Artroscopia

Artroscopia
Artroscopia y reconstrucción articular

sábado, 29 de marzo de 2014

Prosthetic limbs: should they be more advanced by now? - Medical News Today

Prosthetic limbs: should they be more advanced by now? - Medical News Today

"The psychological challenges for amputees is daunting. More can be done, but in my mind, the key to success resides in enabling the amputee to seamlessly engage in activities of daily living," says David Hankin.
Hankin is CEO of the Alfred Mann Foundation - a medical research foundation based in California that works to create advanced medical technologies for people with debilitating medical conditions with the aim of improving their health and overall quality of life.
One area the foundation focuses on is limb loss - a condition that approximately 1.7 million Americans are living with.
According to the Amputee Coalition, around 185,000 amputations occur in the US every year - of which 97% are lower limb.
The main causes of limb loss are vascular disease - including diabetes and peripheral arterial disease - and trauma. A very small number of amputations are caused by cancer.

Physical and psychological difficulties

Individuals living with limb loss can experience difficulties physically and mentally.
Not only is limb loss a debilitating condition in itself, it can cause other conditions that impact a person's general health. For example, individuals with lower limb loss often have to use much more energy in order to be able to move around on different floor surfaces and terrain, and to travel distances that those with intact limbs would not find an issue.
"The additional energy and the wear and tear on other parts of the body create a host of medical problems for the amputee," says Hankin.
In a psychological sense, Hankin says that many amputees can experience feelings of inadequacy when it comes to engaging in day-to-day tasks. For example, something as simple as taking money out of a wallet may take much longer, which can cause embarrassment when the individual is standing in a grocery line.
When it comes to rehabilitation for amputees, prosthetic limbs are the first port of call. But Hankin says that rejection of artificial limbs - particularly upper limbs - is high. This is because most upper limb prosthetic devices do not have advanced functions that allow the amputee to effectively carry out daily activities.
"As a result, many end up in a closet or a drawer rather than affixed to the amputee," says Hankin, adding:
"There is a feeling among some amputees that not nearly enough has been or is being done to improve the technologies available to them and that there is no hope."

Prosthetic limbs: the road so far

jueves, 27 de marzo de 2014

Mira estas recomendaciones para prevenir caídas en personas de la tercera edad

Mira estas recomendaciones para prevenir caídas en personas de la tercera edad



Mira estas recomendaciones para prevenir caídas en personas de la tercera edad
miércoles 26 de marzo de 2014 10:27 AM


 La Fundación Internacional de Osteoporosis elaboró una serie de recomendaciones para prevenir caídas, que apuntan a crear un hogar seguro y fue publicado por el portal Entremujeres.

* Mantener los muebles en su lugar habitual.

* Retirar los cables sueltos.

* Evitar que los objetos estén desordenados.

* Verificar que los felpudos y las alfombras estén firmes y parejos.

* Prestar atención al desplazamiento de las mascotas.

* Asegurarse de que la casa esté bien iluminada, en especial las escaleras, las entradas y los pasillos. Si se levanta durante la noche, encender las luces.

* Usar un calzado adecuado, con suela antideslizante y taco ancho, que brinde un buen apoyo. Evitar  pantuflas que no tomen bien el pie. No andar descalzo.

* Colocar pasamanos en escaleras y chequear que estén firmes y que los escalones sean seguros.

* Colocar barandas y antideslizantes en la bañera o ducha.

* En la cocina, limpiar de inmediato todo aquello que se derrame.

* Si se usa anteojos, asegurarse de hacerlo según las indicaciones y realizar una optometría todos los años.

* Si se usa anteojos bifocales o trifocales, prestar mayor atención al subir o bajar escaleras.

* Usar anteojos de sol para estar al aire libre, a fin de evitar encandilamiento.

* De ser necesario, usar un bastón para mantener el equilibrio.

* Consultar con el médico si, por momentos, se sufre mareos o se siente inestable. Revisar periódicamente con él la medicación.

