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General Topics

What Is Bone Mass Risk In Older Women? | Orthopaedics

Overview of bone mass risk in older women

Older women with low bone mineral density (BMD) have a decreased incidence of breast cancer. It is not known whether this association is confined to early-stage, slow-growing tumours.

Prospectively studied 8905 women who were 65 years of age or older during the period from 1986 through 1988 and had no history of breast cancer. At study entry, we used single-photon absorptiometry to measure each woman’s BMD at three skeletal sites: the wrist, forearm, and heel. The women were followed for a mean of 6.5 years for the occurrence of breast cancer. All statistical tests were two-sided.

There are several reasons why women are more likely to develop osteoporosis than men, including:

  • Women tend to have lesser and solvent bones than men.
  • Estrogen, a women’s hormone that protects bones, drops dramatically when women reach menopause, which can cause bone loss. That is why the accidental of developing osteoporosis increases as women spread menopause.

Risk factors

Although several risk factors affect the risk of fragility fractures, low bone density, mass, and strength contribute to an increased risk of fracture in the event of a fall. In the prevention of fractures, it is essential to improve both bone health and physical performance.

Bone mineral density among men and women aged 35 to 50 years

  • Context: Osteoporosis is characterized by low bone mineral density (BMD) and is believed to be only a major health problem for postmenopausal women. However, osteoporosis and its risk factors have been poorly studied in the male and middle-aged populations.
  • Objective: To assess the probability of low BMD and its association with related risk factors in early middle-aged men and women (defined in this study as 35-50 years).
  • Methods: Men and women completed a questionnaire assessing calcium intake, hours per week of exercise, and other related risk factors associated with osteoporosis and osteopenia. The primary outcome variable, BMD, was obtained by dual-energy X-ray absorptiometry scans taken at the femoral neck, trochanter, intertrochanteric ridge, total femur, and lumbar spine.

Osteoporosis: not just for older women

Women who have been through menopause indeed have a higher risk of osteoporosis, which is a decrease in bone density. But everyone’s bones naturally weaken with age.

Our bodies constantly substitute old bone tissue with new bone tissue. As we age, this rebuilding process takes longer. In fact, your bone density peaks around age 30. After that, you start to lose bone mass. Anything that promotes bone loss or prevents new bone formation can increase the risk of osteoporosis.

In addition to age and gender, family history and having a small, slim body are major risk factors. Also, unhealthy habits can play a role. If you smoke or drink a lot, are sedentary, or if your diet lacks calcium and vitamin D, your risk of osteoporosis will be higher. Some medical conditions and medications can also affect bone health. Among the most common are:

  • Prednisone and other corticosteroids. They are often prescribed for people with asthma, rheumatoid arthritis, or other conditions because they fight inflammation. But taking them for a long period increases the risk of bone loss.
  • Anti-seizure drugs. People with epilepsy may be at higher risk because commonly used anti-seizure medications have been shown to alter the way vitamin D is used in the body, affecting the strength of bones. Also, a seizure itself can result in a fall or other accident that could cause a fracture.
  • Low levels of testosterone and estrogen. Anything that reduces estrogen (in women) or testosterone (in men) has an effect on the bones. This may be due to long-term use of strong pain relievers, cancer treatment, surgery or trauma to the testicles in men or the ovaries in women, elevated levels of sports activity, or genetic factors such as early menopause in women.
  • Other chronic diseases or conditions. Circumstances such as diabetes, untreated hyperthyroidism, extreme levels of the stress hormone cortisol, and kidney or liver disease can affect nutrient and vitamin D levels, and increase bone loss or decrease bone formation.

The loss of bone density related to any of these conditions makes you more vulnerable to bone fractures, especially as you age. If you are at higher risk, it’s important to talk to your doctor about your bone health. The sooner you take steps to protect your bones, the better your chances of avoiding a fracture.

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General Topics

Symphysis Pubis Dysfunction (SPD) in Pregnancy | Orthopaedics

What is symphysis pubis dysfunction (SPD) in pregnancy?

Symphysis pubis dysfunction (SPD) is a group of symptoms that cause uneasiness in the pelvic region. It usually occurs during pregnancy, when the pelvic joints developed stiff or move unevenly. It can occur in both the front and back of the pelvis. Symphysis pubis dysfunction (SPD) is also sometimes known as pelvic girdle pain.

The symphysis pubis dysfunction condition is not harmful to your baby, but it can be extremely painful for you. In some, the pain can be so severe that it affects mobility.

What are the signs and symptoms of SPD?

The most common symptoms of this symphysis pubis dysfunction are difficulty walking and tearing pain (as if the pelvis is tearing). The pain is usually concentrated in the pubic area, but in some women, it radiates to the upper thighs and perineum.

Pain can be worse when you walk and perform weight-bearing activities, particularly those that involve lifting one leg such as climbing stairs, getting dressed, getting in and out of a car, or even rolling over in bed.

What causes symphysis pubis dysfunction?

“We have connective tissue that attaches the two sides of the pubic bone. The connective tissue is called the symphysis pubis,” says Heba Shaheed, a physical therapist specifying in women’s and pelvic fitness who founded The Pelvic Expert in Sydney, Australia. In other words, the symphysis pubis is a cartilaginous joint located between the right and left sides of the pubic bone.

The hormone relaxin increases during pregnancy to increase your body’s range of motion during delivery. This hormonal change causes the ligaments around the pubic symphysis to become elastic, soft and relaxed. In turn, the symphysis pubis can become unstable and cause pain in some women. “People often feel that two sides of the pubic bone are sliding up and down against each other,” Shaheed explains. “It can be incapacitating if you don’t address the problem right away.”

She is aware that in its most severe form, SPD can cause a real separation of the pubic bone. Pelvic and hip pain can be tremendously painful in this situation. But the doctor says that parting of the pubic bone is rare, happening in less than 1 per cent of pregnancies.

Side effects and complications of symphysis pubis dysfunction

Pelvic pain and instability can affect other parts of the body as well. For example, pelvic pain can change the way a person walks and moves, which, in turn, could put stress on different parts of the body, such as the hips or back.

Research indicates that pelvic girdle pain is simple in about 20% of cases. Severe pain can delay mobility and normal daily activities. Walking can be painful and unsteady.

Emotional problems can also develop as a result of pain related to SPD. In one study, women reported feeling irritable, guilty, upset, and unfulfilled due to SPD. When pain touches mobility, it can also lead to social isolation and there is a risk of pain medicine abuse.

