Carpal Tunnel Syndrome and Diabetes, A Challenging Problem

Approximately 20% of diabetic patients will develop carpal tunnel syndrome. Peripheral neuropathy makes the condition of the carpal tunnel worse. It is suggested that the never that already has established hypoxia caused by diabetes is more vulnerable to local compression. Other mechanisms and explanations are also involved, so it is a difficult diagnosis). Some people believe that patients with diabetic neuropathy will have a high prevalence of carpal tunnel syndrome.

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Electrodiagnostic testing (EMG and nerve studies) cannot distinguish patients with clinical carpal tunnel syndrome from patients with diabetic polyneuropathy. The decision to treat these patients should be made independently of the electrodiagnostic findings. When treating the patient, try to figure out the patient’s blood sugar level. There may be difficulty in determining if the blood sugar is under control.

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HBA1C (the glycosylated hemoglobin test) is an important blood test that shows how well the diabetes is being controlled. The test provides an average blood sugar control over the last 2-3 moths. The normal range of hemoglobin A1c is between 4% and 5.6%. When the level is 6.5% or higher, this indicated diabetes. The goal of treatment is to make sure that the patient with diabetes has hemoglobin A1c less than 7%. The higher the levels of Hemoglobin A1c, the higher the risk of developing complications. People should have the test done every three months to check and see that their blood sugar is under control. At least, the test should be done twice a year.

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The difficulty in carpal tunnel syndrome in diabetic patients is the difficulty of diagnosis, the difficulty in determining if the diabetes is being controlled or not, and if there will be surgery needed, will the patient have complications or not.

Patients who develop complications in orthopedics include: diabetics, obese patients, heavy smokers and patients taking blood thinners.

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If the condition is acute or an emergency, we have to do surgery. If the condition is elective, then surgery can wait. If the patient has poor glycemic control, then you probably don’t want to perform elective surgery on the patient such as carpal tunnel release. Remember, elective surgery can wait.

High blood sugar is linked to increased wound complications after surgery. Hemoglobin A1c is used to monitor the patient’s blood sugar level. The higher preoperative Hemoglobin A1c level, the more there is a risk factor for surgical site infection. Elective surgery can be delayed until HBA1c level becomes normal or better. Joint replacement surgery for example is delayed until HBA1c levels are less than 7%.

Since carpal tunnel syndrome is common in patients with diabetes, we need to take time to sort things out with these conditions. We need to know that the patient has better control of their diabetes. Carpal tunnel syndromes is a small surgery, but it can have catastrophic effect if we do not have a good control of the patient’s diabetes. Hemoglobin A1c will help us monitor the patient. Carpal tunnel surgery can cause complications and infection providing that high levels of HBA1c levels is a true risk factor for infection postoperatively.

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Hamstring Injuries

The hamstrings are a group of muscles located on the back of the upper leg (thigh). The muscles of the hamstrings include the biceps femoris, semitendinosus and semimembranosus. The proximal ends of the hamstring muscles originate from the ischial tuberosity in the rear of the pelvis.

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The muscles of the hamstring are all innervated by the sciatic nerve. The hamstring muscles are the major flexors of the knee and also aid in hip extension.

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Injuries to the hamstring muscles primarily occur proximally and are a common source of chronic pain and injury in athletes. It is often referred to as hurdler’s injury, athletes who attempt to clear hurdles are prone to injury due to excessive hamstring tension.

Hamstring strains are classified into three grades: minor tears within the muscle, partial tear within the muscle, and complete muscle tear.

Most hamstring injuries in adults will occur at the musculocutaneous junction but injury may also occur at the insertion into the ischial tuberosity.

Severe hamstring injuries where the tendon tears away with a fragment of bone are called avulsion injuries. Avulsion injuries are not common and typically occur in patients who are younger, skeletally immature athletes.

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The patient will have a sharp pain in the back of the thigh (popping or tearing of the muscle). An ecchymosis of the posterior thigh may also be present along with a palpable mass in the middle of the thigh. It is usually diagnosed by an MRI.

A strained or pulled hamstring can occur due to an insufficient warm up time before an activity. The patient should have treatment consisting of rest, ice, a compression bandage, elevation and possible physical therapy.

Surgery will be done in complete avulsion injuries with muscle retraction; the surgery is usually done early. The incision will be made, the muscle is then located. The nerve will need to be protected. Anchors will be used in the ischium to repair the tendon to the tuberosity. In cases of a bony avulsion, screws may be used in severe cases.

Elbow Bursitis

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Elbow bursitis is a filled sac at the tip of the elbow due to trauma, infection or inflammation. Because of the swelling and the bump that develops at the tip of the elbow, this is sometimes referred to as a popeye elbow.

The normal olecranon bursa provides protection and decreases friction to the elbow joint; it contains a small amount of fluid.

Olecranon bursitis causes pain, swelling, tenderness and a lump in the area at the tip of the elbow. It may be difficult to put the elbow down on a surface due to the tenderness.

Bursitis of the elbow can occur due to trauma, infection, inflammation and medical conditions (like gout or rheumatoid arthritis).

Treatment of elbow bursitis includes anti-inflammatory medications, antibiotics (if the infection is suspected), ice therapy, aspiration and surgery. A protective covering should be placed around the elbow while avoiding activities that aggravate the condition.

 

Causes of Rotator Cuff Tears

Dr Nabil Ebraheim

An accomplished orthopedic surgeon, Dr. Nabil Ebraheim educates the general public about injuries to the bones and muscles through his YouTube channel and trains newly minted orthopedists as the director of the University of Toledo’s orthopedic residency program. Among Dr. Nabil Ebraheim’s areas of interest are shoulder fractures and injuries including rotator cuff tears.

The rotator cuff, the part of the anatomy that holds the arm in the shoulder socket, plays a key role in rotating and raising the arm. If one of the tendons in the rotator cuff becomes either partially or completely torn, the person will experience extreme pain and difficulty in performing everyday movements, such as putting on clothes in the morning.

Rotator cuff tears sometimes occur suddenly, due to a fall or improperly lifting a heavy object. However, in most cases, a rotator cuff tear happens gradually. For instance, athletes such as weightlifters or baseball players might experience a rotator cuff tear due to repeated motion. Other times, degenerative tears occur due to poor blood supply to the tendons or as the result of a bone spur rubbing against a tendon during movement. If a person suspects he or she has a rotator cuff injury, a doctor can evaluate the shoulder and determine a course of treatment.