* Realizar actividad física en forma periódica, que incluya ejercicios que contribuyan al equilibrio, el fortalecimiento de los miembros inferiores y la buena postura

martes, 25 de marzo de 2014

Los efectos del cambio de peso en la articulación de la rodilla

http://www.condroprotectores.es/los-efectos-del-cambio-de-peso-en-la-articulacion-de-la-rodilla/

Los efectos del cambio de peso en la articulación de la rodilla

Un estudio publicado recientemente en la revista Annals of the Rheumatic Diseases analiza la relación entre los cambios de peso y los cambios del volumen del cartílago tibial en adultos obesos.
Para ello se estudiaron 112 personas obesas (con un IMC superior a 30kg/m2) de distintas comunidades. El volumen de su cartílago tibial se midió mediante IRM y sus síntomas de rodilla mediante el índice WOMAC, recogiéndose datos durante una media de 2,3 años.
A través de una pérdida de peso moderada se observó una relación entre el cambio de peso porcentual y el volumen del cartílago tibial medio, aunque no se asociaron cambios en el volumen del cartílago tibial lateral o en la rótula. La pérdida de peso también se asoció a cambios en las subescalas WOMAC de dolor, rigidez y función.
obesidad_artrosis
Fotografía de Tony Alter
Los resultados del estudio implican un efecto lineal entre la pérdida de peso que se asocia con una reducción de la pérdida del volumen del cartílago medial, además de una mejora de los síntomas de la rodilla; lo que significaría que las personas obesas pueden conseguir índices de mejora mediante pequeñas diferencias en el peso corporal, tanto en la estructura de la rodilla como en los síntomas. El estudio destaca que la pérdida de peso es un factor importante en el manejo de la artrosis de pacientes obesos, pero que además el evitar que estos pacientes vuelvan a ganar peso más tarde debería de ser una prioridad clínica.

Shoulder Arthritis / Rotator Cuff Tears: causes of shoulder pain: Essentials of the Ream and Run

Shoulder Arthritis / Rotator Cuff Tears: causes of shoulder pain: Essentials of the Ream and Run: Ream and Run There are a variety of shoulder joint replacement procedures for the management of the different types of shoulder arthritis...

Friday, December 7, 2012

Essentials of the Ream and Run


There are a variety of shoulder joint replacement procedures for the management of the different types of shoulder arthritis, including degenerative joint disease (osteoarthritis) and chondrolysis.


ream and run for individuals with arthritis who desire high levels of physical activity, including impact to the shoulder. A bit about the rational and technique is shown herehere and here. And some details of the technique are shown here andhere. In addition, the Video Journal of Orthopaedics has produced a nice video, which can be seen here.

Some typical pre op films showing a Walch B glenoid deformity



Typical surgical appearance of the humeral head
Post operative films






Here is the common apppearance of the shoulder one week after arthroplasty

The rehabilitation after shoulder replacement needs to be specified by the surgeon. Not infrequently modifications need to be made based on the details of the findings at surgery and the specifics of surgery. For total shoulders and for the ream and run we often prescribe the exercises shown in the following links
Post 1
Post 2
Post 3
Post 4

As well as this series of videos of patients having this procedure.
Supine stretch
Pulley
One month
6 weeks
7 weeks
8 weeks
10 weeks
12 weeks

Some other exercises that can be considered if advised by the surgeon are shown here.

The recovery after a ream and run shoulder replacement can be documented by following the simple shoulder test scores as shown here

Some patients have generously provided a diary of their recovery after the ream and run, as shown in these links
Post A
Post B
Post C
and if you like drumming
Post D
or chopping wood
Post E
or raquetball
Post F
or kayaking
Post G
or badminton and weights
Post H
or getting 'Grandpa' back up on his slalom ski that had been put away for 7 years
Post I
or violin
Post J
or passing, serving, and hand stands
Post L
or throwing batting practice
Post M
or doing pushups and pullups and hitting a body bag
Post N

sábado, 22 de marzo de 2014

Discusión entre pares. Comentarios y criticas


Comments and critics


  • Marwan Majid Sulaiman why was a cancellous screw used for interfragmentary compression

  • Mohammed Ibrahim Parvez Length was not available in cortical screw

  • Amol Patwari I guess washer with cc screw wud hv been d better for inter fragmentary purpose
    Compression cud hv bn achieved in better way
    N this is schatzer type 6 #
    Why not bi condylar plating ?? 
    Anyways nice reduction
  • Sunit Dahal What abt skin and soft tissue condition ?

