Tension pneumotharax

Features
1) Rapidly progressive breathlessness
2)Marked tachycardia
3)Hypotension
4) cyanosis
5)Tracheal displacement

X-ray findings

1)Collapsed lung will be seen in hillum
2) Trachea and mediastinal shift to opposite side
3) distortion on aorta.

Colles fracture

84Y female with ho FOOSH
3Days back
Swelling present
So volar slab applied plan for
Colles cast after 1week

Popcorn calcification

Solitary popcorn calcification chest

Differential diagonis?

Penetreting injury from vestibule to chin

 A 45 yr male pts under influence of alcohol came with h/o cut over chin 30 min back on a dispute with drinking mate ...
O/E
Penetrating cut injury frm vestibule up to chin
...
advice for closure 3 layers
1) stress suture with prolene 4-0
2) muscular layer with vicryl 5-0
3) vestibule and gums with vicryl 5-0
compression bandaging done and antibiotics coverage

CHEST DEFORMITY

 

13 y/m child k/c/o AGN with chest deformity ( pigeon chest and concavity over rt and lt chostophrenic lateral region) ???????

Foreign body

Wire penetrated accidently while knitting a metalic net on 17 yr male rt hand ..

T11wedge compression fracture

55 Yr female with alleged ho hit by a motor bike 30 min back fb pain over lower back reason ..
T/t
Pain mangement and knight tylor brace was applied

9 Treatments for Tennis Elbow

“the most effective and common treatments for tennis elbow:

1. Cryotherapy:

Cryotherapy is proving to be one of the best tennis elbow treatments available. Using cryotherapy to treat tennis elbow involves wearing a special cuff over the elbow.  The cuff applies a cold compress to the elbow in a controlled manner to minimize pain and swelling. When a person is injured, blood vessels rupture and blood cells and other fluids tend to seep under the skin, resulting in bruising and swelling. Cryotherapy decreases these symptoms and eliminates inflammation in the affected area.

2. Counterforce Brace

This type of brace is a strap worn around the patient’s forearm just below the elbow. This brace may spread pressure throughout the arm instead of putting it all on the tendon, which can help alleviate pain caused by grasping or twisting arm movements. These braces are not a substitute for rehab exercises.

3. Changing Movement

Sometimes, changing the way you move your arm or improving your tennis form can alleviate stress on the affected tendons. You may need to follow a specific training schedule and perform low-impact exercise in order to recover quickly, rather than cause further injury.

4. Acupuncture

An alternative treatment method, acupuncture may be helpful for tennis elbow; and a few studies have shown that it helps relieve pain symptoms in some patients. Many claim that this ancient Chinese medical art form does wonders for their injury.

5. Turmeric

The spice turmeric may not be a conventional treatment option, but it does show potential as a natural treatment for inflammation. In one study, discussed in Science Daily, researcher Dr Ali Mobasheri said, “Our research is not suggesting that curry, turmeric or curcumin are cures for inflammatory conditions such as tendonitis and arthritis. However, we believe that it could offer scientists an important new lead in the treatment of these painful conditions through nutrition.”

6. Cortisone Injections

Corticosteroids are a type of medication that contain man-made versions of the hormone cortisol. Corticosteroid injections are sometimes used to treat particularly painful musculoskeletal problems. However, there is limited clinical evidence to support their use as an effective treatment for tennis elbow. Corticosteroid injections may help reduce the pain of tennis elbow in the short term, but their long-term effectiveness has been shown to be poor. The injection is made directly into the painful area around the elbow. Before the injection, local anaesthetic may be given to numb the area to reduce the pain.

7. Physiotherapy

A doctor may refer the patient to a physiotherapist if the tennis elbow is causing more severe or persistent pain. Physiotherapists are healthcare professionals who use a variety of methods to restore movement to injured areas of the body. A physiotherapist may use manual therapy techniques, such as massage and manipulation, to relieve pain and stiffness, and encourage blood flow to the arm. They can also teach exercises to keep the arm mobile and strengthen the forearm muscles.

8. Non-steroidal anti-inflammatory drugs (NSAIDs)

These medicines include Aspirin, Ibuprofen and Naproxen. They can help to reduce pain and inflammation. NSAIDs come in either pill form or as a cream to rub over the sore area. Be safe with medicines; read and follow all instructions on the label. Acetaminophen can also help with pain.

9. Surgery

Tennis elbow usually gets better using the treatments listed above. But, if after six months to two years it hasn’t got better, doctors may suggest surgery to repair or remove the damaged part of your tendon.

TENIS ELBOW (Lateral Epicondylitis)

Tennis elbow (lateral epicondylitis) is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities can also put you at risk.

Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.

There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists, and, in some cases, surgeons work together to provide the most effective care.

Anatomy

Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.

The ECRB muscle and tendon is usually involved in tennis elbow.

Muscles, ligaments, and tendons hold the elbow joint together.

Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone. They attach on the lateral epicondyle. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).

Cause

Overuse

Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.

The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.

Activities or jobs involving repetitive arm motion also cause tennis elbow. They include:

·         Painting

·         Tree-cutting

·         Carpentry

·         Playing some musical

·         Repetitive computer mouse use

Also, cooks, butchers, and assembly-line workers are among those who often suffer tennis elbow.

Note: Tennis elbow is different from Golfer’s elbow even though tendon tears are caused by repetitive movements of the hands. Because, the pain in Golfer’s elbow is focused on the inside of the elbow.

Symptoms

The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with

the start of symptoms.Common signs and symptoms of tennis elbow include:

·         Pain or burning on the outer part of your elbow

·         Weak grip strength

The ache on the outside of the elbow is the major symptom of tennis elbow, which may affect both the arms.

The ache may turn into a chronic pain over time.Eventually, it may become difficult even to lift things.Pain and weakness may make it difficult even to shake hands, turn a door knob, or even hold a coffee cup.The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however both arms can be affected.

Doctor Examination

consider many factors in making a diagnosis. These include how your symptoms developed, any occupational risk factors, and recreational sports participation.

what activities cause symptoms and where on your arm the symptoms occur. History of rheumatoid arthritis, injured your elbow or nerve disease.use of variety of tests to pinpoint the diagnosis. For example, try to straighten your wrist and fingers against resistance with your arm fully straight to see if this causes pain. If the tests are positive, those muscles may not be healthy.

Tests

recommend additional tests to rule out other causes of your problem.

·         X-rays. These tests provide clear images of dense structures like bone. They may be taken to rule out arthritis of the elbow.

·         Magnetic resonance imaging (MRI) scan. If symptoms are related to a neck problem, an MRI scan may be ordered. MRIs scans show details of soft tissues, and possible herniated disk or arthritis in your neck. Both of these conditions often produce arm pain.

·         Electromyography (EMG).  rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression are similar to those of tennis elbow.

Treatment 

Nonsurgical Treatment

        Approximately 80% to 95% of patients have success with nonsurgical treatment.

    Rest: The first step toward recovery is to give your arm proper rest. This means that you   will have to stop participation in sports or heavy work activities for several weeks.

·  Physical therapy: The therapist helps gradually stretch and strengthen muscles, especially of the forearm. Eccentric exercises help big time, as they involve lowering and raising the wrist very slowly. The doctor may suggest the brace or the forearm strap to reduce stress on the injured tissue. 

     Medications as prescribed by the doctor including aspirin, ibuprofen, Motrin, Advil. Over the counter pills may also offer reduce pain and swelling.

  Surgical or other procedures:

 (i) Injections: To control the pain, the doctor might suggest injecting platelet-rich plasma, Botox or some irritant (prolotherapy) into the painful tendon. Dry needling can also help, which is nothing but piercing needles at the damaged tendon in many places. 

(ii) Ultrasonic tenotomy (TENEX procedure): It is a medical procedure that involves inserting a special needle through the skin under ultrasound guidance into the damaged portion of the tendon. The needle is vibrated swiftly by the ultrasonic energy for the damaged tissue to get liquefied and can be suctioned out. 

(iii) Surgery: Even after the 6 to 12 months treatment if the pain does not subside, a surgery may become the option for the removal of the damaged tissue. Such procedures can be performed through several small incisions or a large incision. Rehabilitation exercises play a prominent role in recovery.

· Lifestyle and home remedies: Rest so that the elbow pain doesn’t exaggerate. Expert-evaluation to analyze the tennis techniques and movements to correct and take right measures to reduce the stress on the injured tissues. Self-care measures like applying ice bags or a cold pack for 15 minutes at least thrice a day will be helpful.

·         Exercising as per the expert guidance.

What Are The Strengthening Exercises For Tennis Elbow:Strengthening exercises for Tennis elbow are listed below.

Ball or sock squeeze:

1.      Hold tennis ball in your hand.

2.      Make a fist and squeeze.

3.      Hold for 6 seconds and release.

4.      Repeat 10 times a day. Repeat in both the hands.

Wrist deviation

1.      Sit by resting your arm on a flat surface and leaving your hand hanging off the edge.

2.      Move your hand up and down. Keep repeating the motion for 8 to 12 times.

3.      Repeat by switching arms.

Wrist Curl exercises

1.      Sit placing your forearm on a table, palm up, and hand hanging over the edge.

2.      Place an object that weighs around 1 to 2 pounds in your hand.

3.      Slowing keep raising and rest forearm on the table.

4.      Keep repeating the motion for 8 to 12 times. Switch arms.

Bicep curls

1.      Lean forward and sit with legs spread little.

2.      Place your left hand on your left thigh. Right hand on the right thigh.

3.      Hold weight with your forearm. Curl the weight slowly toward the chest.

4.      Keep repeating the motion for 8 to 12 times. Switch arms.

Overview

Tennis elbow or lateral epicondylitis is a painful condition that occurs due to overuse and muscle strain injury.

