Orthopedic Diseases

Main Orthopedic Diseases:

• Carpal Tunnel Syndrome
• Fractures
• Anterior Cruciate Ligament Injuries
• Meniscus Tears
• Medial Collateral Ligament Injuries
• Avascular Necrosis
• Hip and Knee Prosthesis Surgeries
• Frozen Shoulder - Impingement Syndrome
• Medial and Lateral Epicondylitis
• Muscle Tears
• Thoracic Outlet Syndrome (TOS)
• Heel Spur

CARPAL TUNNEL SYNDROME

What is Carpal Tunnel Syndrome?

The carpal tunnel is a canal in the wrist formed by bones and fibrous tissue. The floor consists of the carpal bones' concave anatomical structure (hamate, scaphoid, trapezium, pisiform), while the roof is formed by the retinaculum flexorum ligament.

The carpal tunnel contains the wrist's flexor muscles and the median nerve, which has both sensory and motor functions. The sensory function of the median nerve covers the palmar sides of the 1st, 2nd, and 3rd fingers and half of the 4th finger. Its motor function involves controlling the muscles responsible for thumb grip.

Carpal tunnel syndrome occurs when the median nerve becomes compressed in the carpal tunnel due to various causes. It is the most common type of nerve compression.

Causes of Carpal Tunnel Syndrome

• Thickening of the volar carpal ligament and tendon sheaths
• Material accumulation in the tunnel
• Abnormal anatomical formations
• Increased connective tissue in the nerve
• Joint synovitis
• Trauma history: repetitive movements caused by work or hobbies, frequent gripping of objects
• Systemic diseases: diabetes mellitus, hypothyroidism, acromegaly, rheumatoid arthritis, gout
• Pregnancy: Swelling in the wrist canal during pregnancy can compress the median nerve. Pregnant women are diagnosed via examination; EMG is avoided. Severe pain can be treated with cortisone injections. Surgery is generally unnecessary as the condition resolves after pregnancy.

Symptoms and Findings of Carpal Tunnel Syndrome

• Numbness and pain in the hand, worsening at night (relieved by shaking the hand)
• Tingling sensation in the fingers
• Pain radiating to the arm and shoulder
• Weakness in the hand, grip problems
• Swelling and hand cramps in the morning
• Atrophy of the thenar muscles (muscle wasting at the base of the thumb) in chronic and advanced cases

Diagnosis of Carpal Tunnel Syndrome

Diagnosis is primarily made through history and physical examination. Nerve conduction studies (EMG) confirm the diagnosis and differentiate it from other conditions like cervical disc herniation, arthritis, and thoracic outlet syndrome.

Tests Used in Diagnosis:

• Phalen’s test
• Reverse Phalen’s test
• Flick sign
• Tinel’s sign
• Ischemic test
• Strength loss test
• Carpal compression test
• Sensory examination

Additional tests may include blood tests, ultrasound, X-ray, CT, and MRI.

Treatment of Carpal Tunnel Syndrome

Non-surgical treatment is recommended for mild and short-term cases:

• Rest
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Neutral position splinting (50% improvement in mild to moderate cases)
• Steroid injections (30% recurrence within 15 months)

Surgical treatment is considered for:

• Cases unresponsive to conservative treatment
• Severe sensory loss and thenar muscle atrophy

Prevention Tips for Carpal Tunnel Syndrome:

• Reduce salt intake to minimize fluid retention
• Avoid keeping the wrist in the same position for long periods
• Rest the wrist at regular intervals
• Avoid repetitive movements
• Maintain a healthy weight
• Perform carpal tunnel prevention exercises
• Avoid overuse and excessive strain
• Avoid sleeping on the affected wrist
• Massage, apply cold compresses, and reduce swelling if edema develops

Always consult your doctor and physiotherapist first for appropriate treatment.

MEDIAL EPICONDYLITIS - GOLFER'S ELBOW

What is Medial Epicondylitis?

Medial epicondylitis is a chronic inflammation of the tendons of the wrist flexor and pronator muscles where they attach to the medial epicondyle of the humerus (inner side of the elbow joint).

Affected Muscles:

• Flexor carpi radialis
• Flexor carpi ulnaris
• Palmaris longus
• Pronator teres

Causes of Medial Epicondylitis:

Repetitive use of activities involving wrist flexion and pronation causes micro-traumas in the tendons and attachment areas, leading to inflammation.

Commonly Affected Groups:

• Golfers
• Racket sports players
• Weightlifters
• Archers
• Writers
• Carpenters

Medial epicondylitis is more common in men aged 20-49.

Symptoms of Medial Epicondylitis:

• Pain and redness over the medial epicondyle, radiating to the inner forearm
• Stiffness
• Weak grip strength
• Numbness and tingling in the 4th and 5th fingers
• Swelling and tenderness

Diagnosis of Medial Epicondylitis:

Usually diagnosed through physical examination. X-rays may be used to rule out other complications.

Treatment of Medial Epicondylitis:

Treatment options include:

• Rest and activity modification
• Cold therapy
• NSAIDs
• Stretching and strengthening exercises
• Orthotic devices
• ESWT (shockwave therapy)
• Steroid injections
• Acupuncture, dry needling, and other advanced therapies

If conservative treatments fail, surgery may be considered.

Consult your doctor and physiotherapist for the best treatment approach.

LATERAL EPICONDYLITIS - TENNIS ELBOW

What is Lateral Epicondylitis?

Lateral epicondylitis is chronic inflammation of the wrist extensor muscle tendons at their attachment site on the lateral epicondyle (outer side of the elbow joint).

Affected Muscles:

• Extensor carpi radialis brevis (most commonly affected)
• Extensor carpi radialis longus
• Extensor carpi ulnaris
• Extensor digitorum
• Extensor digiti minimi

Causes of Lateral Epicondylitis:

It is caused by repetitive, forceful wrist extension and forearm rotation (pronation or supination).

Risk Groups:

• Tennis players
• Carpenters
• Keyboard and mouse users
• Heavy lifters
• Housewives

Symptoms of Lateral Epicondylitis:

• Pain and tenderness over the lateral epicondyle
• Pain radiating to the forearm
• Weak grip strength
• Limited daily activities

Treatment of Lateral Epicondylitis:

Treatment includes rest, ice therapy, massage, medication, and physiotherapy techniques. If conservative treatment fails, surgical options are available.

Consult your doctor and physiotherapist for appropriate treatment.

THORACIC OUTLET SYNDROME (TOS)

What is Thoracic Outlet Syndrome?

TOS occurs when the subclavian artery and vein and brachial plexus nerves are compressed in the thoracic outlet area, which is located between the clavicle, the first rib, and certain muscles.

Causes of Thoracic Outlet Syndrome:

• Trauma: fractures, dislocations, or chest injuries
• Congenital factors: cervical ribs, scalene muscle hypertrophy, or abnormal anatomy

Symptoms of Thoracic Outlet Syndrome:

Symptoms depend on which structures are compressed:

• Neurogenic type: Pain, numbness, weakness, and muscle atrophy
• Vascular type: Swelling, color changes, and reduced pulse

Consult a doctor for an accurate diagnosis and effective treatment.