  • Santoshkumar Sahu fair enough,its a type-VI scatzker #,if soft tissue condition is reasonable,cortical screw 4 interfragmentory compression wid bicondylar fixation using locking plates would 've been a bttr option.....

  • Marwan Hossam Elshafie Very good job,, what will your rehab plan be?

  • Marwan Hossam Elshafie I think bichondylar fixation would put soft tissue at risk of necrosis and would generally have been too much metal work, which would affect vascularity of bone and hence bone healing..

  • Abdel-Aleem Ragab For such type of fracture it is preferred to reduce the articular surface anatomically (i think it is good here) and to fix the diaphyseal fracture biologically.... For me, i prefer using traction table for reduction then pinning of the articular surface by cannulated screws. After that proximal locked plate can be inserted biologically for fixation.

viernes, 21 de marzo de 2014

Surgical Repair of the Torn Shoulder Labrum

http://www.ace-pt.org/2014/03/20/surgical-repair-of-the-torn-shoulder-labrum/


Surgical Repair of the Torn Shoulder Labrum

Torn Shoulder Labrum

Repair and Recovery of Torn Shoulder Labrum
by ACE Physical Therapy and Sports Medicine Institute

Tips for a Torn Shoulder Labrum.

    • A torn SLAP tear can be associated with “clicking and catching” when the arm is moved in certain directions.
    • Many throwing athletes will complain of a “dead arm” when a SLAP tear is present.
    • There is generally no instability in the patient’s shoulder when a SLAP tear is present.
    • Pain with certain movements is the primary complaint of the patient who has a SLAP tear.
    • Seek and follow the advice of your Physical Therapist following the SLAP lesion repair and you will enjoy a successful return to your pre-injury lifestyle.
An injury to the shoulder can cause pain, decrease in movement, and loss of strength. As a result, you may begin to limit shoulder motion and limit activities. One common symptom is pain that occurs in the shoulder, originating in the front and spreading down the front of the upper arm.  These types of pains and injuries can be caused by repetitive above shoulder movements such as throwing a ball or swimming.
If you have dealt with the ache and discomfort for a long time, you may want to talk with your physician and physical therapist about a plan of recovery. One common shoulder injury is a torn shoulder labrum or a Superior Labrum Anterior Posterior (SLAP).

The Nature of a Torn Shoulder Labrum

To get a better picture of the SLAP consider the shoulder joint. It is made up of three bones: scapulae, humerus, and clavicle.  There are four RTC muscles responsible for keeping the humeral head on the glenoid fossa of the scapulae.   The movement of the shoulder joint is dependent upon the humeral head’s articulation on this surface. If the motion is “pure” and normal, the head is held in the center of the fossa by the synchronized muscle action of the RTC.   The ligaments and Labrum offer static stability to the shoulder joint.  The Labrum is a fibrocartilage “ring” that is attached to the outer edge of the Glenoid Fossa.  The Labrum “deepens” the socket and helps to prevent the Humeral head from “sliding” off of the shallow fossa.
When the labrum tears away from the Glenoid Fossa, it can cause major problems.  To picture this, think of the face of a clock. The 12 o’clock position has the Long Head of the Biceps tendon attached to it. Constant pulling, stretching, tugging or compression on the top portion of the Labrum can damage it and pull it away from the bone. When this occurs it is called a SLAP (Superior Labrum Anterior Posterior) tear. Every time the Long Head of the Biceps engages and contracts, the damaged Labrum is affected and causes pain in the shoulder. Movements above shoulder level and when moving the arm backwards with a fully extended elbow are the two most prominent pain-producing motions.