Treatment and remedies for symphysis pubis dysfunction

Both medical treatment and home remedies can help treat symphysis pubis dysfunction (SPD). The harshness of the pain will determine the treatment options. During pregnancy, not all treatments are suitable. For example, medication may not be advisable.

Treatment may include the following:

  • Soft tissue therapy: Soft tissue therapy generally includes chiropractic care, which may involve spinal manipulation and massage to improve the stability and position of the pelvic joint.
  • Wearing a pregnancy support belt: A pregnancy belt supports the pelvic bones and helps maintain proper alignment. The belt can relieve pain in the short term. A study involving 46 pregnant women with pelvic girdle pain found that wearing a pregnancy support belt successfully reduced pain, but only when the women used it regularly for short periods.
  • Extension: Since SPD affects everyone differently, stretches that work for one person may not work for another. It’s best to check with a doctor which stretches are safe, especially during pregnancy.

An example of a stretch that can relieve pain is the pelvic tilt. People can achieve this exercise by following these steps:

  • Lie on your backbone with your knees bent and your feet flat on the floor.
  • Pull your stomach muscles inward and squeeze your gluteal muscles to flatten your back and tilt your pelvis.
  • Hold the place for 5 to 10 seconds and then relax.
  • If this movement alleviates the discomfort, a person can do 10 to 20 repetitions.

Remedies of symphysis pubis dysfunction

These home remedies can also reduce SPD-related discomfort:

  • Insertion a pillow between your legs when sleeping
  • Avoiding sitting for a long time
  • Smear an ice pack to the pelvic area
  • Staying active but avoiding any activity that causes you pain
  • Incorporating breaks every day
  • Wearing supportive shoes
  • Keep your knees organized when getting in and out of the car
  • Perform Kegel exercises to reinforce your pelvic floor muscles.
  • Analgesic

Over-the-counter and prescription pain relievers can also help relieve the symptoms of SPD. However, not all pain relievers are safe during pregnancy. A healthcare professional can offer advice on the appropriate options.

Diagnosis of symphysis pubis dysfunction

Potential symptoms from the differential diagnosis of SPD should be firmly excepted thorough medical history, physical inspection, and appropriate investigations, to ensure the diagnosis of pubic symphysis dysfunction.

Symptoms that can lead to the diagnosis of SPD are nerve compression (injury to the intervertebral disc), symptomatic low back pain (lumbago and sciatica), pubic osteolysis, osteitis pubis, bone infection (osteomyelitis, tuberculosis, syphilis), urinary tract infection., rotund ligament pain, femoral vein thrombosis, and obstetric complications.

Diagnostic procedures of symphysis pubis dysfunction

As with all dysfunctions, an early diagnosis is important to minimize the possibility of a long-term problem. However, not all doctors recognize this problem.

Leadbetter et al. described, in accordance with their findings, a scoring system for diagnosing symphysis pubis dysfunction based on pain during four activities and a previous injury, which could be important in determining symphysis pubis dysfunction.

  1. Pain in the pubic bone when walking
  2. Standing on one leg
  3. Climb stairs
  4. Roll over in bed
  5. Previous damage to the lumbosacral spine or pelvis

Often the diagnosis is made symptomatically, eg. Eg after pregnancy, but imaging is the only way to confirm diastasis of the symphysis pubis. Radiography, such as an MRI (magnetic resonance imaging), X-ray, computed tomography (CT) scan, or ultrasound [1, level 1A], has been used to confirm separation of the symphysis pubis. Although it is not considered as the method of choice due to the danger of exposing the fetus to ionizing radiation. A better technique with superior spatial resolution and avoiding ionizing radiation is magnetic resonance imaging.

Other techniques that can aid in the diagnosis and follow-up of the treatment of pelvic symphysis dysfunction are transvaginal or transperineal ultrasound, which uses high-resolution transducers.  Ultrasound is a useful diagnostic aid that can measure interpubic distance. This may be a consequence of the diastasis of the pubic symphysis after delivery. Interpubic distance is usually measured with electronic callipers. It is also important to know that ultrasound provides a simple means of measuring the interpubic gap, without exposure to ionizing radiation.

Prevention of SPD

It is very little you can do to avoid getting SPD during pregnancy. However, it is more common if you have had a preceding pelvic injury, so it is always important to take all possible steps to protect this vital part of your body.

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Tests

Nerve Conduction Study (NCS) – an Overview | Orthopaedics

What is a nerve conduction velocity test (NCV) or nerve conduction study (NCS)?

A nerve conduction velocity test (NCV) – also called a nerve conduction study (NCS) – measures how quickly electrical impulses move through a nerve. NCV can determine nerve damage.

During the nerve conduction study test, your nerves are stimulated, and electrode patches are usually attached to your skin. Two electrodes are located on the skin over the nerve. One of the electrodes stimulates the nerve with a very light electrical pulse. Scored by the other pole. The resulting electrical activity is registered by another electrode. This is repeated for each nerve that is tested.

The velocity is then calculated by measuring the distance between the electrodes and the time taken for the electrical impulses to travel between the electrodes.

One of the related tests that may be performed is electromyography (EMG). This measures the electrical activity in your muscles. It is often performed at the same time as a nerve conduction study (NCV). Both tests help find the presence, location, and extent of diseases that damage nerves and muscles.

Do I need EMG or NCS?

It’s normal to feel pain or numbness in the muscle from time to time. Your wrist muscle might strain while lifting something heavy, for example.

However, for many people, wrist inflammation is caused by an injury to the nerve, not the affected muscle. When it is not clear why you have problems with your wrist, back, legs, or any other part of your body, one or both of these tests may be helpful.

Tests may be done for people who show the following symptoms that don’t go away:

  • Pain or cramping
  • Tingling or numbness
  • Muscle weakness

Who gets a nerve conduction study test?

The NCV test can be used to diagnose a number of muscular and neuromuscular disorders, including:

  • Guillain-Barré syndrome
  • Carpal tunnel syndrome
  • Charcot-Marie-Tooth disease (CMT)
  • Hard drive disease
  • Chronic inflammatory neuropathy and neuropathy
  • Sciatic nerve problems
  • Peripheral nerve injury

If your doctor suspects you have a pinched nerve, he or she may recommend an NCV test.

An EMG test is often done alongside the NCV test. An electromyogram test records the electrical signals moving through your muscles. This helps reveal the presence, location, and extent of any disease that may damage nerves and muscles.