Occurs when elbow tendons are overloaded due to repetitive motions of arm and the wrist.

Over-the-counter pain relievers and enough rest help relieve tennis elbow. Surgery may be a last option if all the conservative treatments fail or if the symptoms are disabling.

10 Symptoms of Tennis Elbow

Despite the name, you don’t have to be a tennis player to suffer from this painful arm injury. Tennis players are certainly some of the most likely people to get injured in this way, with as many as one out of two getting tennis elbow, but it also affects plumbers, butchers, typists and anyone else who commonly make certain repeated motions with their arms and wrists. Believe it or not, even video game players sometimes get tennis elbow from game controller manipulations. It happens in every age group, but statistics show that those in their 30s and 40s face higher risks than other age groups.

1. Pain on the upper forearm

A persistent pain in the upper forearm is one of the classic tennis elbow symptoms. This pain usually occurs on the outer arm just beneath the elbow. Sufferers commonly describe this sensation as a burning pain. However, similar symptoms happen with certain other illness, so everyone is recommended to consult their doctor. They will be pleased to get a tennis elbow diagnosis since although it can be quite painful, it still represents a mild injury that often requires no medical intervention.

2. Pains increase with activities

Someone with tennis elbow immediately notices that certain activities become very painful to them. Commonly they experience this pain if they raise or bend their arms and even while performing simple tasks like holding a pen and writing a note. They also often get these pains when they need to turn the forearm to open a door; it hurts when they need to move their wrist forcefully. There is no need to lift a heavy item to feel this pain but even lifting up something as light as fork becomes very painful.

3. Normally rest brings a measure of relief

In the majority of cases those with less severe cases of tennis elbow notice that their pain lessens significantly when they rest. Someone in this situation has no need to seek any medical advice, but if rest brings no real relief, or if they find themselves unable to move the elbow or lose feeling in it, they need to contact a doctor urgently.

4. Pains often vary according to the time of day

Sufferers from tennis elbow often notice that the elbow of their injured arm feels very stiff and aches when they wake up in the morning. As the day proceeds, this stiffness and aching lessen somewhat, but it still continues at some level.

5. The nature of the pain changes

The tennis elbow pain often starts off like a burning ache located on the outer forearm and elbow, but it starts to grow more intense. If the arm gets no rest the pain sometimes goes down all the way to the wrist. In the opposite direction, these pains might also ascend the upper section of the arm towards the shoulder. Everything depends on the source of the original injury and subsequent activities using this hand, so it is impossible to describe how the pains will develop in every instance.

6. Handshakes are no fun

The handshake is one of our most common and accepted social interactions. This sign of respect or good will is expected when meeting customers or public figures, but for anyone with tennis elbow, this simple act becomes a very painful procedure. It is not only shaking hands that hurt them, but they experience a similar kind of pain squeezing an orange or some other object. The best way to avoid the pain and social embarrassment are to let the other person know about the hand injury in advance, so they will not get offended.

7. Increased sensitivity to pressure

You might think that handshakes are so painful to someone with tennis elbow because it pains them to move their hand in this way but this is only half of the picture. In addition to the pain, this particular wrist movement causes the pressure of the other person’s hand further exacerbates the pain. Any pressure on the affected area serves to increase their pain. The source of this pain is an inflamed tendon where the muscle is attached to the bone on the outer side of the elbow.

8. These pains start all of a sudden

With sport and most other injuries, the party involved easily makes the connection between an injury they suffer and the pain that comes on but in many instances of tennis elbow, there is no such link. This happens because the person affected might not have noticed whatever action or event led to this injury. Furthermore, symptoms often appear three or four days down the line, so this makes it that much harder to work out the source of the problem. The fact that pains usually develop gradually is another factor that distances the complaint from its cause to impede easy identification.

9. Pains go away without treatment

Although nobody disputes that tennis elbow pains are very painful and interfere with people’s working and sporting lives they still deserve to be classed as a mild injury. In the vast majority of cases, these pains decline and eventually cease altogether without the need for any medical intervention. If you rest the injured arm sufficiently expect a complete healing within a couple of months although there are extreme cases where tennis elbow continues over a couple of years. The more the injured person tries to use this arm the longer the healing takes.

10. It becomes harder to grip everyday objects

The way tennis elbow weakens a person’s grip is one of the most significant ways to which it interferes with their normal life. If it was simply a matter of difficulties holding a racquet, it is easy to put up with, but it makes it harder to hold all kinds of objects people regularly use. Any actions that require some strength of the hand are no longer moves performed with little forethought but challenges. The actions in question include such simple tasks as gripping light objects such as a cup or screwdriver.

Amputed Rt Thumb with # proximal phalynx of Rt 5th digit

WHAT CAN BE THE FURTHER POSSIBILITIES OF MGMT ? 

EXPERT OPINION

E