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26th February,2020

What are Sebaceous Cysts?

Should sebaceous cysts be removed?

These lumps just beneath the skin, more appropriately called epidermal cysts, are common and harmless. The most important thing is to check with a doctor to properly identify them.

They are non-cancerous and not life-threatening, but they can be uncomfortable.

Skin cysts do not usually cause any problems, apart from their appearance. They are not usually tender, but their presence can be obvious to the touch.

If a cyst on the scalp catches on a brush or comb, for example, this may cause pain, but cysts are normally only painful if they become inflamed or infected.

Typically located on the head, neck, or torso, the cysts are firm, round, and sometimes movable, and grow slowly, sometimes to a few centimeters or more in diameter. They may be caused by injury to a hair follicle or other damage to skin. They are filled with a greasy material made of fat and keratin. There can be a familial tendency to developing sebaecous cysts.

If a cyst becomes infected or if you are bothered by it for any other reason, it can be surgically removed. This is a simple procedure, and usually requires stitches which are then removed in a few days. If it is only drained, it will probably quickly grow back again.

Lipomas can look like cysts, but are benign fatty tumors. They seem to run in families and also grow slowly. A doctor will often be able to tell you whether you have a cyst or lipoma by its look and feel, though you may need an ultrasound or other tests for a definite diagnosis. Lipomas can be removed if they are bothersome by being unsightly or uncomfortable.

While skin cysts can look bad, doing anything to them can make them worse. Picking, rubbing, or squeezing cysts is likely to cause damage and make any infection worse. It is also likely to increase the pain and worsen its appearance.

Dealing with skin cysts that are causing concern or producing symptoms means getting them seen by a doctor.

 

24th March,2020

Ingrown toenail / Ingrowing toenail

Overview

An ingrown toenail develops when the sides of the toenail grow into the surrounding skin and pierces it causing inflammation.

The big toe is often affected, either on one or both sides. The nail curls and pierces the skin, which becomes painful, red, swollen and tender.

Common symptoms include:

  • pain if pressure is placed on the toe
  • inflammation of the skin at the end of the toe
  • a build-up of fluid (oedema) in the area surrounding the toe
  • an overgrowth of skin around the affected toe (hypertrophy)
  • bleeding
  • white or yellow pus coming from the affected area

What causes ingrown toenails?

The following can contribute in causing an ingrown toenail to develop :

  • badly cut toenails – cutting your toenails too short, or cutting the edges, will encourage the skin to fold over your nail and the nail to grow into the skin
  • wearing tight-fitting shoes, socks or tights – this places pressure on the skin around your toenail; the skin may be pierced if it’s pressed on to your toenail
  • sweaty feet – if the skin around your toenails is soft, it’s easier for your nail to pierce it and embed itself within it
  • injury – for example, stubbing your toe can sometimes cause an ingrown toenail to develop
  • natural shape of the nail – the sides of curved or fan-shaped toenails are more likely to press into the skin surrounding the nail

Treatment for ingrown toenail :

Left untreated, an ingrown toenail can become infected, so it’s important that you:

  • keep your feet clean by washing them regularly and keeping them clean and dry.
  • change your socks regularly
  • cut your toenails straight across to stop them digging into the surrounding skin
  • gently push the skin away from the nail using a cotton bud (this may be easier after using a small amount of olive oil to soften the skin)
  • wear comfortable shoes that fit properly

Surgery may be recommended if your toenail doesn’t improve. Depending on the severity of your symptoms, this may involve removing part or all of your toenail.

1. Partial nail avulsion

Partial nail avulsion removes part of your toenail under local anaesthesia and is the most commonly used operation for treating ingrown toenails.

A local anaesthetic medicine is used to numb your toe and the ingrown part of your toenail is cut away. Any pus is drained and dead tissue is debrided.

A course of an antibiotic may be prescribed if your nail is infected.

2. Total nail avulsion

Total nail avulsion completely removes your toenail. This may be necessary if your nail is thick and pressing into the skin surrounding your toe on both inner and outer sides in the same toe.

 

After surgery

After toenail surgery, your toe will be wrapped in a sterile bandage. This will help prevent any bleeding and also prevent infection. Rest your foot and keep it raised for 1 to 2 days after the operation.

To help reduce the pain, you may prescribed a pain killer. Wear soft or open-toed shoes for the first few days after surgery.

Preventing ingrown toenails

Taking care of your feet will help prevent foot problems such as ingrown toenails. It’s important to cut your toenails properly (straight across, not at an angle or down the edges).

Wash your feet every day, dry them thoroughly and use foot moisturiser.

Wearing shoes that fit properly will help to ensure your feet remain healthy. You should also change your socks (or tights) every day.