Will I need to do anything to prepare for these nerve conduction study tests?

  • Tell your healthcare provider if you have a pacemaker or cardiac defibrillator. Special steps should be taken before testing if you have one of these devices.
  • Wear loose, comfortable clothing that allows easy access to the test area or can easily be taken off if you need to wear a hospital gown.
  • Make sure your skin is clean. Do not use lotions, creams, or perfumes for a day or two before the test.

What happens during a nerve conduction study?

  • You will sit or lie on a table or bed.
  • Your provider will attach one or more electrodes to a specific nerve or nerves using duct tape or paste. The electrodes, called stimulation electrodes, deliver a mild electrical impulse.
  • Your provider will connect different types of electrodes to the muscles or muscles that control those nerves. These electrodes will record the responses to electrical stimulation from the nerve.
  • Your provider will send a small electrical pulse through the stimulating electrodes to stimulate the nerve to send a signal to the muscles.
  • This may cause a slight tingling sensation.
  • Your provider will record the time it takes your muscles to respond to the nerve signal.
  • The speed of response is called the conduction velocity.

What happens after a nerve conduction study (NSC)/EMG?

After the nerve conduction study test, you will be permitted to wear your clothes and shoes. It should be noted that the final interpretation of the clinical meaning of the text rests with the physician who ordered the test. This is because they can compile the entire image.

For this reason, the neurologist who performs the test can only give you limited information about what the results mean, and may not even be able to provide any information about the next step or any potential treatments because they are unaware of all the other clinical information.

Side effects of an NCS/EMG

Rarely, there are any side effects from the NCS procedure. Although some discomfort (for some palpable ones) is felt during the test, there are often no complications afterwards. The doctor may avoid stimulation near the stump if you have a pacemaker or similar device.

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Tests

What Is Muscle Testing? | Orthopaedics

Overview of muscle testing

Muscle testing is also known as applied kinesiology (AK) or manual muscle testing (MMT). It is an alternative medicine practice that claims to effectively diagnose structural, muscular, chemical, and mental ailments.

The basic idea behind AK is similar to Sir Isaac Newton’s Law of Motion, which states that “every action in nature has an equal and opposite reaction.”

It takes this concept and applies it to the human body. This means that any internal problems you face are associated with muscle weakness.

By following this thought process, you will be able to do a muscle test to confirm any underlying medical conditions. Muscle testing performed in applied kinesiology is different from standard orthopedic muscle testing.

Here’s an example: You have had a muscle test and your muscle mass is considered “weak.” A person doing a muscle test with the standard approach to Medicine may suggest that you exercise more muscle mass in the gym.

Is muscle testing legal?

According to several studies, including the 2001 study on kinesiology muscle testing, some standard orthopaedic or chiropractic muscle tests may be helpful for specific muscle-related weaknesses, while muscle testing is not effective in diagnosing medical conditions (such as organic disease or disease mental).

A brief history of applied kinesiology

Applied kinesiology began with George Goodheart Jr. in 1964 as a system of muscle testing and therapy.

Several years later, in a study conducted by Ray Hyman, a group of chiropractors wanted to demonstrate that they were able to tell the difference between subjects given good sugar (fructose) and bad sugar (glucose).

A drop of sugar water was placed on a test subject’s tongue. They then measured the strength of each test subject’s arms. The chiropractors anticipated being able to identify which subject had been given the bad sugar based on their muscles being weaker. However, multiple failed attempts later, they ended the test.

More recently, these concepts have been debunked and described as “not conforming to the scientific fact” regarding medical conditions and their causes or treatments.

Who practices applied kinesiology?

In a 1998 survey conducted by the National Board of Chiropractic Examiners (NBCE), 43% of chiropractic offices in the United States used applied kinesiology. Although the majority of the practitioners in the survey are chiropractors, the professions also include nutritionists, naturopathic physicians, and massage and physical therapists.

Currently, the Nambudripad Allergy Elimination Technique (NAET) suggests the use of applied kinesiology in the treatment of allergies and other sensitivities.

However, the results of a 2001 study that used muscle testing such as a wasp venom allergy test did not help much in allergy diagnosis other than a randomized evaluation.

Takeaway

For the most part, the medical community has rejected applied kinesiology as a diagnostic tool. Citing a 2013 study “The field of applied kinesiology is not based on published research, and in experimental studies that conform to accepted scientific standards, applied kinesiology is not a useful or reliable diagnostic tool based on decisions of Health.”

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Tests

Everything You Need To Know About Flexibility Tests | Orthopaedics

Definition

Flexibility tests assess the ability of muscles and joints to move easily through their full range of motion.

Purpose of flexibility tests

Joint conditions such as arthritis, tight muscles, or other problems with the muscles and connective tissue around the joints limit flexibility. Flexibility tests are used to diagnose conditions such as muscle imbalance, arthritis in the joint, or a shoulder sprain or obstruction. They are also used to identify tight muscle groups that can lead to injury during daily activities or exercise.

Flexibility tests that assess a range of motion in joints are often included in routine physical exams to assess limitations in daily activities such as walking, reaching, or lifting objects. For example, walking with bent knees due to the inability to fully extend the knee space puts pressure on the hips and back. The compression of the hamstrings (muscles behind the thigh) limits pelvic tilt. It can alter the lumbar or lower spine. Flexibility tests indicate the need for specific exercises to test flexibility.

Sit-and-reach tests

The sit-and-stretch test is the most common flexibility test. First described in 1952, it is often used as a general flexibility measure. The sit-and-stretch test assesses the flexibility of the hamstrings, hips, and lower back by measuring the ability to move forward from a seated position – the longer, the less pelvic movement is restricted. Stress in the hamstrings and lower back is often associated with low back pain, risk of injury, and other complications.

There are many variations on the sit-and-stretch test, sometimes called the V-sit test. The basic test consists of sitting on the floor, without shoes, with the legs fully extended and the feet of 2 inches (5 cm) and 12 inches (30 cm) with the arms extended, palms down, one hand on top of the other. Bend over, extending from your lower back to your spine, slowly advance as far as possible while inhaling and stretch for two seconds. The distance reached by fingerprints on the fourth or best of three or four attempts should rest for several seconds between each attempt.