Torn Shoulder Labrum Surgery

Treatment usually begins with conservative approaches that involve stretching and exercises and other protocols. When these treatments fail to resolve the symptoms, the Labrum needs to be surgically re-attached to the bone.  In most cases, the surgery is performed via an arthroscopic procedure, and the Labrum is held to the prepared bone by sutures and bone anchors.  The size and extent of the tear determines how many suture anchors are needed to hold it in place until the natural healing process occurs.

Post Surgery Therapy

Formal Physical Therapy normally begins within 7-10 days of your surgery. Most surgeons will limit your range of motion and active movement in certain planes of motion for a couple of weeks.  The primary protective action taken to preserve the repaired Labrum is avoiding any motion or activity that will engage the Long Head of the Biceps tendon.  The active contraction or aggressive passive stretching could damage the repair and tear the Labrum away from the bone.  Your Physical Therapist can instruct and guide you through the formal rehabilitation process and ensure a speedy and safe recovery to a fully functional shoulder.

What to Expect after SLAP Surgery

Pain:  The amount of pain felt post operatively is different for everyone.  For the first 24 hours, pain is usually controlled through a long lasting (several hours) numbing agent and possibly a nerve block that the surgeon injects. The day after a surgery, the shoulder is very painful if you moves the arm.  Pain levels at rest can vary greatly. While the intense pain usually decreases within a few days, you should be prepared to experience varying levels of pain throughout the rehabilitation process.  During this time, your recovering should will be manually stretched and mobilized by the therapist. This will cause pain at the end range of motion.
Wearing a sling:  For the first couple of weeks, the surgeon will require you to a use sling that protects the repaired Labrum from quick and sudden motions. This sling should actually help comfort the recovering area while also reducing inflammation. Inflammation causes more pain, less movement and loss of neuromuscular control.
Swelling and bruising:  Your shoulder might be swollen and there might be bruising in the area around the suture sites.  The swelling can extend down the entire arm and into the hand.  Repetitive squeezing of a soft object (e.g. stress ball, ball of socks or a sponge) will help to prevent and/or eliminate the swelling in the hand.  Bruising may occur in the area around the suture sites and possibly extending into the chest or upper arm area. Repetitively bending and straightening of the elbow can help to reduce the swelling and discomfort in the upper arm.   When moving the elbow, there should be no weight in the involved hand and the use of the non-involved hand might be needed to help with the motion.
Sleeping: Sleeping is difficult and most patients will sleep in an upright position for several days.   Placing a pillow behind the involved shoulder helps to prevent it from “rolling” backwards during sleep.   Once you get back into the bed, you may find it more comfortable to wear the sling or prop a pillow under their arm and against the involved shoulder blade.   It usually takes several weeks to get comfortable enough to lie on the involved side.
Driving: Returning to the driver’s seat is determined in part by which shoulder is involved, if the transmission is automatic, and if you have quit taking narcotics.The doctor ultimately determines when you are ready to drive. If the pain level and movement is adequate, you should be able to resume driving within the few days of surgery.
Return to work: Depending on the type of work, you might return to work within a few days.  If your job is physical, you’ll will have to discuss a return date with the doctor.  Most people can return to some capacity of work within one week of the surgery date. If your job is physical in nature, it might be several months before you can return to a full duty capacity.
Having fun:  You should be able to participate in recreational sports, hobbies and leisure activities when the shoulder has healed sufficiently to support the movements and actions associated with that activity.  If a specific activity requires you to throw or move the involved arm above shoulder level repetitively, it will take 4-6 months (minimum!) to be able to successfully return to that activity. You should discuss return date with the doctor and physical therapist.
SLAP tears are troublesome and painful.  While the shoulder remains fully functional, the damage and pain can cause you to modify many motions.  If the torn Labrum surgery is successful, you can expect to return to all pre-injury activities providing you follow the guidelines of the rehabilitation program which will be established  by the surgeon and Physical Therapist.