27th March,2020

Joint Injection Treatments for Osteoarthritis

Joint injections or aspirations (taking fluid out of a joint) are performed often with local anaesthesia. After the skin surface is thoroughly cleaned, a needle in injected directly into a joint. At this point, either joint fluid can be removed (aspirated) and used for appropriate laboratory testing. Steroids, Platelet Rich Plasma (PRP) or adipose ( fat ) derived Stem Cells can be injected into the joint according the indication of treatment. These treatments can treat inflammation inside the joint, leading to decreased swelling and pain with to effective pain management and in turn translate into a better quality of life.

Commonly injected joints include the knee, Hip joint, shoulder, ankle, elbow, wrist, base of the thumb, and small joints of the hands and feet.

  1. Joint injections are used to deliver the therapeutic agent  directly into a joint, such as a knee, ankle, or wrist. Sometimes fluid is removed from the joint before the steroid is injected.
  2. Steroid joint injections can help with pain and swelling by treating the underlying joint inflammation – improvement is often quick.
  3. The risks for joint aspirations and injections are minimal. Infection, bleeding, and other risks are rare.

What is a joint aspiration or joint injection?

Steroid joint injections can be used as part of a treatment plan for people with arthritis. A medication/PRP/Stem Cells is injected using a needle directly into a joint, such as a knee. The steroid treats the inflammation inside the joint, leading to decreased swelling and pain.

Sometimes joint fluid is removed before the steroid is injected (called aspiration), and then the therapeutic agent is injected into the joint, without requiring a new needle stick. Fluid obtained from a joint aspiration can be examined by the physician or sent for laboratory analysis, which may include a cell count (the number of white or red blood cells), crystal analysis (to confirm the presence of gout or calcium pyrophosphate crystal disease), and/or culture (to determine if an infection is present inside the joint). Drainage of a large joint effusion can provide pain relief and improved mobility.

The decision to use joint injections as part of a treatment depends on each individual case. Joint injections may decrease the accumulation of fluid and cells in the joint and may decrease pain and stiffness. The positive effects of joint injections are for pain management and better quality of life and may not be permanent. Often, the improvement in inflammation, swelling and joint pain lasts a long time before needing another treatment, but depends on the extent of the joint osteoarthritis. In some milder conditions, a joint injection may produce long periods of disease control.

Steroid joint injections may be given to treat inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendonitis, bursitis and, osteoarthritis.

 

How is a Joint Injection usually given?

Joint injections can be performed safely in the clinic. It is important for the patient to stay still during the procedure. Hyaluronic acids and corticosteroids (such as methylprednisolone and triamcinolone formulated to stay primarily in the joint) are frequently used. Corticosteroids are anti-inflammatory agents that slow down the accumulation of cells causing inflammation and pain within the joint space.

When it is time for the injection, the skin at and around the injection site will be carefully cleaned to remove bacteria from the skin. A needle is then inserted into the joint space. If the plan is to remove fluid, an empty syringe will be attached to the needle to pull the fluid out. Sometimes, multiple syringes need to be used to remove all the fluid. After any necessary fluid is removed, a small syringe containing the therapeutic agent is attached to the needle and is slowly injected into the joint. The needle is removed, and pressure is held to prevent any bleeding. A bandage is applied to the injection site.

 

Possible Risks/Side Effects

Infections are very rare complications of joint injections. Another uncommon complication is post-injection flare – joint swelling and pain several hours after the injection – which occurs in approximately 1 out of 50 patients and usually subsides within several days. Some patients may have a temporary increase in pain that can last a few days and is usually manageable with pain killer medication,

Other complications, which is associated with a corticosteroid injection treatment may include depigmentation (a whitening of the skin), local fat atrophy (thinning of the skin) at the injection site and rupture of a tendon near the injection site.

Joint injections also should not be given if an infection is present inside or around a joint and if someone has a serious allergy to one or more of the medications that are injected into a joint. If an infection is suspected, aspirating the joint to gather cultures is essential.

 

28th March,2020

What is Carpal Tunnel Syndrome (CTS) ?

Carpal tunnel syndrome is a common condition that is caused by compression of Median nerve at the wrist, when this nerve runs through a confined space known as the carpal tunnel. 

When the median nerve is compressed at the wrist in the carpal tunnel, this results in disruption of electrical impulses through the nerve. This nerve provides sensation to the thumb, index and middle fingers, and to half of the ring finger. The small finger is typically not affected. The median nerve also carries impulses to small muscles in the hand.

The main cause of carpal tunnel syndrome is swelling due to repetitive motion or overuse of the wrist and fingers, hence creating edema in the carpal tunnel. It can also be a feature of pregnancy, particularly in women who suffer from generalised swelling of the hands and feet throughout their pregnancy.

In short, Carpal Tunnel Syndrome is the name given to a sensation of numbness, weakness, tingling and general discomfort in the outer area of the wrist and hand. 

Who is prone to develop Carpal Tunnel Syndrome ?

People most at risk are those with jobs or activities that involve repetitive finger use, especially those associated with high force, long-term use, extreme wrist motions, and vibration, creating edema in the carpal tunnel, which in turn results in compression of the median nerve.