There are several variations for sitting and stretching:

  • The partner can hold the knees to keep the legs extended.
  • The feet can be placed on a box, step, or another flat surface.
  • The subject can sit against the wall.
  • The back-saving version tests the legs separately, one stretched out and the other flat with the foot on the floor.
  • Older people can sit 17 inches (43 cm) high on the edge of a chair. With one foot flat on the ground, the other leg is extended straight at the knee, heel, and ankle on the ground.
  • The lift and tendon flexibility test uses a goniometer and eliminates the effects of arm, leg, and trunk length.

There are several ways to measure range, including:

  • Specially constructed sit-and-stretch box.
  • Ruler on the ground or foot.
  • The position of the crotch and heel is marked with “zero” near the patio between the legs.
  • A tape on the ground to reach a great distance from the wall.
  • The “zero” person adjusts, replacing different lengths of arms and legs, depending on their upright sitting position.

Upper body tests

Flexibility in the chest, shoulders, and muscles is very important for good posture. A test is performed by holding the ends of the wrapped towel and standing with the feet at the hips. Using the towel, lift your arms, and then roll your body slightly back until your chest, shoulders, and buttocks are comfortably stretched. Repeat the test closely with your hands on the towel.

External rotation of the shoulder is important for activities ranging from dressing to racquet sports. The knees are bent, with the feet resting on the back on a flat surface, with one arm at shoulder height and the elbow bent with the upper hand on the floor. The arm and forearm should return to the side of the head as much as possible.

The back-scratch, shoulder stretch, or shoulder flexibility test assesses the internal or internal rotation of the shoulder. One arm is raised above the head and bent at the elbow, reaching as far back as possible. The other hand reaches around the waist and tries to touch the fingers of the upper hand. The distance between the fingers is measured.

Flexibility tests precautions

Flexibility tests should not be painful and stretching should never be taken for granted. It is important to perform flexibility tests smoothly, without bouncing or jerking. Rapid movements can cause injury.

The flexibility of body proportion affects the test results. For example, people with long arms and/or short legs perform better sitting and stretching tests than those with short arms and/or long legs. Rounding the back during the sit-and-stretch test negates the results.

There are specific precautions for various flexibility tests:

  • Sit-and-stretch tests increase low back pain and should not be performed by anyone with osteoporosis or a recent total hip replacement.
  • Trunk rotation tests should not be exacerbated by distortion of someone with osteoporosis or back pain.
  • Anyone with a complete hip replacement should not have a hip flexion test.
  • People with foot or ankle problems should be examined by a physical therapist before performing the calf flexibility test.

Aftercare

In many cases, flexibility tests are similar to exercises that improve flexibility. Flexibility exercises should be done at least three times a week. Retests should be done every two to three months, but only once a week. Dynamic warm-up stretches can be added to a flexibility exercise routine. These include double hip rotations, shoulder stretches, neck rotations, and ligament stretches. Rules like yoga and Pilates always include exercises that improve flexibility.

Results

Online maps and calculators are available to perform flexibility tests and compare results for the same age and gender. However, due to the many variations in test protocols and individual and developmental differences in arm, leg, and trunk lengths, it is generally advisable to record test results and compare them over time to assess progress. individual.

Depending on how the measurements are taken, the average results on a sit-and-stretch test at home can range from 0 to 2 inches (5 cm) for men and 0.5 to 4 inches (1 to 10 cm) for women. The highest results can be above 10.5 inches (27 cm) for men and 11.5 inches (29 cm) for women. Very Poor Results for Men -8.0 in. (-20 cm) less and -6 in for women. It can be less than (-15 cm).

Other typical results of flexibility tests include:

  • Trunk rotation: excellent (8 inches or 20 cm), Poor (0 inches) (fingers touching the line)
  • Groove test: excellent (2 inches or 5 cm) Poor (10 inches or 25 cm).
  • Normal calf flexibility: pulling the leg past the ankle joint or bending the ankle more than 90 than the body.
  • Normal shoulder height: armrests above the head in full contact with the ground.
  • Normal Shoulder External Rotation – Rest your entire arm on the floor at shoulder level with your elbow bent.
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Tests

Dual-Energy X-ray Absorptiometry (DEXA, DXA) | Orthopaedics

What is a bone density scan (DEXA, DXA)?

Bone density test, also called dual-energy X-ray absorptiometry (DXA) or bone density measurement, is an improved form of X-ray technology used to measure bone loss. Dual-energy X-ray absorptiometry (DXA) is the standard in force today for measuring bone mineral density (BMD).

X-ray (radiography) is a non-invasive medical test that helps doctors diagnose and treat medical conditions. X-ray imaging involves exposing a part of the body to a small dose of ionizing radiation to produce images inside the body. X-rays are the oldest and most widely used form of medical imaging.

Dual-energy X-ray absorptiometry (DXA) is nearly often performed on the lower spine and hips. In children and some adults, the whole body is sometimes examined. Peripheral devices that use X-rays or ultrasound are sometimes used to detect a low bone mass, mostly in the forearm. In some societies, CT may also be used with special software to diagnose or monitor low bone mass (QCT). This is accurate but is less frequently used than the DXA scan.

How the dual-energy x-ray absorptiometry is performed?

A bone density test can be done in several ways. The most common and accurate method uses dual-energy X-ray absorptiometry (DEXA) scanning. DEXA uses a low-dose X-ray. (She receives more radiation from a chest X-ray.)

There are two types of Dual-energy X-ray absorptiometry (DEXA) assays:

  • Central DEXA: You lie on a soft table. The scanner passes over the lower part of the spine and the hip. In most cases, you do not need to take off your clothes. This scan is the best test for predicting the risk of developing a fracture, especially of the hip.
  • Peripheral DEXA (p-DEXA): These smaller devices measure the density of the bone in your wrist, fingers, leg, or heel. These machines are found in health care offices, pharmacies, malls, and health fairs.

How to prepare for the dual-energy x-ray absorptiometry?

  • If you are or could be pregnant, tell your provider before having this test. Do not take calcium supplements for 24 hours before the test.
  • You will be required to remove all metal items from your body, such as jewellery and buckles.

Who interprets the results and how will I get them?

A radiologist, a physician specially trained to supervise and interpret radiology examinations, analyzes the images and sends a signed report to your primary care or referring physician, who will discuss the results with you.

