base of his finger)...he was treated in emergency where they stitched it together and gave him a splint to wear. He has been in a lot of pain since and had a lot of swelling that is still happening. He has seen our family dr a couple of times who doesn't think it's doing as well as it should. The specialist he saw seems to think its fine and will see him again in a few days to see if he can start physio yet. Couple of questions.....is it common to be still very swollen after three weeks? (double normal size at times) and how easy is it to tell if the initial repair failed?

Thanks