Other factors that contribute to the development of carpal tunnel syndrome include:

1. Heredity (smaller carpal tunnels can run in families).

2. Pregnancy

3. Wrist fracture and dislocation.

4. Hand or wrist deformity.

5. Arthritic diseases involving the wrist.

6. Thyroid gland under activity (hypothyroidism).

7. Diabetes

8. Alcoholism

9. A mass in the carpal tunnel.

10. Old age.

11. Repetitive use of a vibrating tool.

29th March,2020

What happens during carpal tunnel Release (Decompression) surgery?

Carpal tunnel release is an outpatient procedure, which means that you can go home after the procedure.

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Carpal Tunnel Surgery also called Carpal Tunnel Decompression surgery for Carpal Tunnel Syndrome

Surgery Overview

During open carpal Tunnel surgery, the transverse carpal ligament is cut, which releases pressure on the median nerve  and relieves the symptoms of carpal tunnel syndrome.

An incision is made at the base of the palm of the hand. This allows to see the transverse carpal ligament. After the ligament is cut, the skin is closed with stitches. The gap where the ligament was cut is left alone in order to widen the carpal tunnel to relieve median nerve compression.

For open carpal tunnel release surgery, a patient does not need to stay in the hospital, it is done under local anaesthesia, and patient can go home on the same day.

 

Carpal Tunnel Release Surgery

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In open carpal tunnel release surgery, the transverse carpal ligament is cut, releasing the median nerve. The size and shape of the incision may vary.

 

Indication for Surgical treatment for Carpal Tunnel Syndrome

Surgery is recommended when carpal tunnel syndrome does not respond to non-surgical treatments or has already become severe. The goal of surgery is to increase the size of the tunnel in order to decrease pressure on the nerves and tendons that pass through the tunnel. This is done by cutting (“releasing”) or (‘decompressing’) the ligament that covers the carpal tunnel at the base of the palm. This ligament is called the transverse carpal ligament.

Surgery for carpal tunnel syndrome is an outpatient procedure that is usually performed under local anesthesia  and you will be awake. But sedation can be added for comfort. After surgery, brief discomfort lasts 24 to 72 hours. However, patients often experience complete night time symptom relief even the night after surgery. Stitches are removed 10 to 14 days after surgery. Hand and wrist use for everyday activities are gradually restored by advising exercising.

Heavier activities with the affected hand are restricted for 4 to 6 weeks. Recovery times vary depending on the patient’s age, general health, severity of carpal tunnel syndrome, and the length of time symptoms have been present. Strength and sensation continue to improve over the following year.

Many patients who undergo carpal tunnel release surgery achieve nearly complete relief of all symptoms. Recovery in some individuals with severe carpal tunnel syndrome may be slow and may not be complete due to nerve injury cuased by prolongd compression. Carpal tunnel syndrome can reoccur, but this is not common.

Carpal Tunnel Release Surgery, explained in more detail :

In carpal tunnel release surgery, the transverse carpal ligament is cut, releasing the median nerve. The size and shape of the incision may vary.

It is a myth that Carpal tunnel syndrome occurs only in office workers or factory assembly line workers. The truth is patients with carpal tunnel syndrome have never done office work or worked on an assembly line.

Anyone can get carpal tunnel syndrome, but it is unusual before age 20. The chance of getting carpal tunnel syndrome increases with age. Women have a slightly higher chance of getting carpal tunnel syndrome. It affects people who use their wrists and hands repeatedly at work and at play.

Myth: It takes a long time to recover from surgery to treat carpal tunnel syndrome. Truth: The bandage that covers the stitches after surgery can be removed in a few days. The hand can then be used for light activities. Making a fist is encouraged. Full range of finger motion and symptom relief is usually seen within 2 weeks after stitches have been removed. You can usually return to most activities by 6 weeks. Return to work depends on many factors, such as type of work, how much control you have over your work, and workplace equipment.

Myth: Surgery usually doesn’t work. Truth: Surgery has a high success rate, over 90%.

The tingling sensation and waking up at night is usually relieved fairly quickly, as is any pain that is coming from the carpal tunnel. Numbness may take longer to be relieved, even up to 3 months. When the carpal tunnel syndrome has become severe, relief may not be complete. There may be some pain in the palm around the incisions that can last up to a few months. Other after-surgery pain may not be related to carpal tunnel syndrome. Patients who complain of pain or whose symptoms remain unchanged after surgery either had severe carpal tunnel syndrome with median nerve damage. Only a small percentage of patients do not gain complete relief from symptoms.

Myth: Carpal tunnel syndrome frequently comes back after surgery. Truth: Recurrences are unusual.

What happens during carpal tunnel release surgery ?

You usually lie on your back for carpal tunnel release surgery, with your arm stretched out on an operating board by your side. Your will be in a comfortable position. 

You’ll be given local anaesthetic injections so you won’t feel any discomfort during the procedure. It will be tested whether or not you can feel any pain before starting the operation. You may still feel some pressure once the anaesthetic is working. 

 

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