Dual-energy X-ray absorptiometry (DXA) scans are also interpreted by other doctors such as rheumatologists and endocrinologists. A physician should review your DXA scan while evaluating the presence of clinical risk factors such as:

  • Rheumatoid arthritis
  • Chronic renal and liver disease
  • Respiratory disease
  • Inflammatory bowel disease

Your test results will be in two degrees:

  • T score: This number shows the amount of bone that I compared a young adult of the same sex with a peak bone mass. A grade of -1 and above is considered normal. A score between -1.1 and -2.4 is classified as osteopenia (low bone mass). A score of -2.5 and below is known as osteoporosis. The T score is used to estimate your risk of a fracture and also to determine whether treatment is required.
  • Z score: This number reflects the amount of bone that you compared with other people of your age group and the same size and sex. If this score is unusually high or low, it may indicate the need for further medical tests.

Small changes are usually noticed between scans due to differences in positioning and are usually insignificant.

Risks of dual-energy X-ray absorptiometry

Bone mineral density uses a small amount of radiation. Most experts feel the risk is very low compared to the benefits of detecting osteoporosis before a bone is broken.

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Tests

Doppler Ultrasound – What is it Used For? | Orthopaedics

What is a doppler ultrasound?

A Doppler ultrasound is a test that utilizes high-recurrence sound waves to gauge the measure of blood coursing through corridors and veins, as a rule, the ones that flexibly blood to your arms and legs.

Vascular flow studies, also known as blood flow studies, can detect abnormal flow within an artery or blood vessels. This can help diagnose and treat a variety of conditions, including blood clots and poor circulation. Doppler ultrasound may be used as part of a blood flow study.

Doppler ultrasound is a risk-free, pain-free procedure that requires little preparation. The Doppler ultrasound test provides your doctor with important information about blood flow through major arteries and veins. It can also reveal blockages or reduced blood flow through narrowed areas in the arteries, which may eventually lead to a stroke.

Why does a person need a doppler ultrasound?

A doctor may order a Doppler ultrasound if the person shows signs of decreased blood flow to the arms, neck, or legs.

The following, for example, can reduce blood flow:

  • Blood clots in the veins
  • Arteries are blocked or narrowed
  • Vascular injuries

A health care provider usually recommends a Doppler ultrasound if a person shows signs or symptoms of certain conditions, such as peripheral arterial disease. This occurs when fatty deposits collect in the arteries, restricting blood flow.

It can cause peripheral arterial disease:

  • Cold feet or lower legs
  • Weakness or numbness in the legs
  • Painful cramps in the muscles of the legs or hips while walking or climbing stairs
  • Changes in skin colour
  • The shiny complexion on the legs

In other cases, a doctor may order a Doppler ultrasound if a person has symptoms of heart disease, such as:

  • Fatigue
  • Shortness of breath
  • Swelling in the feet, legs, or abdomen

In general, a doctor tends to order this type of ultrasound in a person:

  • It may have damaged blood vessels
  • He is currently receiving treatment for his blood flow disorder
  • Have recently had a stroke, in which case they will check blood flow in the brain, called a transcranial Doppler procedure

Also, if the fetus is smaller than expected, a Doppler ultrasound can look for any abnormalities in blood flow.

Will I need to do anything to prepare for the doppler ultrasound test?

To prepare for a Doppler ultrasound, you may need this:

  • Remove clothing and jewellery from the area of the body being tested.
  • Avoid cigarettes and other products containing nicotine for up to two hours before the test. Nicotine causes blood vessels to narrow, which may affect your results.
  • For certain types of Doppler tests, you may be required to fast (do not eat or drink) for several hours before the test.
  • Your healthcare provider will tell you if you need to do anything to prepare for the test.

What happens during a Doppler ultrasound?

  • You will be asked to lie on a table, usually on your side or on your back. You will be covered with a blanket, except for the part of your body that is being scanned.
  • The ultrasound staff will apply a gel to your skin on the part of your body being examined so that there is good contact between the probe and your body. They will then place the handheld scanner over the gel, moving it around the area being scanned. Sometimes they’ll need pressure, which can be uncomfortable, but that shouldn’t hurt.
  • You will need to lie still while the staff can. You may hear the sound of blood flowing through the blood vessels.
  • When the ultrasound is finished, the staff will give you something to clean off the gel and ask you to wait for them to check the pictures.
  • A Doppler ultrasound usually takes about 30-60 minutes including the time taken to prepare. Some scans may take longer.

Normal results

A normal result means that the blood vessels are not showing signs of narrowing, clots, or blockages and that the arteries have a normal blood flow.

What abnormal results of doppler ultrasound mean?

Abnormal results may be due to:

  • A blockage in an artery due to a blood clot
  • A blood clot in a vein (DVT)
  • Artery narrowing or widening
  • Spastic arterial disease (contractions of the arteries caused by cold or excitement)
  • Venous embolism (closing a vein)
  • Venous reflux (blood flowing in the wrong direction in the veins)
  • Arterial blockage from atherosclerosis

This test may also be done to help evaluate the following conditions:

  • Arteriosclerosis in the extremities
  • Deep venous thrombosis
  • Superficial thrombophlebitis
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Tests

Uses of Magnetic Resonance Imaging (MRI) | Orthopaedics

What is magnetic resonance imaging (MRI)?

Magnetic resonance imaging (MRI) is a medical imaging technology that uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in your body. Most magnetic resonance imaging machines are large tube-shaped magnets.

When you lie inside the magnetic resonance imaging machine, the magnetic field temporarily realigns the water molecules in your body. The radio waves cause these aligned atoms to produce faint signals, which are used to create cross-sectional MRI images – like slices in a loaf of bread.

The magnetic resonance imaging machine can likewise deliver 3D pictures that can be seen from various edges.

How does magnetic resonance imaging work?

Magnetic resonance imaging machines use powerful magnets that produce a strong magnetic field that forces the protons in the body to conform to that field. When the radiofrequency current pulses through the patient, the protons are stimulated, spin out of equilibrium, tensing against the magnetic field pull.

When the radiofrequency field is turned off, the magnetic resonance imaging sensors are able to detect the energy released during the rearrangement of the protons with the magnetic field. The time it takes for protons to realign the magnetic field, as well as the amount of energy released, varies depending on the environment and the chemical nature of the molecules. Doctors can tell the difference between different types of tissue based on these magnetic properties.

To obtain an MRI image, the patient is placed inside a large magnet and it must remain still during the imaging process so that the image is not blurred. Contrast agents (which often contain gadolinium) may be given to the patient intravenously before or during the MRI to increase the speed of the realignment of protons with the magnetic field. The faster the protons are realigned, the brighter the image. 

Uses of magnetic resonance imaging

A magnetic resonance imaging scan can be used as a very accurate way to detect disease throughout the body and is often used after other tests have failed to provide enough information to confirm a patient’s diagnosis. In the head, trauma to the brain can be seen as a hemorrhage or swelling. Other abnormalities that are often found include brain aneurysms, stroke, and brain tumors, in addition to tumors or inflammation of the spine.

Neurosurgeons use a magnetic resonance imaging scan not only to define the anatomy of the brain but also to evaluate the integrity of the spinal cord after trauma. It is also used when thinking about the problems associated with the vertebrae or intervertebral discs in the spine. An MRI scan can evaluate the structure of the heart and aorta, as it can detect an aneurysm or a tear. Magnetic resonance imaging scans are not the first line of imaging testing for these problems or in cases of trauma.

It provides valuable information on glands and organs inside the abdomen, and accurate information on the joint structure, soft tissues, and bones of the body. Oftentimes, surgery can be delayed or directed with more precision after the results of the magnetic resonance imaging scan are known.

Risks factors of MRI

Because an MRI uses strong magnets, the presence of metal in your body can pose a safety risk if you are attracted to the magnet. Even if you are not attracted to the magnet, metallic objects can distort the MRI image. Before having magnetic resonance imaging, you’ll probably finish a survey that incorporates whether you have metal or electronic gadgets in your body.

Unless your device is certified as safe for magnetic resonance imaging, you may not be able to get an MRI scan. Hardware included:

  • Metallic joint prostheses
  • Implanted nerve stimulators
  • An implantable heart defibrillator
  • A bullet, shrapnel, or any other type of metal fragment
  • Cochlear implants
  • Intrauterine device
  • Implanted drug infusion pumps
  • A pacemaker
  • Artificial heart valves
  • Metal clips
  • Metal pins, screws, plates, stents, or surgical staples

If you have permanent tattoos or makeup, ask your doctor if they will affect the MRI. Some darker inks contain a mineral.

Before scheduling a magnetic resonance imaging scan, tell your doctor if you think you could be pregnant. The effects of magnetic fields on fetuses are not well understood. Your doctor may recommend an alternative test or delay the magnetic resonance imaging. Also tell your doctor if you are breast-feeding a baby, especially if you will be receiving a contrast material during the procedure.

It is also important to discuss kidney or liver problems with your doctor and technologist, as problems in these organs may limit the use of the contrast agents injected during the examination.

Preparation for an MRI

When you make your magnetic resonance imaging appointment, you’ll get detailed instructions on how to prepare.

Food: You may need to avoid eating for two hours or more before the magnetic resonance imaging.

Topics for discussion. Tell your doctor about any medications you are taking. Also mention if you have any allergies to any medication or any other medical condition. Women should tell their doctors if there is any possibility of pregnancy.

It is important to mention any metal implants or metal fragments in your body. They can cause serious, even fatal, problems when exposed to the magnetic traction of magnetic resonance imaging. For example, people who use pacemakers cannot have an MRI.

Consider asking if you can bring music to the appointment. Some centers allow people to listen to music through headphones during an MRI scan. It may help to distract you from the loud noises made by the magnetic resonance imaging machine.

Insurance, costs, and approval. Before your appointment, ask your health insurance provider what costs will be covered. Discover the amount you should pay. Once you get to the doctor’s office or hospital, you will be asked to sign a consent form. This form demonstrates that you understand the benefits and risks of the procedure and that you agree to it.

During the test

What should I wear?

Before the test, you will remove the jewelry and other metal items. You may also need to wear a hospital gown.

What will happen during the operation?

  • Depending on the part of your body to be scanned, you may be given a contrast medium. This is a special dye. It is given intravenously (IV) or orally.
  • If the dye is given through a vein, the nurse or doctor will insert a small needle into a vein in your arm or hand. The saline solution will flow through the line until the dye is injected. Brine is a mixture of salt and water. Once infused, the color will go through the circulation system and help make a more clear image of explicit pieces of your body.
  • Next, you’ll lie on a moveable examination table outside of the MRI machine. You will lie on your back with your arms at your side, with your head on a headrest.
  • Small devices, called coils, help transmit and receive radio waves. These may be placed over or around a part of your body to create a clearer image.
  • When you are ready, the examination table will slide through the hole in the center of the magnetic resonance imaging machine. You will need to lie down while the device takes a series of photos. Each series will last up to 15 minutes. You may need to get 2 to 6 sets. This means the MRI usually lasts for up to 90 minutes. The technician can give you an estimate of time before you begin.
  • During the examination, the technologist will be in an adjacent computer room, separated by a window. The technologist will be able to see you. You will be able to speak with the technician through the intercom system.
  • You will know when the device is taking pictures because you will hear loud banging sounds. Also, the part of your body being examined may feel warm during the MRI. This is normal.
  • Magnetic resonance imaging is not painful. But you may feel uncomfortable when lying. If you received an IV, you may feel discomfort when the needle is inserted. Intravenous saline may feel cold at the injection site.
  • Meanwhile, some people find the loud device sounds annoying. You can reduce this discomfort by wearing earplugs or listening to music.
  • If you are afraid of small spaces, tell the technician before starting the examination. A radiologist may be able to give you medication to help you relax. This drug is called a sedative.
  • Once the MRI is complete, you may be asked to remain on the examination table while a radiologist reviews the images to see if more is needed.

After an MRI scan

After the examination, the radiologist will examine the images to check if more is needed. In the event that the radiologist is fulfilled, the patient can return home.

The radiologist prepares a report for the requesting physician. Patients are generally approached to make a meeting with their primary care physician to examine the outcomes.

Results

A doctor specially trained to interpret magnetic resonance imaging (radiologist) will analyze the images taken from the scan and report the results to your doctor. Your doctor will discuss the important results and the next steps with you.

Categories
Tests

Why would a doctor order a bone scan? | Orthopaedics

What is a bone scan?

A bone scan is an imaging test used to help diagnose problems with your bones. Safely use a very small amount of a radioactive drug called a radiopharmaceutical. It has also been referred to as “dye,” but it does not stain tissues.

Specifically, a bone scan is performed to screen for problems with bone metabolism. Bone metabolism refers to the process in which bone breaks down and rebuilds itself. New bone is part of the healing process when the bone is injured or broken. A bone scan is a good way to view and document abnormal metabolic activity in the bones.

A bone scan may also be used to determine whether cancer has spread to the bones from another area of the body, such as the prostate or breast. During a bone scan, a radioactive substance is injected into a vein that your bone takes. You will then be monitored for several hours. A very small amount of radiation is used in the material, and almost all of it is released from your body within two or three days.

Why a bone scan is done?

If you have unexplained bone pain, a bone scan may help determine the cause. The test is very sensitive to any difference in bone metabolism. The ability to scan the entire skeleton makes the bone scan very helpful in diagnosing a wide range of bone disorders, including:

  • Fractures
  • Arthritis
  • Paget’s disease of bone
  • Cancer that originates in the bones
  • Cancer that has spread to the bone from a different site
  • Arthritis or joint or bone replacement (osteomyelitis).
  • Impaired blood flow to the bone or death of bone tissue (avascular necrosis)

Risks of bone scan

Although the test relies on radiotracers to produce images, these reagents produce very little radiation exposure – less than a CT scan.

Getting ready for a bone scan

When you schedule an orthopaedic scan, the hospital or imaging centre staff will tell you how to prepare. Usually, you don’t need a lot of special preparations before a bone scan, but it is important to confirm this from the location where the test will be performed. If there is anything unclear in the instructions, speak with your health care team. Here are some things to expect:

  • What are you going to eat?: You can usually eat and drink normally before your appointment.
  • Your usual medications: Tell your health care team about all the medicines you take, including over-the-counter (OTC) medicines and supplements. Medicines containing barium or bismuth can affect test results. Your doctor may ask you not to take it before the test.
  • Personal medical history: Inform the staff if you have any allergies to any medication or medical condition. Women should tell their health care team if they are breastfeeding or may be pregnant.
  • What to wear: Before the test, you will need to remove metallic objects, such as jewellery. You may also need to wear a hospital gown.
  • Insurance, costs, and approval: If you are concerned about bone scan costs, contact your insurance provider before the scan. Ask if the test is covered and what, if any, you will pay. The hospital or centre staff will ask you to sign a consent form upon your arrival for the examination. This form demonstrates that you understand the risks and benefits of the test. The form also states that you agree to take the test. If you have concerns, talk to your doctor before signing up.

What happens during a bone scan?

The bone scan can be done on an outpatient basis or as part of your hospital stay. Procedures may vary depending on your condition and your doctor’s practices.

Generally, a bone scan follows this process:

  • You may be asked to remove any clothing, jewellery, or other items that may interfere with the procedure.
  • If you are asked to undress, you will be given a dress to wear.
  • An intravenous (IV) line will be started in the hand or arm to inject the reagent.
  • The reagent will be injected into a vein. The tracer will be allowed to focus on the bone tissue for one to three hours. You may be permitted to walk around or even leave the facility during this time. You will not be dangerous to other people, as the tracking device emits less radiation than a standard x-ray.
  • During the waiting period, you will need to drink several cups of water (four to six cups) to help flush out any tracer that is not concentrated in the bone tissue.
  • If a bone scan is performed to detect bone infection, a set of scans can be performed immediately after the injection of the tracer. Another set of scans will be done after the tracer is allowed to focus on the bone tissue.
  • When the tracer is allowed to concentrate in the bone tissue for an appropriate period of time, you will be asked to empty your bladder before the scan begins. A full bladder can deform the bones of the pelvis and may become uncomfortable during the examination, which may take up to an hour to complete.
  • You will be asked to lie flat on the scanning table, as any movement may affect the quality of the scan.
  • The scanner will slowly move over you several times as it detects the gamma rays emitted by the tracking device in the bone tissue.
  • Your position may be changed during the scan to obtain specific views of the bones.
  • When the scan is complete, the fourth streak will be removed.

While the bone scan itself does not cause any pain, having to lie still for the duration of the procedure may cause some discomfort or pain, especially in the case of a recent injury or a surgical procedure such as surgery. The technician will use all possible comfort measures and complete the procedure as quickly as possible to reduce any discomfort or pain.

What should I expect after a bone scan?

Bone scans generally do not cause any after-effects. Through the natural radioactive decay process, a small amount of the radioactive chemical in your body will lose its radioactivity over time. It is also excreted from your body in the urine for about 24 hours. You may be asked to take special precautions after urinating, to flush the toilet twice, and wash your hands well.

It is advised that you drink plenty of water for the day after the scan to help flush radionuclides from your system. If you have been in contact with children or pregnant women, you should let your doctor know. Although the radiation levels used in the scan are small, special precautions may be advised. Your hospital should give you more advice about this.

Categories
Disease

Congenital Hand Deformities – an Overview | Orthopaedics

What are congenital hand deformities?

Congenital differences in hands affect both the shape and function of the baby’s hand and arm. They occur in 20 out of 10,000 babies born and are more common in boys than girls. Congenital hand deformities can be prevented especially as the child learns to interact with the environment through the use of her hands. The degree of deformity ranges from a minor deformity, such as uneven or irregular fingers or toe deformity, to a severe deformity, such as complete lack of bone.

Early consultation with a hand surgeon is an important part of the treatment process for children born with congenital hand deformities. Although reconstructive surgery is not possible, a wide variety of prosthetic devices can be used to increase performance.

Congenital hand deformities are generally not detected before birth. Occasionally a prenatal ultrasound can see a difference such as extra fingers or missing bones, but this is very rare. Congenital hand deformities are often divided into two categories:

  • Malformations: In which the hand or part of the arm does not develop normally while the baby is in the womb, and
  • Deformations: In which the hand and arm usually begin to develop, but are somehow prevented from doing so.

Defects occur when the baby’s upper extremities first develop 4 to 8 weeks after conception. Disabilities occur after pregnancy.

Types of congenital hand deformities

Pediatric orthopaedic and plastic surgeons diagnose and treat children with all types of hand defects. There are many types. The following are the most common congenital hand deformities.

Extra digits (polydactyly)

Polydactyly is the most common congenital hand deformities. It affects boys and girls equally. A baby born polydactyly has more than five thousand on one side. The extra finger is usually a small piece of soft tissue that can be removed. Sometimes the extra toe contains the bones but not the joints. Very rarely, a series of extra fingers will do. A baby can be born with many extra fingers. There are several types of polydactyly:

  • Preaxial polydactyly: Contains an extra finger. It is more common in Caucasians. The pediatric surgeon can repair tendons by removing excess bone and skin.
  • Postaxial Polydactyly: Has extra fingers on the opposite side (“little finger” side). It is more common in African Americans. These can occur as complete and distinct fingers or small stumps. Stumps can be treated by a hand specialist in the office.
  • Central polydactyly: Additional fingers are found between the fingers, but this is less common.

Fused fingers (Syndactyly)

Fused fingers (syndactyly) Example Syndactyly is one of the most common birth defects of the upper extremities, occurring in up to 1 in 2000 live births. This condition occurs when the baby is unable to separate two or more fingers during pregnancy, resulting in “webbed” fingers at birth. It usually consists of the middle and ring fingers.

Syndactyly affects boys twice as much as girls. Family history is frequent and, in these cases, it is usually fingers and toes. Children may need surgery before 18 months to separate the fingers or toes, and additional skin may need to be removed from a specific area of ​​the body, depending on the degree to which the fingers have joined. Situation categories:

  • Finish syntactically: Skin meets affected fingers or toes.
  • Incomplete: Only the fingers or toes are on the way to the tips.
  • Simple syndactyly: The fingers or toes are attached only through the skin and soft tissues.
  • Complex syndactyly: The bones of the fingers intertwine with each other.

Undeveloped hand (Symbrachydactyly)

Babies born with symbrachydactyly have small or missing fingers. They may also have webbed fingers or a small hand or forearm.

  • Mild symbrachydactyly: Mobile fingers slightly smaller than the hand, with small membranes. There are bones in the hand and some bones in the fingers and toes. Moderate symbrachydactyly: Most or all of the finger bones are absent and the baby has small projections of skin and soft tissue. The toe is normal, but it may be smaller.
  • Symbrachydactyly acute: The baby does not have a toe or toes and partial fingers.

Stick hand

  • Club hand: Example Babies with club hands lose part or all of the two long bones that make up the forearm: the radius or the ulna. As a result, the forearm may be lower than normal. The hand is turned inward, limiting the movement of the wrist. A child with this condition may have a hard time doing the things that her hands require. This condition is most often seen on one side of the hand or the other side: the radial side (toe) or the ulnar side (little finger).
  • Radial club hand: Children with a club hand on the radial side (radial dysplasia) often have the forearm and wrist bent at the ball of the foot. After a child is 6 and 12 months old, surgery may be recommended to straighten the forearm and repair tendons. The condition may be related to other medical syndromes such as Fanconi anemia, Holt-Oram syndrome, and Water syndrome.
  • Ulnar equinovarus arm: This condition is less common than the radial equinus varus arm and is not usually associated with other syndromes. It varies from mild to more severe cases with the baby’s wrist and is fixed and bent towards the side of the short finger of the hand. Deformity or absence of the toe.

Cleft arm (ectrodactyly)

Split hand: Sample hand (also known as ectrodactyly or split hand) when the central part of the sample develops abnormally. Children with this condition do not have one or more middle fingers on their hands.

There are generally two types:

  1. Typical cleft hand: V-shaped and the middle fingers are usually missing or partially missing. Usually, both arms are affected and sometimes the feet as well. The family history of this type of arm cleft is frequent.
  2. Divergent wedge arm: It is U-shaped and usually has only one arm. This type of cleft hand is often not inherited. A heterogeneous cleft arm can be a symptom of Poland syndrome.

Small thumbs (hypoplastic)

Little (Hypoplastic) Toe: Example Hypoplastic toe is not fully formed during pregnancy or is completely absent at birth. Treatment depends on how secure or stable the joint that connects the base of the toe to the wrist is. Children with stable joints use their thumbs in regular play. Children with unstable joints tend to ignore the big toe. For stable wrist and toe joints, reconstructive surgery is generally recommended to strengthen the toe and its tendons. For loose or floating unstable joints, the little finger is removed and the index finger is replaced with the big toe.

Stimulate the toe

Sometimes babies are born with an abnormality in the toe tendon, making it difficult to flex. This condition disappears on its own by one year of age. At other times, surgical correction may be recommended before age 3 to release the tendon and allow the toe to function properly.

What causes congenital hand deformities?

Between the fourth and sixth week of pregnancy, the fetus develops arms and hands. Any interruption of this process can cause congenital hand deformities. Many factors affect the development of the human hand. These factors are generally divided into genetic and environmental factors. Genetic factors include changes in the information of the genes that cause the formation of hands and arms. Genes are the basic biological unit of heredity and are passed on to children by their parents. They contain instructions for the growth and function of every cell in the body. In the case of differences in hands, genetic changes usually occur for no apparent reason (abrupt). The changes that occur in families are minimal.

Environmental factors include infections and thalidomide (a drug used to treat nausea) and some drugs used for chemotherapy. These factors cause the deterioration of healthy tissue, alter the development process and cause a difference in the structure of the hand. Some congenital hand deformities can be explained by these factors, while others have no unknown cause. In some cases, the difference of hands is an isolated event. In other cases, the difference is part of a syndrome that affects multiple parts of the body.

What are the benefits of treatment for congenital hand deformities?

Each child with a hand difference is unique and the approach to treatment depends on the individual needs of the child. The main goal and purpose of treatment are to improve the child’s ability to work differently. Another goal is to improve the shape of the hand and support the child’s self-esteem. Options for dealing with congenital hand deformities:

  • Extension
  • Splinting or cast
  • Physical therapy (to help increase strength and performance)
  • Prosthesis (in case parts or bones are missing)

Specific treatment for congenital hand deformities is determined by your paediatrician based on:

  • Your child’s age, general health, and medical history
  • The extent of the situation
  • The cause of the condition

Your child’s tolerance for specific medications, procedures, or treatments.

  • Estimates of the course of the situation
  • Your opinion or preference
  • Treatment may include:
  • Limb manipulation and stretching
  • Rupture of affected organs
  • Tendon transfers
  • External tools (to help identify deformed fingers or hands)
  • Physical therapy (to help increase arm strength and function)
  • Correction of contracts
  • Skin grafts: These include replacing or attaching the skin to a part of the hand that was missing or removed during a procedure.
  • Prosthesis: These can be used when surgery is not an option or in conjunction with surgical correction.

Surgery for congenital hand deformities

The treatment perspective varies depending on the type and complexity of the difference. When congenital hand deformities is an isolated incident, the outlook is generally good. Most children can learn to adjust to their differences. If the difference is part of the syndrome, the outlook depends on the type and extent of the condition.

Note that treatment does not “cure” the congenital hand deformities, but it does help improve the function and appearance of the hand. Accepting a positive attitude and a difference, on the part of children and parents, is important for the success of treatment, as well as for the healthy development of a child.